Indiana Navigator actual exam with 100% correct answers(latest update)

Governing Bodies/Law Department of Health and Human Services Centers for Medicare and Medicaid Services H Types of federally-designated consumer assistants Federal Navigators State Navigators Conflicts of Interest Financial incentive Conflict of loyalty Can Indiana Navigators provide specific plan selection? No Hoosier Healthwise Covers; Pregnant women Children up to 19 years old Children's Health Insurance Program (CHIP) Created for children with higher family income Healthy Indiana Plan (HIP) Low-cost health insurance for Indiana residents 19-64 HIP Plus Comprehensive vision, dental and chiropractic coverage No copays HIP Basic Minimum coverage standards Must pay copays HIP State Plan Comprehensive with additional benefits to align with traditional Medicaid Cost-sharing POWER Accounts Similar to Health Savings account for HIP Hoosier Care Connect For individuals not eligible for Medicare 65+ Traditional Medicaid Fee-for-Service Covers adults, children and refugees Medicaid for Employees with Disabilities Coverage for disabled individuals who are working 16-64 Home and Community Based Services Waivers Must meet medicaid requirements and be at risk of institutionalized care Goal is to keep individual in home and community setting Medicare Savings Program Must be eligible for Medicare Part A Low income Medicare beneficiaries Qualified Medicare Beneficiary Pays Medicare part A&B premiums, deductible, and coinsurance Also/Only Specified Low-Income Medicare Beneficiary Medicare part B premium only Can be combined Qualified Individual Medicare Part B premium only Cannot be combined Qualified Disabled Worker A qualified individual with a disability who can perform the essential functions of a position without reasonable accommodation Family Planning Eligibility Program Provide family planning services Pregnancy prevention/delay DO NOT qualify for Medicaid Breast and Cervical Cancer Progam Provide Medicaid coverage to women with breast or cervical cancer Ages 19-64 Not eligible for Medicaid Managed Care Entities Anthem MDWise Caresource MHS (Managed Health Services) Modified Adjusted Gross Income (MAGI) Standardized income calculation across all states Used in FFM to determine eligibility for tax credits and cost sharing Household size and income affect whose income counts in the calculation Applying for Health Coverage 1. Inform of any conflicts of interest 2. Complete preliminary eligibility screening 3. Application 4. Medicaid decides eligibility within 45 days Presumptive Eligibility (PE) Online application based on self-attested answers provided by the applicant Based on consumer information, individual receives an immediate, real time decision Authorized Representative (AR) Individual or organization to act responsibly on their behalf in assisting with the application Affordable Care Act (ACA) Subsidized coverage for lower incomes No denial for preexisting conditions Functions of the Marketplace i) Determining Eligibility ii) Accepting Qualified Health Plan selections iii) Monitoring QHP Issuers iv) Manages eligibility appeals v) Facilitates enrollment in QHP vi) Ensures appropriate payments to insurance plans vii) Collects and publishes data on health plans viii) Operates consumer assistance call center ix) Collects premiums for small businesses Cost Sharing Reductions Share of costs covered by an individual's insurance that the individual pays out of his or her own pocket Deductibles Coinsurance Co-payments Premium Tax Credits Reduces premium costs for eligible individuals Available only when coverage is purchased through FFM 3 Options for using Premium Tax Credits Full advanced payment Partial advanced payment Claim later Federal Poverty Level Published by the U.S Department of Health and Human Services each year Determines coverage eligibility Small Business Health Options Program (SHOP) Helps small business owners provide medical and dental insurance to their employees Open Enrollment Period November 1st through December 15th Special Enrollment Period Life events including; Loss of minimum essential coverage Gain or lose dependent Marriage Divorce Gain citizenship