Indiana Navigator Test (2024) Questions With Correct Answers

True or False: An Indiana Navigator can recommend payment plans? - Answer False - They can only say what plans most people use, as well as give information about the plans themselves Where can customers go for information about these health plans: - Affordable Care Act - General health insurance - Consumer complaints - Language resources - Disability resources - Answer - Affordable care act = or - General health insurance = glossary of commonly used terms - Complaints = Health insurance company (check insurance card) or IDOI ( - Language resources = FFM (for FFM coverage) or DFR (for IHCP coverage, ) - Disability resources = FFM or area agencies on aging or division of disability and rehab services AO means... - Answer Application organization - Must be registered Navigators must be... - Answer - Certified - Can be non-residents or residents of Indiana - Unbiased - Cannot be brokers or agents who make money off of selling insurance IDOI... - Answer - Indiana Department of Insurance - Receives and reviews all Indiana Navigator apps - Monitors any complaints How many hours of training must navigators complete when completing their renewal? - Answer 2 hours Where do consumers go to make complaints about: - Indiana Navigators - Health Insurance Companies or Plans - Complaints about FFM - Answer - Indiana Navigators = IDOI - Health Insurance Companies = Contact company first, then IDOI - FFM = Contact FFM at An Indiana Navigator must report a change in name or contact information to IDOI no later than... - Answer 30 days after the change occurs It is acceptable for an Indiana Navigator to give the following plan selection advice... - Answer Help a consumer: - Compare plan benefits - Estimate out-of-pocket expenses - Consider healthcare use Indiana Health Coverage Programs (IHCPs) - Answer - State funded - Free or low-cost health insurance to low-income people - Ex. children, adults, parents, caretakers, pregnant people, aged, blind, disabled Hoosier Healthwise - Answer Includes: - Pregnant women - Children up to 19 years old = Package A is children of low income households = Package C is CHIP for children (ONLY CHILDREN) of higher income families - Covers doctor visits, meds, mental healthcare, dental care, surgeries, family planning - Little or no cost Healthy Indiana Plan (HIP) - Answer - Low-cost health insurance - Minimum essential coverage (MEC) - Must be: Indiana resident, 19-64, income at or below 138% FPL - Three possible plans called HIP: Plus, Basic, State Plan - Annual deductible - Copays for ED - POWER Account can help fund the annual deductible HIP Maternity - Answer - Income at or below 138% FPL - No cost sharing for pregnant members (ex. no POWER account contributions) - Full coverage HIP - Gateway to Work - Answer - Requires all able-bodied (with some exceptions, ex. students, chronically homeless, already employed) people to work or complete qualifying activities HIP Basic - Copayment Amounts - Answer - Outpatient = $4 - Inpatient = $75 - Preferred drugs = $4 - Non-preferred drugs = $8 - Non-emergency ER visit = $8 (same for HIP Plus members) HIP - Fast Track Payments - Answer - Allows eligible Hoosiers to expedite the start of their coverage in HIP Plus - $10 - Once payment made, cannot change health plan until open enrollment - Payment goes toward first POWER account contribution - Effective date = First month payment made if eligible (if no fast track, will be first date of POWER contribution after being found eligible) There are 4 Managed Care Entities (MCEs) in Indiana called... - Answer - Anthem, CareSource, MDWise, and MHS - Goal = integrate programs in Hoosier Healthwise and Healthy Indiana Plan (HIP) Hoosier Care Connect covers those... - Answer - In Indiana who are not eligible for Medicare and who are 65+, blind, disabled, enrolled in MED Works, or receiving SSI - Enrollees select either Anthem or MHS to ensure individual gets best care for their individualized needs Traditional Medicaid includes... - Answer - People who are aged, blind, or disabled (dual eligible for Medicare and Medicaid, long-term care institutes, hospice) - Adults (recipients of waivers, medicaid eligible due to breast/cervical cancer) - Children (Former foster care, in psychiatric facilities) - Refugees who do not qualify for another aid category Medicaid for Employees with Disabilities (M.E.D. Works) cover those who... - Answer - Are disabled individuals who are working - Age 16-64 - Income less than or equal to 350% M.E.D. Recipients have benefits of... - Answer - Full Medicaid - May have employer insurance (apply through IN Application for Health Coverage + Medicaid is secondary payer) Home and Community-Based Services Waivers (HCBS) are for those who... - Answer - Meet certain Medicaid requirements and are at risk of institutionalized care. - Goal is to avoid the need for institutions (ex. nursing homes). HCBS - Behavioral and Primary Healthcare Coordination Program (BPHC) consists of... - Answer - Healthcare services that manage the mental health/addiction and physical healthcare needs of eligible people - To be eligible, one must be: 19 or older, diagnosed with BPHC eligible primary health diagnosis, reside somewhere that meets setting requirements for community-based services (HCBS), have an income below 300% Marketplace - Answer FFM True or false: The Medicare Savings Program is under Medicaid. - Answer True The Medicare Savings Program... Covered population: Goal: Eligibility: - Answer Covered population: Low-income Medicare beneficiaries Goal: Help pay out-of-pocket Medicare costs Eligibility: Must be eligible for Medicare part A Right Choices Program - Answer - Provide care through healthcare management. - Members identified by IHCP because they use services more extensively than their peers. End Stage Renal Disease (ESRD) Program requires... - Answer - Current diagnosis of End-Stage Renal Disease - Approved to receive Medicare part A and B - Not institutionalized - Not eligible for any other Medicaid - Meet all non-financial Medicaid eligibility requirements What are ESRD members covered with? - Answer Aged, blind, and disabled category. - Medicare will be primary and Medicaid is the secondary payer. What is the presumptive eligibility idea for? - Answer - Allows uninsured/underinsured people to obtain temporary coverage quickly = immediate care. - Must still complete a full application to determine eligibility for continued coverage. What coverage does presumptive eligibility (PE) aid in? - Infants, children, parents/caretakers, former foster children: - Pregnant women: - Family planning: - Adult: - Inmates: - Answer - Infants, children, parents/caretakers, former foster children: Full coverage - Pregnant women: Only covers ambulatory services - Family planning: Only covers services and supplies for pregnancy prevention - Adult: HIP Basic equivalent - Inmates: Inpatient hospital services only Who is the payment for Medicaid Inpatient Hospital services for inmates reimbursed by? - Answer Fee-for-service delivery system (FFS) What are the Indiana full coverage programs? - Answer Hoosier Healthwise CHIP HIP Plus Medicaid for the aged, blind, and disabled MED Works Breast and Cervical Cancer Program Some PE categories (PE: infants, children, parents/caregivers, former foster care children)