Milton is retiring on his 65th birthday. He is eligible for Medicare and already receives Social Security benefits. How does he enroll in Original Medicare? - ANSWER His enrollment in Medicare Parts A and B is generally
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Milton is retiring on his 65th birthday. He is eligible for Medicare and already receives Social Security benefits. How does he enroll in Original Medicare? - ANSWER His enrollment in Medicare Parts A and B is generally automatic if he meets all eligibility requirements
Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? - ANSWER When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA plan.
Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? - ANSWER Original Medicare
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - ANSWER An MA Plan is a health plan option approved by Medicare and offered by private insurance companies, An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often includes Medicare prescription drug coverage (Part D), An MA Plan is part of Medicare and is also called Part C.
Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? - ANSWER Resides in the plan's service area
Which of the following is NOT a correct statement about in-network provider services? - ANSWER HMO-POS Plans only cover in-network services.
When is Mary's Medicare Supplement Open Enrollment period if she turns 65 on September 23, 2021, and her Medicare Part B effective date is September 1, 2021? - ANSWER September 2021 through February 2022
What is Medicare Part D? - ANSWER A voluntary program, offered by private insurance companies that are contracted with the federal government, that provides prescription drug coverage for an additional monthly plan premium
Which of the following statements is true about eligibility requirements for stand-alone Medicare Prescription Drug Plans? - ANSWER A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B
Which of the following statements is NOT true about the Coverage Gap? - ANSWER All members reach the Coverage Gap
A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for ______________. - ANSWER 63 or more continuous days
How does a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? - ANSWER Through subsidies such as lower or no monthly plan premiums and lower or no copayments
Formulary is defined as: - ANSWER A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists.
Which of the following are true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Plans and the impact to Plans C and F? (Select 2) - ANSWER 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 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 statement is true about the Medicare Advantage (MA) Out-of-Pocket Maximum? - ANSWER All MA plans have an Out-of-Pocket Maximum to help limit the member's out-of-pocket costs for Medicare-covered services
Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan? - ANSWER Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member must cancel their Medicare Supplement Insurance policy according to their carrier's rules.
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible consumer get Part D prescription drug coverage? - ANSWER They could enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage.
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