Anthem - HMO Plans 2022

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The beneficiary must continue to pay the Medicare Part B premium in order to be eligible for the HMO plan. - ANSWER True Which of the following statements regarding eligibility criteria for Medicar... e Advantage HMO plans is true? - ANSWER All of the above statements are true. If the member obtains preventive care and screening tests from out-of-network providers, neither Medicare nor the HMO plan will be responsible for the costs. The member will be responsible for the costs in this case. - ANSWER True For a beneficiary who enrolled in a MA-only plan during the Annual Election Period, they will not be able to enroll in a plan that offers prescription drug coverage until the following Annual Election Period; unless the beneficiary chooses to use their one-time election during the Open Enrollment Period or qualifies for a Special Election Period. - ANSWER True Which statement about rules on rates is NOT true? - ANSWER Rates vary, depending on gender or age Enrollees in HMO plans must use doctors, specialists, or hospitals in the plan's network except in an emergency. - ANSWER True Coinsurance is defined as: - ANSWER A Percentage In most situations, the PCP must give approval in advance before the member can see other providers in the plan's network. This is called a ________. - ANSWER Referral A medical __________ is defined as "when you believe that your health is in serious danger." - ANSWER Emergency Prescription drug costs under Part D apply toward the medical out-of-pocket maximum. - ANSWER False The Medicare Advantage (MA) Program, sometimes called "Part C", combines coverage for Parts A & B benefits and is administered by private health plans. - ANSWER True Once a member reaches their annual maximum out of pocket, they are still subject to pay their medical care copayments for the remainder of the calendar year. - ANSWER False [Show More]

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