Medicare Basics BCBSM test questions fully solved & updated.

Medicare is the federal health insurance program administered by the Centers for Medicare & Medicaid Services for three groups of people: People ages 65 and older, People under age 65 with certain disabilities, People with end-stage renal disease (kidney failure) If you're turning 65 and retiring You should enroll during the seven-month window - the three months before your 65th birthday, your birthday month and the three months after your 65th birthday. Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:04 / 0:15 Full screen If you're turning 65 and plan to keep working Your employer has 20 or more employees and you’re in a group plan – You may be able to delay enrollment in both Medicare Part A and Part B and avoid the lifetime late enrollment penalty. Check with your benefits manager to determine how the IRS defines your group health plan. Your employer has fewer than 20 employees – Sign up for Medicare Part A and Part B when you’re first eligible. Otherwise, you may have to pay a lifetime Part B late enrollment penalty if you decide you want Part B later. Part A Hospital care, skilled nursing facility care, hospice, home health care Part B Doctor visits, mental health care, outpatient surgery, lab tests, durable medical equipment Part D Prescription drugs - purchased through private insurers such as Blue Cross Two ways to get Medicare coverage : #1 (Part C) Medicare Advantage= Part A + Part B Additional Benefits and Services And most Medicare Advantage Plans contain Part D Two ways to get Medicare coverage : #2 Build Your Own Package: Part A+ Part B + Part D + Medicare Supplement Plan How Does Part D Work? Part D is sold by insurance companies contracted by the Federal government. You can buy standalone Part D coverage, or get it in a Medicare Advantage plan that combines parts A, B and D (provided you live in the plan's service area). Original Medicare and Medicare supplement plans don't include prescription drug coverage. You may be penalized for not enrolling when you're first eligible, and don't have other creditable prescription drug coverage or if you had a break in coverage of at least 63 consecutive days.* Part D- Initial Coverage Stage You pay a portion of the cost and the plan pays the rest up to $4,020 Part D- Coverage Gap Stage You pay 25% for brand-name and generic drugs until your total out-of-pocket costs reach $6,350. Part D- Catastrophic Coverage Once your out-of-pocket costs reach $6,350, you pay the greater of 5% of the cost or $3.60 for generics and 5% or $8.95 copay for all other drugs. Your formulary drug tiers Drug tier Includes Tier 1 Preferred generic drugs Generic drugs Tier 2 Generic drugs Additional generic drugs Tier 3 Preferred brand drugs Brand-name drugs Tier 4 Non-preferred drugs Additional generics and brand-name drugs Tier 5 Specialty drugs Very high-cost generic and brand-name drugs Built-in Part D protections Prior authorization - A clinical review done by your plan before approving a drug to protect against drug interactions or potentially negative outcomes. Transition prescription fill - Available to members transferring to a Blue Cross plan from another plan. It provides a temporary one-month supply of your drug during the first 90 days of membership. Step therapy - Trying a proven, often lower-cost, drug before prescribing a more expensive one. Quantity limit - A limit on the amount of the drug that can be dispensed at one time to maintain safe limits and prevent waste. Medication therapy management program - No cost medication review to high use members who qualify. Helps improve use and reduce chances of adverse drug interactions. Extra Help - A program for members with limited income to help pay for prescription drugs. Contact Social Security to see if you qualify Costs to consider Premium: Amount you pay each month for your plan Deductible: Amount you pay before your plan begins to pay Coinsurance: Percentage of the cost you pay for a service Copay: Fixed dollar amount you pay for health care services Out-of-pocket maximum: The most you will spend in a year for copays, coinsurance and deductibles. Questions to think about Do you want medical and drug coverage in a single plan? Are your doctors in the network? How often do you see your doctors? What will prescription drugs cost in our formulary? Are your drugs in the formulary? Do you want extras like a fitness benefit? Would you use dental, vision and hearing coverage? How much do you travel in Michigan? Nationwide? Worldwide? Non-discrimination statement BCBSM and BCN complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). ملحوظة: تتحدثكنتإذا العربیة، فإن خدمات المساعدة تتوافراللغویة لك بالمجان .اتصل برقم