Medicare CE Questions And Answers Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of: - Answer - Selling DSNPs
The consumer states they currently pay a percentage of charges when they receive medical care. This means: - Answer - WRONG - The consumer is enrolled in a Medicare Supplement Insurance Plan.
Which of the following consumers is best suited for a CSNP? - Answer - Mary, who has been seeing a specialist for a qualifying chronic condition
On May 10, Michael meets with an agent and says he is enrolled in another carrier's CSNP due to his diabetes. When can Michael enroll in a different CSNP that also covers diabetes (his only chronic condition), assuming he has not moved out of his current plan's service area? - Answer - DURING OPEN OR ANNUAL
Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level? - Answer - ALL of the responses
It is very important for consumers enrolling in a CSNP to know the following about accessing providers: - Answer - Some CSNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers, generally with higher cost sharing.
Which statement is true about the Medicaid program? - Answer - It helps pay medical costs for certain groups of people with limited income and resources.
Which statement is true of DSNP members? - Answer - Members who are QMB+ or are
Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a DSNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs.
Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified? - Answer - WRONG - At the end of the first month of enrollment
WRONG - 30 days after the last attempt to contact the provider
WRONG - After a 6 month grace period
Members who lose their eligibility for the DSNP due to a change or loss of Medicaid status are responsible for what cost sharing? - Answer - All, such as premiums, deductibles, copayments, and coinsurance
What are Dual Special Needs Plans (DSNP)? - Answer - Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid
The consumer states they currently pay a percentage of charges when they receive medical care. This means: - Answer - WRONG - The consumer is enrolled in a Medicare Supplement Insurance Plan.
Which of the following consumers is best suited for a CSNP? - Answer - Mary, who has been seeing a specialist for a qualifying chronic condition
On May 10, Michael meets with an agent and says he is enrolled in another carrier's CSNP due to his diabetes. When can Michael enroll in a different CSNP that also covers diabetes (his only chronic condition), assuming he has not moved out of his current plan's service area? - Answer - DURING OPEN OR ANNUAL
Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level? - Answer - ALL of the responses
It is very important for consumers enrolling in a CSNP to know the following about accessing providers: - Answer - Some CSNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers, generally with higher cost sharing.
Which statement is true about the Medicaid program? - Answer - It helps pay medical costs for certain groups of people with limited income and resources.
Which statement is true of DSNP members? - Answer - Members who are QMB+ or are
Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a DSNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs.
Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified? - Answer - WRONG - At the end of the first month of enrollment
WRONG - 30 days after the last attempt to contact the provider
WRONG - After a 6 month grace period
Members who lose their eligibility for the DSNP due to a change or loss of Medicaid status are responsible for what cost sharing? - Answer - All, such as premiums, deductibles, copayments, and coinsurance
What are Dual Special Needs Plans (DSNP)? - Answer - Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid
