Aetna 2025 MA/MAPD/DSNP Questions And Answers Graded A+

Each pharmacy component of an MAPD plan consists of a formulary, a pharmacy network and benefit designs (cost sharing and tier structure). Select one: True False - True What is a Special Needs Plan (SNP)? a.A type of Medicare Advantage Prescription Drug (MAPD) coordinated care plan that limits enrollment to people with specific diseases or characteristics. b.An MA plan that tailors benefits, provider choices, and drug formularies to meet specific needs of the groups they serve. c.An MA plan for those who are eligible for Medicare and Medicaid. d.A MA plan required to contract with a state Medicaid agency. e. All of the above - e. All of the above Which of the following is true for Low Income Subsidy? a.Beneficiaries pay no more than $3.95 for a covered generic and $9.85 for each brand name drug b.There is no coverage gap c.There is no Late Enrollment Penalty d.All of the above - d.All of the above Which are attributes of the Aetna's Model of Care? a.An Interdisciplinary Care Team approach b.Clinical programs to improve health and well-beingc.Transition of Care Program d.A and B e. All of the above - e. All of the above Which plan type allows members to see preferred doctors in network, doctors out-of-network, and does not require referrals to a specialist? a. PDP plan b. Cost plan c. PPO plan d. HMO plan - c. PPO plan All of our HMO and PPO plans include a maximum out-of-pocket limit. Select one: True False - True Which of the following statements are true? a. If PPO members see a doctor who is not in the network their cost share for services may be higher b. In the Aetna Medicare Open Access HMO plan, members can go to any Aetna Medicare plan HMO network doctor they choose for covered services, without a PCP referral, as long as the doctor is a contracted HMO doctor. c.All of the Medicare Advantage plans include free monthly fitness club memberships to any facility participating within the SilverSneakers network. d. All of the above - d. All of the above You can find a quick list of tools for Aetna Medicare plans on includes information about plans, medications, and doctors. Select one: True False - True Low Income Subsidy (LIS) is a Federal program that helps eligible beneficiaries with their Part D drug costs. Select one: True False - True The difference between LIS and the Medicare Savings Program (MSP) is LIS helps reduce prescription drug costs and MSP helps with Medicare plan premiums, as well as deductibles, copayments and coinsurance associated with medical services. Select one: True False - True D-SNP plans are for only Medicare beneficiaries that need help with Medicare premiums Select one: True False - FalseLIS Medicare drug plan premium and deductible costs are based on income level. Select one: True False - True Individuals and families who earn less than the federal poverty level by up to 150% may qualify for Extra Help. Select one: True False - True One of Aetna's Model of Care goals is to improve use of preventive health services. Select one: True False - True Aetna offers a variety of Aetna Medicare Advantage plan types. Which plan type requires a person to use only network providers? (Excluding emergency or urgently needed services) a. PDP plan b. HMO plan c. PPO plan d. ESRD plan - b. HMO plan