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 - ANSWER B) HMO
Which plan type al
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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 - ANSWER B) HMO
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 - ANSWER C) PPO
Most Aetna Medicare Advantage plans are integrated with prescription drug coverage, so they are called MAPD plans.
True or False - ANSWER True
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 - ANSWER True
Aetna Medicare Advantage HMO and PPO plans have no out-of-pocket maximum.
True or False - ANSWER 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 - ANSWER True
A member's cost share at a preferred pharmacy will usually be lower than cost share at a standard pharmacy.
True or False - ANSWER True
All MAPD plans have a prescription drug component.
True or False - ANSWER True
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 - ANSWER 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 - ANSWER True
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 - ANSWER 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 - ANSWER True
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 - ANSWER True
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 - ANSWER 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 - ANSWER False
LIS Medicare drug plan premium and deductible costs are based on income level.
True or False - ANSWER True
Full benefit duals meet state Medicaid eligibility requirements and are entitled to receive the Medicaid services they need.
True or False - ANSWER True
One of Aetna's Model of Care goals is to improve use of preventive health services.
True or False - ANSWER True
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 - ANSWER 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 - ANSWER True
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