Lesson 6/5b/5a/4/3 quiz

Select what Medicare Pays, Plan F Pays, and what the Client Pays in the given scenario: Bob has a Plan F. He has an outpatient knee replacement surgery for a total cost of $5,600. What does Medicare Pay, Plan F Pay, and what does Bob pay for this service? (not factoring in the Part B Deductible) Medicare Pays: $4,480, Plan F Pays: $1,120 how much does BOB pay?

0

What is the last day of the disenrollment period for MAPD plans in 2018?

02/14/2018

What is the latest date a consumer can enroll in an MAPD if their birth date is 04/15/1953?

07/31/2018

when a client is moving, how early can i sign them up for a MAPD?

1 month prior to move date

Medigap Plans supplement Original Medicare, Plan F is the most comprehensive Medigap Plan, Medigap Plans work to fill in the gaps found in Original Medicare and??

10 different Medigap Plans

partial Extra help:what percent of the insurance or the plans copay whichever is less

15%

What is the 2018 Part B Annual Deductible?

183

When do Medicare Advantage plans take effect?

1st of the month

Vered is 73 and has had Part A and B since 2009 and just lost her employer drug plan. How long does Vered have to get a Part D plan?

2 months

The deductible for High Deductible Plan F is?

2240

If a person wants to enroll in an MAPD during the IEP (Initial Election Period), when is the earliest they can do this?

3 months before they turn 65

full extra help generics no greater than...

3.30

What percentages does Sarah pay for generics in the Coverage Gap?

44%

What will the beneficiary pay in the Coverage Gap? 35% of the retail cost for brand name drugs and for the percentage of the retail cost for generic?

44%

What is the benefit period for the Part A deductible?

60 days post discharge

Medicare is health insurance for: People under 65 with certain disabilities, People of any age with End Stage Renal Disease and?

65 and over

How many states do not allow, by law, Part B Excess Charges to be billed?

8

Jean is 73 and already has Part A. She retired and is losing group coverage and now has the option to enroll in Medicare Part B. How long does she have?

8 months

full extra help brand name no greater than...

8.25

Partial extra help: deductible or the plans deductible, whichever is cheaper. Partial extra help's deductible is?

82

James is in a Guaranteed Issue Window, what plans can he get Guaranteed Issue?

ABCFKL

What is the enrollment period from Oct 15 - Dec 7th?

AEP

Which of the following statements are true?The Benefit Periods in a Medicare Drug Plan are based on the calendar year, The client will pay 35% of the retail cost for brand name drugs while in the Coverage Gap and??

All drug plans have premiums

James Jones is turning 65 on August 21st, when will his Part A begin?

August 1st

chemotherapy is covered under what part of medicare? You will need to look under the summary of benefits

B

Which Medigap Plans do NOT cover the Part B deductible?

Bland MKG

Which of the following resources can you find on the carrier info drive? Carrier height and weight, CA-OR-MO rules and??

Carrier health questions

We sell the following carrier's DSNPs: United health care, Humana and?

Cigna

An insurance company will set rates for a certain area and charge the same for everyone, regardless of age Which Medigap Rating Method does this describe?

Community rated policy

Prescription Drug plan costs the customer pays are: annual deductible, premium, and?

Copays

When a client is GI they cannot enroll in the following Medigap plans, without going through medical underwriting and answering health questions:

D,G,M,N

Which of the following services are covered by Medicare Part B? Occupational Therapy, Diagnostic tests and??

DME

What type of plan is generally "best" to put a cost-share protected member on?

DSNP

The amount you must pay for health care before Medicare begins to pay. These amounts can change every year

Deductible

Each and every phone call you make, whether it be inbound or outbound you must state your ______

Disclaimers

A spend down does not qualify the client for a?

Dsnp

Someone who has Medicaid and Medicare is:

Dual Eligible

Which of the following health consideration(s) keep you from getting a MA/MAPD?

ESRD

A person can enroll in a standalone drug plan with an MAPD PPO.

False

All MAPD plans offer additional benefits (ie: dental, vision, health club membership).

False

Creditable coverage describes a non-Medicare health plan that isn't as good as the coverage offered by Original Medicare.

False

Everyone qualifies for Medigap Plans.

False

James turns 65 November 1st and his Part A will begin November 1st

False

Medicaid and LIS recipients can only change their MAPD plan 1 time a quarter

False

Medicare Part B is an 80/20 split and there is a maximum out-of-pocket of $1,340.00

False

Original Medicare is Part A, B, and D

False

PPO's have both in and out-of-network services, the client will pay less for out-of-network services

False

Part B of Medicare covers inpatient hospital care.

