What are Dual Special Needs Plans (DSNP)? - ANSWER Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid.
Meredith, a DSNP member, loses Medicaid eligibility. What impact does
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What are Dual Special Needs Plans (DSNP)? - ANSWER Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid.
Meredith, a DSNP member, loses Medicaid eligibility. What impact does this have on her DSNP enrollment? - ANSWER She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility
A DSNP might be in the best interest of which of these consumers? - ANSWER Joe, whose low income qualifies him for full Medicaid coverage
Which program is available to support the unique health care needs of CSNP and DSNP members? - ANSWER A care management program that varies depending upon the level of the member's health risk level
Which statement best describes a DSNP? - ANSWER The monthly premium is at or below the Low Income Subsidy benchmark to cover drug costs
When selling DSNPs, agents must: - ANSWER Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part
Which consumer may be a good candidate for a DSNP? - ANSWER Anne, who does not pay a percentage of charges when she receives medical care
The following is a characteristic of consumers for whom a CSNP may be most appropriate: - ANSWER Consumers who have a qualifying chronic condition, are focused on their health issues and may have concerns with having to manage their illness or dealing with multiple providers
On July 19, each of the following consumers met with an agent. Based on the information provided, which consumer must wait until the Annual Election Period (AEP) or Open Enrollment Period (OEP) to enroll? - ANSWER Joy has a cardiovascular disorder, is enrolled in a CSNP that covers the condition, and wants to enroll in another CSNP offered by the plan that covers the same condition.
Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level? - ANSWER All of the responses are correct.
What is the purpose of the Chronic Condition Verification form? - ANSWER It authorizes the plan to contact the provider identified on the form in order to verify that the consumer has at least one of the qualifying chronic conditions covered by the CSNP.
Which statement is true about the Medicaid program? - ANSWER It helps pay medical costs for certain groups of people with limited income and resources
You must advise consumers enrolling in a DSNP that: - ANSWER They are not required to pay copayments for Medicare-covered services received from a DSNP network provider if they are Full Dual-Eligible or determined DSNP eligible by our plan agreement with the state in which they reside. Their provider should bill the state Medicaid program.
Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified? - ANSWER IDK THIS ONE
A DSNP member loses his eligibility due to a change or loss of Medicaid status. What cost sharing is he responsible for while in the grace period? - ANSWER All, such as premiums, deductibles, copa
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