Midterm Quiz

What expenses are associated with Medicare Part B? Select all that apply $1,288 annual deductible 20% coinsurance $166 annual deductible None of the answers are correct $20 coinsurance

20% coinsurance $166 annual deductible

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

58%

What is the benefit period for the Part A deductible?

60 days post discharge

During Catastrophic Coverage the client will either pay $2.95 for generic drugs and $7.40 for brand drugs.

False

During Catastrophic Coverage the client will pay the lesser of 5% coinsurance or $2.95 for generics and $7.40 for brand drugs. T/F

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 Is this statement true or false?

False

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

False

MAPD/MA plans supplement Medicare. T/F

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 $1,288.00. T/F

False

Original Medicare is Part A, B, and D. T/F

False

PPO's have both in and out-of-network services, the client will pay less for out-of-network services. T/F

False

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

False

The PFFS is always a network based plan.

False

Value Props should be 30-40 seconds long. T/F

False

You must have Medicare Part B to be eligible for Medicare Part D. T/F

False

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

False

You should only use value props to explain who Tiburon is to your client when you start talking with a client. T/F

False

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

True

LIS=Low Income Subsidy

True

Premium: A monthly payment that enables the individual to receive insurance coverage. T/F

True

To join Medicare when under 65 years old, you must be legally declared disabled for 24 months or have ESRD. T/F

True

The client will pay no more than what $ amount for brand-name drugs when on Full Extra Help?

$7.40

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

AEP

Features of Tiburon Insurance Services: Select all that apply All the answers are correct We charge $20 per consult Agents are commission agnostic There is no charge for our service!

Agents are commission agnostic There is no charge for our service!

Prescription Drug plan costs the customer pays are: Select all that apply Annual Deductibles(if applicable) Premium Copays

Annual Deductibles(if applicable) Premium Copays

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

August 1st

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 has Sarah likely entered by mid-year?

Coverage gap/donut hole

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

Deductible

Someone who has Medicaid and Medicare is:

Dual Eligible

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

ESRD

Lorenzo Martinez turned 65 years old February 20, 2015 and his Part A started February 1, 2015. He now wants to enroll in Part B and has not had any insurance coverage since 2010. It is June 9, 2016, what is the next enrollment period available for Lorenzo to get Part B?

GEP

Which MA/MAPD plan(s) does Tiburon sell? Check all that apply None of them SNP-POS HMO-POS PFFS PDP SNP HMO PPO LIS

HMO-POS PFFS SNP HMO PPO

Write a PERSONAL value proposition based on the following scenario: John is 66 years old and is considering retiring. He is wanting to look at his Medicare options and compare those to his company's retirement plan.

Hi John. I understand that you would like to look at your Medicare options and see how those will compare to your company's retirement plan. Tiburon Insurance Services partners with Humana, who has an A+ Better Business Bureau rating and over 7 million customers nationwide. It was smart of you to call today because now you have the benefit of having me work for you for free to find a Humana plan that will suit your financial and medical needs. So let's get started!

The following are important points to make in Value Propositions: None of the answers are correct Highlights company's points of difference over competitors Relevancy to client situation Highlights Features, Advantages, and Benefits

Highlights company's points of difference over competitors Relevancy to client situation Highlights Features, Advantages, and Benefits

Chao Nyguen 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, 2016 after he has been legally declared disabled for 24 months. It is October 7, 2016, what enrollment period does Chao qualify for to get Part B?

IEP

Which MAPD Election Period(s) follows the 3-1-3 rule? Select all that apply OE AEP IEP ICEP SEP None of the above

IEP

Ben is retiring from his company in Utah on April 16th, after his 67th bday. His employer coverage ends April 30th. He enrolled into Medicare Part B which is going to begin May 1. What is the last date possible for him to enroll in his PDP plan and when does it have to take effect based off the choices given?

June 30th/July 1st (2 months for SEP)

Which Part C Plan includes prescription drug coverage?

MAPD

Which is/are advantages of MAPD/MA plans over Original Medicare?

Might include dental, vision, and drug coverage checkmark Maximum out-of-pocket limits

A fixed dollar amount paid by the beneficiary for the services rendered. None of the answers are correct Coinsurance Excess Charges All of the answers are correct

None of the answers are correct Coinsurance Excess Charges All of the answers are correct

You can add standalone PDP plans to which of the following MA Plans? Select all that apply HMO HMO-POS PPO PFFS PFFS-POS None of them

PFFS

Select the correct statements: Part C = Medicare Advantage Part D = Prescription Drug Insurance Part B = Medical Insurance Part A = Hospital Insurance

Part C = Medicare Advantage Part D = Prescription Drug Insurance Part B = Medical Insurance Part A = Hospital Insurance

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

SEP (2 months for part D)

Maria Chavoya is 68 years old and retired January 1, 2016. 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, 2016, what enrollment period does Maria qualify for to get Part B?

Special Enrollment Period

Explain how a client will enter in the Coverage Gap and what will they pay while in the Gap?

There are three levels of coverage with your prescription drug coverage. The first level is the initial coverage. During this time you will pay your normal copays and deductibles on your drugs. After the retail prices of your portion and your provider's portion hits $3,310, then you get into the second level of coverage, the Coverage Gap (AKA The Donut Hole). Keep in mind, this does not include the premiums you pay, any part B drugs or any pharmacy fees. While in the Coverage Gap, you will pay 58% of the retail price of generic drugs and 45% of the retail price of brand name drugs. During this time, you are banking only your costs (the percentages you are paying) and will be in this level until you reach $4,850 in total costs (including the $3,310 from the Initial Coverage level). Once you make your way out of the Coverage Gap, you will enter Catastrophic Coverage for the remainder of the year. During this time, you will pay $2.95 for generic drugs and $7.40 for brand name drugs, or 5% of the retail price (whichever is a greater charge).

It is July 9th, 2016 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, 2016 after he has been legally declared disabled for 24 months. What enrollment period does Mike qualify for to get Part B as of today?

There is no enrollment period

It is May 9, 2016 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, 2016. What enrollment period does Sarah qualify for to get Part B as of today?

There is no enrollment period.

$4,850 is the amount you must reach to enter into Catastrophic Coverage. That amount is a combination of the coinsurance/out of pocket expenses and the $3,310 amount

True

Durable Medical Equipment is covered under Part B of Medicare

True

ESRD is kidney failure`

True

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

True

When the beneficiary has Full Extra Help, they will pay no more than $2.95 for generics and $7.40 for brand name medicines. T/F

True

You possibly could be eligible for Medicare at age 3

True

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

coinsurance

Medicare will not penalize you if you do not sign up for your Part B when you are first turning 65, and do not have creditable coverage

false