False

Part D/Medicare Prescription Drug plans are Medicare programs that provide prescription drug coverage regulated and provided by Medicare

False

Regardless of when or how you enroll into Medicare, Parts A and B can only take effect at the end of the month.

False

SelectQuote Senior agents typically advise clients to purchase Plans F, G, or L.

False

The PFFS is always a network-based plan

False

The Part B premium is $134 for all Americans who are on Medicare.

False

The only way to obtain Part D coverage is to purchase a standalone drug plan.

False

There is a maximum out-of-pocket expense for the client on Original Medicare

False

True or False? Abdul lives in Utah and voluntarily leaves his retiree coverage and gets a Plan F Guaranteed Issue?

False

True or False? Hector can leave his MAPD in the middle of the year to join a Plan F if he passes medical underwriting?

False

True or false? Joan recently moved and she used an SEP to enroll in an MAPD. The MAPD became effective last week, but she is still in the SEP window. Joan can get a new MAPD under her SEP.

False

True or false? Medigap Plans cover dental services.?

False

True or false?All MAPD plans are network based.?

False

You must have Medicare Part B to be eligible for Medicare Part D

False

You only have 2 months to enroll in Part B after your creditable coverage ends

False

true or false? During the disenrollment period, Bob can drop his MAPD and join a new MAPD.

False

true or false? In both Trial Right #1 and Trial Right #2 the client's time frame is: 60 calendar days before their prior coverage ends and no later than 60 calendar days after that.

False

true or false? Some Medigap plans include prescription drug coverage.

False

A list of certain drugs and their proper dosages for which a drug plan will cover What term is the definition describing?

Formulary

Harry missed his window to sign up for Part B, when can he sign up?

GEP

Lorenzo Martinez turned 65 years old February 20, 2017 and his Part A started February 1, 2017. He now wants to enroll in Part B and has not had any insurance coverage since 2010. It is June 9, 2018, what is the next enrollment period available for Lorenzo to get Part B?

GEP

Which Medigap carriers are underwritten by MOO? Assured Life Association, Gerber life and?

GPM life

Which of the following carriers do we NOT represent for Part D?Heartland, mutual of omaha and??

Gerber

We sell the following carrier's CSNPs: Cigna, united health care and??

Humana

Which MAPD Election Period(s) follows the 3-1-3 rule?

IEP

Which of the following are Benefit Periods of a Part D Plan? Catastrophic coverage, coverage gap and??

Initial Coverage

The Disenrollment Period for an MAPD is:

Jan 1-Feb 14

Which of the following dates represent an enrollment period that happens each year? October 15-December 7, January 1-March 31 and??

Jan 1-Feb 14

You can switch your Medigap policy surrounding the date of your policy's anniversary in the following states:

MO

Which is/are advantages of MAPD/MA plans over Original Medicare? might include dental, vision, and drug coverage as well as..

Max out of pocket limits

the only time a dual eligble client can get a medicare supplement plan is if they have a?

Medicaid spend down

client used their election period(IEP/SEP) and the MAPD has taken effect, can they still get a new MAPD if they are still within their window of allotted time?

NO

NO OE =??

NO G!

the doctor isnt showing in the carrier doctor finder online. I called the doctor's office and they verified that they do accept the plan. can we list the doctor on the enrollment form?

NO choose another doctor

Kim is on Medicaid and Medicare. She recently joined a DSNP with Humana. Can Kim go to a doctor that accepts Medicaid only and not the DSNP?

No

client moves to a new area. is the client guaranteed issue for a supplement? if they have original medicare A and B?

No

client has a plan F and moves to a new area. The clients rates increase due to the move. is the client guaranteed issue for a new plan F?

No since they havent lost coverage

Annual Enrollment Period (AEP) is:

Oct 15-Dec 7

The 7 month IEP applies for Part B of original medicare, MAPD and

PDP

You can add standalone PDP plans to which of the following MA Plans?

PFFS

We sell which of the following? PFFS,HMO, HMO-POS, SNP and????

PPO

What does not count towards the Coverage Gap?Drug plan premium, Dispensing Fees and drugs that are not on the plans formulary and???

Part B Drugs

A payment to insurance plan that enables the individual to receive coverage

Premium

Which of the following items does a Full Extra Help subsidy pay for? Part D premium, deductibles if applicable

Reduces copays

George turned 65 and was still covered under his employer insurance. He didn't enroll in Part B or Part D then. Now George is retiring at age 72. What election period will allow him to enroll in a drug plan?

SEP

Maria Chavoya is 68 years old and retired January 1, 2018. When she retired, she lost her employer coverage. She has been very busy and forgot to enroll in Part B when she first retired. It is June 2, 2018, what enrollment period does Maria qualify for to get Part B?

