2024-2025 Kaiser Exam With Complete Solutions
True or False: Kaiser Permanente Senior Advantage KPSA and Medicare Advantage
members agree to seek care at Kaiser Permanente or contracted network facilities
except for certain urgent care and emergency-related services. Answer True
Choose all that apply: To be eligible for Kaiser Permanente Senior Advantage KPSA and
Medicare Advantage, and individual must: Answer Permanently reside in the KP service
area
U.S. citizen or lawfully present in the United States
Eligible to enroll in Medicare Part A and enrolled in Medicare Part B
True or False: Any KPSA or KPMA member may utilize the new POS benefit. -Answer
False
True or False: A member enrolled in the Medicare Explorer plan may utilize the new POS
benefit in service. - Answer False
In order to be qualified for the Senior Advantage Special Needs Plan, an individual
already has to have _____________ - Answer Both Medicare and Medicaid
At Kaiser Permanente, ____________ apply to the maximum out-of-pocket - Answer All
Medicare Parts A and B-covered services
Which of the following is NOT an advantage of this benefit? - Answer Elimination of the
specialty tier
, Which of the following is not true of the M3P program? - Answer Eligibility is based on
income
Lower copays for selected chronic condition drugs are in ___________ (in most plans) -
Answer Tier 1, preferred generic
What is the tier for non-preferred drugs? - Answer Tier 4
What is the tier for non-preferred generic drugs? - Answer Tier 2
What is the tier for injectable Part D vaccines? - Answer Tier 6
What is the tier for preferred generic drugs? Tier 1
What is the tier for specialty tier drugs? Tier 5
What is the tier for preferred brand-name drugs? Tier 3
Edward is a potential member who uses generic asthma medication. Which of the
options below does Edwards's prescription most likely fall under? Preferred generic
drugs
What document(s) are needed to verify specific drug coverage and cost sharing?
-Answer Summary of Benefits and the Drug Formulary
During the Coverage Gap the ___________ pays a portion of the dispensing fee 75% and a
portion of the drug cost 5%. -Answer Health plan
In Coverage Gap, the ____________ pays a portion of the dispensing fee and a portion of
the drug cost. - Answer Beneficiary
True or False: Kaiser Permanente Senior Advantage KPSA and Medicare Advantage
members agree to seek care at Kaiser Permanente or contracted network facilities
except for certain urgent care and emergency-related services. Answer True
Choose all that apply: To be eligible for Kaiser Permanente Senior Advantage KPSA and
Medicare Advantage, and individual must: Answer Permanently reside in the KP service
area
U.S. citizen or lawfully present in the United States
Eligible to enroll in Medicare Part A and enrolled in Medicare Part B
True or False: Any KPSA or KPMA member may utilize the new POS benefit. -Answer
False
True or False: A member enrolled in the Medicare Explorer plan may utilize the new POS
benefit in service. - Answer False
In order to be qualified for the Senior Advantage Special Needs Plan, an individual
already has to have _____________ - Answer Both Medicare and Medicaid
At Kaiser Permanente, ____________ apply to the maximum out-of-pocket - Answer All
Medicare Parts A and B-covered services
Which of the following is NOT an advantage of this benefit? - Answer Elimination of the
specialty tier
, Which of the following is not true of the M3P program? - Answer Eligibility is based on
income
Lower copays for selected chronic condition drugs are in ___________ (in most plans) -
Answer Tier 1, preferred generic
What is the tier for non-preferred drugs? - Answer Tier 4
What is the tier for non-preferred generic drugs? - Answer Tier 2
What is the tier for injectable Part D vaccines? - Answer Tier 6
What is the tier for preferred generic drugs? Tier 1
What is the tier for specialty tier drugs? Tier 5
What is the tier for preferred brand-name drugs? Tier 3
Edward is a potential member who uses generic asthma medication. Which of the
options below does Edwards's prescription most likely fall under? Preferred generic
drugs
What document(s) are needed to verify specific drug coverage and cost sharing?
-Answer Summary of Benefits and the Drug Formulary
During the Coverage Gap the ___________ pays a portion of the dispensing fee 75% and a
portion of the drug cost 5%. -Answer Health plan
In Coverage Gap, the ____________ pays a portion of the dispensing fee and a portion of
the drug cost. - Answer Beneficiary
