UHC 2024 AHIP - Medicare Basics Assessment (Medicare Advantage [non-SNP], Prescription Drug and Medicare Supplement Plans) | Quizlet

Lisa turned 65 and is now eligible for Medicare. She already receives Social Security benefits. How does she enroll in Original Medicare?

Her enrollment in Medicare Parts A and B is generally automatic if she meets all eligibility requirements.

Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan?

When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA Plan.

Being 65 or older, being under 65 years of age with a qualifying disability or being any age with ESRD or ALS are each eligibility requirements for which program?

Original Medicare

Which of the following defines a Medicare Advantage (MA) Plan? (Select 3)

-An MA Plan is part of Medicare and is also called Part C.

-An MA Plan is a health plan option approved by Medicare and offered by private insurance companies.

-An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often includes Medicare prescription drug coverage (Part D).

To be eligible for this plan type, consumers must meet the following requirements: be entitled to Medicare Part A and enrolled in Part B, and reside in the plan's service area. Which plan is being described?

Medicare Advantage

Which of the following is a correct statement about in-network provider services?

HMO Plans cover only in-network services. In most cases, members pay the full cost of any out-of-network services received, with a few important exceptions.

Which of the following is NOT a correct statement about in-network provider services?

HMO-POS Plans only cover in-network services.

Which statement is true about Medicare Supplement Open Enrollment?

It is the six-month period that starts the month the consumer is 65 or older and is enrolled in Medicare Part B.

Which statement is true about the Medicare Advantage (MA) Out-of-Pocket Maximum?

All MA plans have an Out-of-Pocket Maximum to help limit the member's out-of-pocket costs for Medicare-covered medical services.

Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP?

She would be disenrolled automatically from her MAPD Plan.

What is Medicare Part D?

A voluntary program, offered by private insurance companies that are contracted with the federal government, that provides prescription drug coverage for an additional monthly plan premium.

Which of the following best describes eligibility to enroll in a stand-alone Prescription Drug Plan?

Entitled to Part A and/or enrolled in Part B and reside in the plan service area.

Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible consumer get Part D prescription drug coverage?

They could enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage.

Which of the following statements accurately describes a prescription drug stage?

Starting in 2024, the catastrophic coverage stage is when the member will pay nothing for covered drugs for the remainder of the plan year.

Which of these statements is NOT true about the drug utilization management (UM) rules?

If a medication has a UM rule, the member will not be able to get that medication.

What is the amount added to the member's monthly plan premium if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for 63 or more continuous days?

Late Enrollment Penalty (LEP)

What kind of financial assistance does a consumer receive who qualifies for Low Income Subsidy?

Lower or no monthly plan premiums and lower or no copayments

Which of the following lists drug tiers from least expensive cost share to most expensive cost share?

Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty

In states where Medicare Supplement Insurance underwriting criteria can apply, all of the following underwriting criteria apply EXCEPT:

Most consumers who are switching from another Medicare supplement plan are entitled to Guaranteed Issue and, therefore, are not subject to underwriting.

Which of the following are true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Plans and the impact to Plans C and F? (Select 2)

-Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to purchase Medicare Supplement Insurance Plans C or F.

-Consumers eligible for Medicare Part A before January 1, 2020, can enroll in Plan C or F even after 2020 and can keep their plans as long as they choose.

Which statement is true of Medicare Supplement Insurance Plans?

Insured members have the freedom to choose any doctor who accepts Medicare patients.

In which two parts of Medicare is enrollment generally automatic for eligible consumers who are receiving Social Security benefits, UNLESS they choose to delay their coverage?

Parts A and B

Provided other eligibility requirements are met, who is eligible for Medicare?

Consumers age 65 or older, consumers under 65 years of age with a qualifying disability and consumers of all ages with ESRD or ALS who are receiving Social Security Disability Insurance (SSDI) for ALS.

Which of the following defines a Medicare Advantage (MA) Plan?

MA Plans are health plan options approved by Medicare and offered by private insurance companies.

Which of the following best describes eligibility to enroll in a MA Plan?

Entitled to Part A and enrolled in Part B, reside in plan service area, may have pre-existing conditions such as ESRD.

Which type of MA Plan is an HMO plan that also covers certain benefits out-of-network, generally at a higher cost?

Point-of-Service (POS) Plan

When is Mary's Medicare Supplement Open Enrollment period if she turns 65 on September 23, 2023, and her Medicare Part B effective date is September 1, 2023?

September 2023 through February 2024

Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan?

Medicare Supplement Insurance cannot be used in conjunction with an MA Plan. After receiving confirmation of enrollment into the MA Plan, the member should cancel their Medicare Supplement Insurance policy according to their carrier's rules.

Which of the following best defines Medicare Part D?

It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage.

A consumer with only Part A residing in the plan's service area can enroll in which plan type to get Part D coverage?

A stand-alone Part D Plan.

Which of the following statements is NOT true about the Coverage Gap?

All members reach the Coverage Gap.

Which of the following best describes the Late Enrollment Penalty (LEP)?

The amount added to the member's monthly plan premium if they did not enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for 63 or more continuous days.

How does a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs?

Through subsidies such as lower or no monthly plan premiums and lower or no copayments.

Formulary is defined as:

A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists.

When is a Medicare Supplement Insurance consumer subject to underwriting and screened for eligibility?

When the consumer is not in their Medicare Supplement Open Enrollment or does not meet Guaranteed Issue criteria.

Which of the following is true about Medicare Supplement Insurance Plans?

Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments.

Which statement is true about members of a Medicare Advantage (MA) Plan who want to enroll in a Medicare Supplement Insurance Plan?

The consumer must be in a valid MA election or disenrollment period.

Which of the following statements is correct about HMO MA Plans?

Members must receive covered services from contracted network providers with limited exceptions.

A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated prescription drug coverage?

The consumer will be automatically disenrolled from their stand-alone PDP upon enrollment in the MA Plan that has integrated prescription drug coverage

Which of the following is a fact about Medicare Prescription Drug Plans?

To enroll, the consumer must reside in the plan's service area.

Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible consumer get Part D prescription drug coverage?

They could enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage.

Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs?

Through subsidies such as lower or no monthly plan premiums and lower or no copayments.