SEP

Keep It Successfully ______.

Simple

To find the right MAPD for a client you MUST know their , Doctors, Prescriptions and?

State

The monthly premiums of Medigap plans can depend on: Age, County, Height and weight, gender and what use?

Tobacco

1-800-MEDICARE is the number for Medicare.

True

A client can obtain their prescriptions through the mail.

True

After conducting a needs analysis you should be able to guide your client towards an MA/MAPD or Medigap plan based on their specific situation.

True

Annual Enrollment does not apply to Medigap Plans.

True

Durable Medical Equipment is covered under Part B of Medicare

True

Enrollment in an MA only HMO will cause you to be disenrolled from a standalone PDP

True

For most Americans, there is no monthly premium for Medicare Part A. This is if you have worked 40 quarters, paying into Medicare or if you are married for 10 years to a spouse that worked the required 40 quarters.

True

LIS=Low Income Subsidy

True

Medicare will not penalize you if you do not sign up for Part B when you first become eligible, and do not have creditable coverage

True

Medigap Plans help pay for some or all of the services provided under Original Medicare

True

Premium: A payment, often monthly, that enables the individual to receive insurance coverage

True

The Birthday Rule allows Medigap members to switch their policy to any of the 10 supplemental plans surrounding their birthdate

True

The National Base Beneficiary Premium is $35.02 in 2018.

True

True or False, Jamie lives in missouri and leaves her employer coverage voluntarily to join a plan F Guaranteed issue.

True

True or False, during the disenrollment period, Joan can drop her MAPD and join a PDP

True

True or False? During AEP the client can drop a PDP and only have Original Medicare.

True

True or False? In October 2018, John entered into the Coverage Gap and stayed in it for the remainder of the year. Is this statement possible?

True

True or False? if the PFFS plan is an MA (medical only), you can pair it with a PDP.

True

True or false. you should not enroll a medicaid client into MA only, even if it is a PFFS. these plans do not coordinate well with medicaid.

True

True or false? Joan is moving in 2 weeks and used an SEP to get a new MAPD plan effective in 2 weeks. She received the plan materials and decided she wants to enroll in a new MAPD. Joan can enroll in a new MAPD under her SEP?

True

True or false? Medicare Advantage Plans replace Original Medicare.

True

True or false? Medicare Advantage plans are also called Medicare Part C.

True

When you are first eligible for Medicare, you have a 7-month window to sign up for Part B. This includes the 3 months before you turn 65, the month you turn 65, and the 3 months after you turn 65

True

You have an 8-month Special Enrollment Period to sign up for Part B that starts the month after your employment ends or your group health plan insurance ends, whichever happens first

True

You possibly could be eligible for Medicare at age 3

True

true or false? Plan L and Plan K are the only two Medigap plans with out-of-pocket limits.

True

If Drew signs up for a Plan N and lives in Missouri, are Part B excess charges allowable and who pays them?

Yes and Drew pays them

Jan is 68 years old, lives in Texas, and has a Plan F. What can she do with the Plan F?Can see a specialist in New York that accepts Original Medicare and??

any doctor

How does one qualify for an MAPD? Must continue to pay Part B Premium (if applicable) Must pay your MA/MAPD Plan Premium (if applicable)Must be eligible for Medicare checkmark and??

can't have ESRD

A fixed percentage paid by the beneficiary for the services provided:

coinsurance

Sarah takes lisinopril, levothyroxine sodium, atorvastatin, and Xanax. By the middle of the year her copays increase from $4 / $4/ $4/ $20 respectfully to $5/ $7/ $7 and $75. What drug plan Benefit Period does Sarah enter by mid-year?

coverage gap

Attained-Age-Rated policies premiums are based on which of the following?

current age

The amount you pay before Medicare begins to pay?

deductible

What is the Part A deductible benefit period? 60 days post?

discharge

Client: "I'm on Medicare and Medicaid" This is a likely clue that the client should purchase a Medigap plan

false

During Catastrophic Coverage the client will pay the lesser of 5% coinsurance or $3.35 for generics and $8.35 for brand drugs

false

During Guaranteed Issue Period your client will not have to go through underwriting but during Open Enrollment they must go through underwriting.

false

During a Guaranteed Issue window you can sign a client up on any supplement plans available in their area, without medical underwriting

false

Full Extra Help = Dual Eligible

false

If you are enrolled in a HMO plan and you go to a doctor's office out-of-network, you are responsible for the Part B 20% coinsurance

false

In ICEP you have 3-1-3 just like the IEP for MAPD/PDP's when your client is using GEP to enroll in Part B.

