Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan?
When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is automatically disenrolled from his/her MA Plan.
A member does not need a valid election period to disenroll from an MA plan.
When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is not automatically disenrolled from his/her MA Plan.
A consumer can use a Medicare Supplement Insurance Plan and an MA Plan at the same time.
When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is automatically disenrolled from his/her MA Plan.
A member does not need a valid election period to disenroll from an MA plan.
When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is not automatically disenrolled from his/her MA Plan.
A consumer can use a Medicare Supplement Insurance Plan and an MA Plan at the same time.
What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA Plan? (Select 3)
They must see contracted network providers in order to receive coverage under the plan.
In most cases, they will pay the entire cost of the service if they see an out-of-network provider.
Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers.
They must see contracted network providers in order to receive coverage under the plan.
In most cases, they will pay the entire cost of the service if they see an out-of-network provider.
Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers.
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What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA Plan? (Select 3)
They must see contracted network providers in order to receive coverage under the plan.
In most cases, they will pay the entire cost of the service if they see an out-of-network provider.
Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers.
They must see contracted network providers in order to receive coverage under the plan.
In most cases, they will pay the entire cost of the service if they see an out-of-network provider.
Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers.
In most cases, they will pay the entire cost of the service if they see an out-of-network provider.
Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers.
Most benefits are covered out-of-network but at a higher cost.
The exception to the provider network requirement is emergency visits, urgent care and renal dialysis services, which can be obtained from out-of-network providers.
When does Medicare Supplement Open Enrollment take place?
During the three months prior to the consumer’s 65th birthday, the month of their birthday, and the three months following the month of their 65th birthday and enrolled in Medicare Part B.
During the first six months a consumer is 65 or older and enrolled in Medicare Part B.
Annually from October 15 to December 7.
During the first three months a consumer is 65 or older and enrolled in Medicare Part B.
During the three months prior to the consumer’s 65th birthday, the month of their birthday, and the three months following the month of their 65th birthday and enrolled in Medicare Part B.
During the first six months a consumer is 65 or older and enrolled in Medicare Part B.
Annually from October 15 to December 7.
During the first three months a consumer is 65 or older and enrolled in Medicare Part B.
How does the Medicare Advantage Out-of-Pocket (OOP) maximum work?
The OOP maximum is a feature that limits the amount of money a consumer will have to spend on Medicare-covered health care services each year.
The OOP maximum is a feature that limits the amount of money a consumer will have to spend on all health care services each year.
The OOP maximum is a feature that limits the amount of money a consumer will have to spend on prescription drugs and plan premiums each year.
The OOP maximum is a feature that limits the amount of money a consumer will have to spend on Medicare-covered health care services each year.
The OOP maximum is a feature that limits the amount of money a consumer will have to spend on all health care services each year.
The OOP maximum is a feature that limits the amount of money a consumer will have to spend on prescription drugs and plan premiums each year.
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Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan?
Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member should submit to their Medicare Supplement Insurance carrier a written request to cancel his/her policy.
When a member enrolls in the MA Plan their current Medicare Supplement Insurance Plan will automatically cancel.
The member must submit a written request to cancel their Medicare Supplement Insurance Plan the same day they submit their MA Plan enrollment application.
The member should not cancel their Medicare Supplement Insurance Plan because Medicare Supplement Insurance can be used in conjunction with an MA Plan.
Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member should submit to their Medicare Supplement Insurance carrier a written request to cancel his/her policy.
When a member enrolls in the MA Plan their current Medicare Supplement Insurance Plan will automatically cancel.
The member must submit a written request to cancel their Medicare Supplement Insurance Plan the same day they submit their MA Plan enrollment application.
The member should not cancel their Medicare Supplement Insurance Plan because Medicare Supplement Insurance can be used in conjunction with an MA Plan.
Which of the following best defines Medicare Part D?
It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides hospitalization coverage.
It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage.
It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical and hospitalization coverage.
It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical coverage.
It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides hospitalization coverage.
