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Aetna Medicare Advantage plan types

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Question 2

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Which plan type allows members to see preferred doctors in-network, doctors out-of-network, and does not require referrals to a specialist?

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PDP plan

Cost plan

PPO plan

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HMO plan

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Question 3

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

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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.

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

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

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A member’s cost share at a preferred pharmacy will usually be lower than cost share at a standard pharmacy.
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All MAPD plans have a prescription drug component.

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Question 9

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Which of the following statements are true?

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The Aetna Medicare PPO plans provide access to services from doctors in the PPO network at a lower out-of-pocket cost.

In the Aetna Medicare PPO plan, members can go to any Aetna Medicare Plan PPO network doctor they choose for covered services without a PCP referral as long the doctor is a contracted PPO doctor.

All of the Medicare Advantage plans include free monthly fitness club memberships to any facility participating within the SilverSneakers network.

All of the above.

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Question 10

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You can find a quick list of tools for Aetna Medicare plans on https://www.aetnamedicare.com/en/for-producers.html, which includes information about plans, medications, and doctors.

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Question 11

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

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A type of Medicare Advantage Prescription Drug (MAPD) plan designed to provide targeted care and services to individuals with specific needs.

A MA plan that tailors benefits, provider choices, and drug formularies to meet specific needs of the groups they serve.

A MA plan for those who are eligible for Medicare and Medicaid.

A MA plan required to contract with a state Medicaid agency.

All of the above.

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Question 12

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

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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.

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Which of the following is true for Low-Income Subsidy?

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Beneficiaries pay no more than $3.70 for a covered generic and $9.20 for each brand name drug

There is no coverage gap

There is no Late Enrollment Penalty

All of the above

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Question 15

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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

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Question 16

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

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

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

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Question 19

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

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An Interdisciplinary Care Team approach

Clinical Programs to improve health and well-being

Transition of Care Program

A and B

All of the above

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Question 20

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

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