Aetna Care Management

Aetna offers a variety of Aetna Medicare Advantage plan types. Which plan type requires a person to use only network providers?

A) PDP plan
B) HMO plan
C) PPO plan
D) ESRD plan

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

Most Aetna Medicare Advantage plans are integrated with prescription drug coverage, so they are called MAPD plans.

True or False

Aetna case management consists of registered nurses, social workers, behavioral health professionals and pharmacists who help members navigate the health care system and access services.

True or False

Aetna Medicare Advantage HMO and PPO plans have no out-of-pocket maximum.

True or False

Aetna Medicare Advantage HMO and PPO plans cover routine preventative care including an annual wellness visit, screening mammograms, and prostate cancer screenings.

True or False

A member’s cost share at a preferred pharmacy will usually be lower than cost share at a standard pharmacy.

True or False

All MAPD plans have a prescription drug component.

True or False

Which of the following are true?

A) The PPO plans provide access to services from doctors in the PPO network at a lower out-of-pocket cost.
B) In the 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

You can find a quick list of tools for Aetna Medicare plans on www.aetnamedicare.com/brokers which includes information about plans, medications, and doctors.

True or False

What is a Dual eligible Special Needs Plan (D-SNP)?

A) A type of MAPD plan designed to provide targeted care and services to individuals with specific needs.
B) A MA plan that tailors benefits, provider choices and drug formularies to meet specific needs of the groups they serve.
C) A 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

Low Income Subsidy (LIS) is a Medicare financial assistance program that helps to reduce prescription drug costs.

True or False

The difference between LIS and the Medicare Savings Program (MSP) is LIS helps reduce prescription drug costs and MSP helps with Medicare plan premiums, deductibles and copayments/coinsurance with medical services.

True or False

Which of the following is true for LIS?

A) Beneficiaries pay no more than $3.60 for a covered generic and $8.95 for each brand name drug.
B) There is no coverage gap
C) There is no Late Enrollment Penalty
D) All of the above

A full dual eligible means an individual has Medicare, but is only eligible for assistance with Medicare premiums and sometimes cost share through the Medicare Saving Program.

True or False

LIS Medicare drug plan premium and deductible costs are based on income level.

True or False

Full benefit duals meet state Medicaid eligibility requirements and are entitled to receive the Medicaid services they need.

True or False

One of Aetna’s Model of Care goals is to improve use of preventive health services.

True or False

Which are attributes of the Aetna’s Model of Care:

A) An Interdisciplinary Care Team approach
B) Clinical Programs to improve health and well-being
C) Transition of Care Program
D) A and B
E) All of the above

The Aetna DSNP care manager and care team provide a single point-of-contact to help coordinate all Medicare and Medicaid covered care and services that the member needs.

True or False