It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage.
It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical and hospitalization coverage.
It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical coverage.
Which of the following statements is true about eligibility requirements for Medicare Prescription Drug Plans?
Consumers must live in the same zip code as the pharmacy they intend to use
A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B
A consumer must receive a pension from a former employer
Consumers do not need to live in the plan’s service area
Consumers must live in the same zip code as the pharmacy they intend to use
A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B
A consumer must receive a pension from a former employer
Consumers do not need to live in the plan’s service area
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible consumer get Part D prescription drug coverage?
They could sign up for a pharmacy savings card through their local pharmacy.
There is no other way a Medicare consumer could get Part D prescription drug coverage.
They could enroll in a Medicare Supplement Insurance Plan.
They could enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage.
They could sign up for a pharmacy savings card through their local pharmacy.
There is no other way a Medicare consumer could get Part D prescription drug coverage.
They could enroll in a Medicare Supplement Insurance Plan.
They could enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage.
Which of the following statements does not correctly define prescription drug stages?
The catastrophic coverage stage is when the member will only pay a small coinsurance or copayment for covered drugs for the remainder of the plan year.
Initial coverage is the stage when the plan pays part and the member pays part, usually as coinsurance or copayments.
A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in.
The coverage gap ends when the member has spent $6,550 (in 2021) in out-of-pocket expenses for the plan year.
The catastrophic coverage stage is when the member will only pay a small coinsurance or copayment for covered drugs for the remainder of the plan year.
Initial coverage is the stage when the plan pays part and the member pays part, usually as coinsurance or copayments.
A deductible is the amount the member must pay for every prescription medication, regardless of what stage they are in.
The coverage gap ends when the member has spent $6,550 (in 2021) in out-of-pocket expenses for the plan year.
Prior Authorization
Step Therapy
Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs?
Through a combination of subsidies and annual refund checks
Through subsidies such as lower or no monthly plan premiums and lower or no copayments
Such financial assistance will no longer be available as of January 1, 2020
By receiving annual checks with a refund based on a predetermined percentage of Part D costs
Through a combination of subsidies and annual refund checks
Through subsidies such as lower or no monthly plan premiums and lower or no copayments
Such financial assistance will no longer be available as of January 1, 2020
By receiving annual checks with a refund based on a predetermined percentage of Part D costs
Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies?
Underwriting is required if the consumer is not in his/her Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria.
Consumers will never be underwritten to determine their rate.
If the consumer meets Guaranteed Issue criteria, he/she may be underwritten to determine his/her rate.
During Medicare Supplement Open Enrollment, consumers will only be required to answer the underwriting eligibility questions.
Underwriting is required if the consumer is not in his/her Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria.
Consumers will never be underwritten to determine their rate.
If the consumer meets Guaranteed Issue criteria, he/she may be underwritten to determine his/her rate.
During Medicare Supplement Open Enrollment, consumers will only be required to answer the underwriting eligibility questions.
Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F?
Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to purchase Medicare Supplement Insurance Plans C or F.
Consumers already enrolled in Plans C or F are required to change plans.
Consumers eligible for Medicare Part A before January 1, 2020, can enroll in Plan C or F even after 2020 and can keep their plans as long as they choose.
Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to purchase Medicare Supplement Insurance Plans C or F.
Consumers already enrolled in Plans C or F are required to change plans.
Consumers eligible for Medicare Part A before January 1, 2020, can enroll in Plan C or F even after 2020 and can keep their plans as long as they choose.
Which of the following is true about Medicare Supplement Insurance Plans?
They are regulated by the Centers for Medicare & Medicaid Services (CMS).
Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments.
To see a specialist, insured members must obtain referrals from a primary care physician.
They can only be purchased during the Annual Election Period (AEP).
They are regulated by the Centers for Medicare & Medicaid Services (CMS).
Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments.
To see a specialist, insured members must obtain referrals from a primary care physician.
They can only be purchased during the Annual Election Period (AEP).
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