false

MAPD/MA plans supplement Medicare

false

Medicare Part B is an 80/20 split and there is a maximum out-of-pocket for the beneficiary

false

Medigap plans are standardized and offered by the government

false

Plan N pays the Part A deductible and Part B coinsurance except for the $20 or less copay for Emergency room visits and $50 copays or less for each doctor visit.

false

Supplement premiums can be calculated based off; gender, county, tobacco use, and medical claims

false

The 3 most common supplement plans promoted are: F, G, M?

false

To join an MA/MAPD/or Medigap plan the client must go through medical underwriting, unless in GI window

false

When you are Guaranteed Issue, Supplements will cover all expenses even if Medicare won't pay

false

Partial extra help: premiums depend on?

income

Chao Nguen has been on disability for almost 2 years now. He was notified by the Social Security Administration that his Part A would automatically begin December 1, 2018 after he has been legally declared disabled for 24 months. He was told that he will need to sign up for Part B to be enrolled in it. It is October 7, 2018, what enrollment period does Chao qualify for to get Part B?

initial enrollment period

Gary is on original medicare only and is moving from NY to FL in 2 weeks. what can gary do besides, join a medicare advantage plan, join F and G by successfully going through medical underwriting and??

join a part D plan

Supplements do not cover: vision, part D prescriptions,dental and

long term care

what creates an SEP for medicare Advantage plans? Besides involuntarily loss of coverage, Eligble for extra help, Voluntarily loss of creditable coverage, moving-change of residence and??

loss of medicaid

Dual Eligible means that a client is:

medicare and medicaid

dsnp verification process cigna: does the client need to be on the call?

must be on the call

The doctor doesn't have a PCP ID listed, can we still list this doctor on the enrollment form?

no

dsnp verification process UHC: does the client need to be on the call?

no

dsnp verification process humana: does the client need to be on the call?

no

It is July 9th, 2018. Mike Manny has been on disability for almost 2 years now. He was notified by the Social Security Administration that his Part A would automatically begin December 1, 2018 after he has been legally declared disabled for 24 months. What enrollment period does Mike qualify for to get Part B as of today?

no enrollment period

OE stands for?

open enrollment

The PCP can be referred to as: the gate keeper, Primary care physician and?

overseer

To qualify for a Medigap plan: Must pay the Medigap Premium/You must have Medicare Part A and Part B and, also do what?

pay the Part B Premium

It is May 9, 2018 and Sarah Smith is 64 years old and would like to sign up for Part B. She is still working, but wants to make sure she has everything ready for when she retires at age 65. She will be turning 65 December 2, 2018. What enrollment period does Sarah qualify for to get Part B as of today?

there is no enrollment period

Doctors can choose to bill up to 15% above the Medicare allowable amount

true

During AEP a client can enroll in as many plans as they want and the last plan they enroll in will be the plan that will be effective the following year.

true

ESRD is also known as kidney failure

true

Full extra help does not create an election period for a MA only. It only creates an election period for MAPDs or PDPs.

true

If the plan includes prescription drug coverage with the medical plan, it is called a MAPD.

true

In some states the client will not have to go through medical underwriting for Medigap Plans, when leaving group coverage voluntarily

true

Initial Enrollment Period (IEP) entitles you to a 7-month window to sign up for Part B

true

John turns 65 November 1st, his Part A will begin October 1st.

true

Medicare Advantage plans replace Original Medicare.

true

Supplements are government standardized but offered by private insurance companies

true

The most common Medigap Plans that we sell are Plan F, Plan G, and Plan N.

true

To join Medicare when under 65 years old, you must be on disability for 24 consecutive months or any amount of time with ESRD

true

True or False: has no deductible and no drug premium for amounts equal to or less than the client's state threshold.

true

When the beneficiary has Full Extra Help, most clients will pay no more than $3.35 for generics and $8.35 for brand name medicines

true

You must be 65 years of age in order to qualify for Trial Right 1.

true

true or false: My client's MAPD is discontinuing at the end of the year, what options do they have? MAPD have 2 months to enroll after loss of coverage and supplement abcfkl and has 63 days after loss of coverage.

true

Client moved several months ago, but never notified their old MAPD carrier of their move. Can the client join a new MAPD even though they are past the 2 month SEP-Move window

yes

Client moves to a new area. is the client guaranteed issue for a supplement? If they have a Mapd?

yes

The MAPD has an optional supplemental benefit rider for dental benefits that have a premium for a dual eligble client. will the client have to pay the premium?

yes

client has original medicare A and B only and moves down the street. can the client get a MAPD if there are new options avaliable from their old zip to their new.

yes

client has original medicare A and B only and moves to a new area. can the client get a new mapd?

yes

my client is dual eligible and there are no dsnp avaliable, can i get them a normal part c plan?

yes