UHC Certification Latest Updated 2022/2023 Document Content and Description Below

UHC Certification Latest Updated 2022/2023 Document Content and Description Below UHC Certification Latest Updated 2022 Medicare Federal health insurance program Medicare is administered by whom? CMS ( Centers for medicare and medicaid services) Parts A & B of medica re are federal health insurance program referred to as original medicare Part A? Hospital insurance Part B? Medical insurance What doesnt medicare cover? routine dental, eye care hearing exam,deductibles, coinsurance and copayments Part C? Medicare Advantage Plans MA covers? Part A &B coverage, and some part D coverage MA plans are not? Medicare supplement insurance plans What offers lower monthly premiums MADP or supplement? MADP do MAP's have a annual maximum OOP maximum that limits the amount of money a member must spend every year for covered services? YES MA plans integrate what type of additonal coverage? part D prescription drug coverageIf a customer wants to keep their stand alone prescription drug plan, what may the customer want to enroll in? MA-only PFFS plan What is a stand alone drug plan called? PDP WHat is PFFS? Private Fee for Service (PFFS) - Plans that allow you to go to any doctor or hospital that accepts their terms If a customer lives in a rural area, what type of plan may they want because it gives them freedom to access doctors that may not be in their network? PFFS plan Do HMO's require referals? Yes Do PPO's require a referal? No When a member enrolls in a MA plan, they receive their coverage from medicare or the MA plan? MA plan When a customer is enrolled in a MA plan, they must continue paying their premiums for what other plan? Part B MA plans have a maxium annual limit on OOP costs called a? MOOP amount ( Maxium out of pocket) When a member is enrolled in a MA plan, they are automatically disenrolled from any other MA plan or PDP( prescription drug plan) in which they are enrolled as of the new plans_____? effective dateAn exception exisits for MA-only PFFS plans as a member can also be enrolled in a what? Stand alone PDP If a member enrolls in a MA plan, what must the member do? Cancel in writing their medicare supplement insurance policy with the carrier after their request to enroll in MA plan has been approved. Medicare supplement insurance policies cannot be used in conjunction with what type of plan? MA plan A medicare supplement insurance plan helps to cover some of the OOP costs associated with? original medicare. A medicare supplement insurance plan does NOT pay the cost-sharing of what type of plan? MA plan when a client enrolls in a MA plan, will it automatically terminate their MA plan? NO Can a customer call to terminate their Med Sup plan? no it must be done in writing What are the different types of MA plans? HMO, POS, PPO, RPPO, PFFS, SNP, and MSA For an HMO, they customer must us IN network providers, what are the exceptions to their rule? Emergencies, Urgent care, and renal dialysis services. In a HMO plan, does a member have to choose a PCP? and do they require referrals to see a specialist? Yes In a POS plan, does a member need a referral from their PCP to see a specialist? yesCan a member with a POS plan see a specialist? Yes, but they may have to pay a higher cost, and there coverage limits With a PFFS plan, can a member seek treatment from any medicare eligible provider who agrees to accept the plans conditions and payment rates? Yes Does a PCP need to be selected with a PFFS plan? No What is the only plan to offer non-network PFFS plans? UHC What are SNP's for? ( Dual SNP) People who have both medicare and Medicaid Institutional SNP? Nursing homes Chronic condition SNP? people who have certain chronic medical conditions MSA? Medical savings account What does a MSA do? Combines a high deductible medicare advantage plan and a bank account How does MSA plans work? the plan deposits money from emdicare in the account which can then be used to pay for medical expenses until their deductible is met Does UHC currently offer a MSA? no MA plans include some key features such as? Prescription drug coverage, PCPs and a OOP maxiumIn a MA-Part D plan, A member will be disenrolled from their stand alone PDP upon enrollment in a ? MA-PD in a MA-part D plan, A member will be disenrolled from their MA-PD upon enrollment in? a stand-alone PDP With MA only, a member will be disenrolled from their stand alone PDP upon enrolling in a? Non-PFFS MA