2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS MEDICARE HEALTH PLANS

2022 OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS MEDICARE HEALTH PLANS PART 2 1. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? a. Mr. Kumar will be able to obtain routine care outside of the plan’s service area, but will pay a higher co-payment (except in an emergency). Incorrect b. In most Medicare Advantage HMOs, Mr. Kumar must generally obtain hisservices only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network). Correct c. In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%, but those of specialists are covered at 80%. Incorrect d. With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as that provider participates in Original Medicare. Incorrect 2. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? a. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Correct b. Even if Mrs. Radford has end-stage renal disease,she will be able to enroll in any Medicare Advantage plan in her service area. Incorrect c. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. Incorrect d. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. Incorrect 3. Mr. Wellsis trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description? a. Medicare Advantage is designed to pick up where Original Medicare leaves off, covering those health care services that would not normally be covered by Original Medicare. Incorrect b. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. Incorrect c. Medicare Advantage is a new name for the Original Medicare program. Incorrect d. Medicare Advantage is a way of covering all the Original Medicare benefitsthrough private health insurance companies. Correct 4. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him? a. SNPs are essentially the same as Original Medicare and are not likely to have a noticeable impact on how Mr. Sinclair receives his care. Incorrect b. Since SNPs don’t cover prescription drugs Mr. Sinclairshould consider a different option. Incorrect c. SNPs offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will always be lower than in Original Medicare. Incorrect d. SNPs have special programsfor enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. Correct 5. Mrs. Walters is enrolled in her state’s Medicaid program in addition to Medicare. Whatshould she be aware of when considering enrollment in a Medicare Advantage plan? a. She can submit any billsshe hasfor co-payments under Medicare to the state’s Medicaid program and they will always be fully covered. Incorrect b. If a provider accepts her Medicare Advantage plan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid. Incorrect c. State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. Incorrect d. She can enroll in any type of Medicare Advantage (MA) plan except an MA Medical Savings Account (MSA) plan. Correct 6. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him? a. FIDE-SNP Incorrect b. C-SNP Correct c. I-SNP Incorrect d. D-SNP Incorrect 7. Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan. As part of that discussion, what should you be sure to tell her? a. PFFS plans are not permitted to provide any benefits beyond what is covered under Original Medicare. Incorrect b. Ifshe uses non-network providers, she would not be permitted to obtain care outside of her plan’s service area. Incorrect c. If she uses non-network providers, her cost sharing would be the same under a PFFS plan as it would be under Original Medicare. Incorrect d. PFFS plans may choose to offer Part D benefits but are not required to do so. Correct 8. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Davenport have in regard to her MA plan during the next open enrollment season? a. She must immediately drop her ABC MA plan and enroll in Original Medicare. Incorrect b. She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Correct c. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Incorrect d. She must remain enrolled in her ABC MA plan unless the plan terminates. Incorrect 9. Mr. McTaggart notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? a. If a PFFS enrollee shows his/her card when obtaining services from a provider who participates in Original Medicare, then that provider is required to accept the plan’s terms and conditions. Incorrect b. If offered, beneficiaries can select a stand-alone Part D prescription drug plan (PDP) with an HMO or a PPO, but not with a PFFS plan. Incorrect c. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan’s terms and conditions and agrees to accept them. Correct d. PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S. Incorrect 10. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from hisinvestments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend hasmentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him? a. SNPs only serve individuals in long-term care facilities, so he cannot enroll. Incorrect b. SNPs only serve individuals eligible for both Medicaid and Medicare, so he cannot enroll. Incorrect c. SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he isunlikely to qualify and would not be able to enroll in the SNP. Correct d. SNPs do not provide Part D prescription drug coverage, so if he does enroll, he should be aware thathe will not have coverage for any medications he may need now or in the future. Incorrect