AHIP- MEDICARE (Module 2 - Plans)

AHIP- MEDICARE (Module 2 - Plans) Question 1: What is the primary characteristic of a PACE plan? a. It is a publicly sponsored Medicaid plan for the elderly b. It provides comprehensive medical and social services in an adult day health center c. It is an all-inclusive Medicare plan available nationwide d. It is a Medicare Advantage plan that covers only prescription drugs Correct answer: b. It provides comprehensive medical and social services in an adult day health center Question 2: What are the key features of Medicare Savings Account (MSA) plans? I. They may have a partial network, full network, or no network of providers II. They cover Part A and Part B benefits, but not Part D prescription drug benefits III. Enrollees are responsible for a minimal deductible of $500, indexed for inflation IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full Correct answer: II, III, and IV only Question 3: How does a Medicare Advantage HMO plan typically work? a. Enrollees can see any provider who participates in Original Medicare b. Enrollees must generally obtain services from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network) c. Enrollees can receive routine care outside of the plan's service area, but will pay a higher co-payment (except in an emergency) d. Services provided by primary care physicians are covered at 100%, but those of specialists are covered at 80% Correct answer: b. Enrollees must generally obtain services from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network) Question 4: How does a Private Fee-for-Service (PFFS) plan work? a. Enrollees can receive health care services from any doctor allowed to bill Medicare, as long as they show the doctor their plan's identification card and agree to accept the plan's payment terms and conditions b. If enrollees show their card to a doctor who participates in Original Medicare, that doctor must accept the plan's terms and conditions c. Enrollees can go to any doctor anywhere as long as they accept Original Medicare d. Enrollees may receive services from any physician, regardless of whether or not that physician accepts the plan Correct answer: a. Enrollees can receive health care services from any doctor allowed to bill Medicare, as long as they show the doctor their plan's identification card and agree to accept the plan's payment terms and conditions Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program? Choose one answer. a. They are long-term care plans for people with Medicare. b. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. c. They are major medical policies, but are only for low-income beneficiaries with Medicare. d. They are Medigap Supplemental plans that fill in the gaps not covered by Medicare. ️b. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage plan? Choose one answer. a. State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. b. She can submit any bills she has for co-payments under Medicare to the state's Medicaid program and they will always be fully covered.