Medicare Basics Test Q&A.

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? - ANSWER Parts A and B Which statement is true about a member of a Medicare Advantage Plan who wants to enroll in a Medicare Supplement Insurance Plan? - ANSWER When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically unenrolled from their MA plan Which of the following consumers are eligible for Medicare if other eligibility requirements are met? - ANSWER Consumers age 65 or older, consumers under age 65 with certain disabilities for more than 24 months, and consumers of all ages with ESRD or ALS Which of the following defines a Medicare Advantage Plan? - ANSWER MA plans must provide benefits equivalent to Original Medicare, and most also offer additional benefits MA plans provide Medicare hospital and medical insurance and often include Medicare prescription drug coverage Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? - ANSWER Does not have any pre existing conditions, such as diabetes or ESRD What must be explained to consumers enrolling in an HMO MA plan? - ANSWER The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out of network providers They must see contracted network providers in order to receive coverage under the plan Most benefits are covered out of network but at a higher cost Which of the following are MA plans that focus on using network providers to maximize the benefits and reduce out of network expenses? - ANSWER HMO, POS, PPO When is Mary's Medicare Supplement Open Enrollment period if she turns 65 on September 23, 2021, and her Medicare Part B effective date is September 1, 2021? - ANSWER Sept 2021 - Feb 2022 Jennifer is enrolling into a Medicare Advantage plan and wants to know what counts toward the out of pocket maximum. Which of the following is accurate? - ANSWER Margaret currently has a MAPD plan. What would happen if you enrolled her into a stand alone PDP? - ANSWER What is Medicare Part D? - ANSWER 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 by Which of the following is a fact about Medicare Prescription Drug Plan? - ANSWER To enroll, the consumer must reside in the plans service area What are two options for Medicare consumers to get Part D prescription drug coverage? - ANSWER In what order do the four prescription drug coverage stages occur? - ANSWER Deductible, initial coverage, coverage gap, catastrophic coverage Which of these statements is NOT true about the drug utilization management rules? - ANSWER If the medication has a UM rule, the member will not be able to get that medication Which of the following lists drug tiers from least expensive cost share to the most expensive cost share? - ANSWER Preferred Generics, Generics, Preferred Brand, Non Preferred Drug, Specialty Medications that are covered in a Plans formulary have various levels of associated member cost sharing. What are these drug levels called? - ANSWER Drug tiers Which of the following statements is correct about HMO MA Plans? - ANSWER Members must receive covered services from contracted network providers Which of the following is NOT a statement about in network provider services? - ANSWER HMO POS plans only cover in network services When does Medicare Supplement Open Enrollment take place? - ANSWER Jennifer is enrolling into a Medicare Advantage plan wants to know what counts toward the out of pocket maximum. Which of the following is accurate? - ANSWER Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 impact to Plans C and F? - ANSWER