Medicare CE Exam 2022 Questions and Answers

Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of: - ANSWER Selling DSNPs The consumer states they currently pay a percen ...

Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of: - ANSWER Selling DSNPs The consumer states they currently pay a percentage of charges when they receive medical care. This means: - ANSWER WRONG - The consumer is enrolled in a Medicare Supplement Insurance Plan. Which of the following consumers is best suited for a CSNP? - ANSWER Mary, who has been seeing a specialist for a qualifying chronic condition On May 10, Michael meets with an agent and says he is enrolled in another carrier's CSNP due to his diabetes. When can Michael enroll in a different CSNP that also covers diabetes (his only chronic condition), assuming he has not moved out of his current plan's service area? - ANSWER DURING OPEN OR ANNUAL 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 It is very important for consumers enrolling in a CSNP to know the following about accessing providers: - ANSWER Some CSNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers, generally with higher cost sharing. Which statement is true about the Medicaid program? - ANSWER It helps pay medical costs for certain groups of people with limited income and resources. Which statement is true of DSNP members? - ANSWER Members who are QMB+ or are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a DSNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs. Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified? - ANSWER WRONG - At the end of the first month of enrollment WRONG - 30 days after the last attempt to contact the provider WRONG - After a 6 month grace period Members who lose their eligibility for the DSNP due to a change or loss of Medicaid status are responsible for what cost sharing? - ANSWER All, such as premiums, deductibles, copayments, and coinsurance What are Dual Special Needs Plans (DSNP)? - ANSWER Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members that lose Medicaid eligibility? - ANSWER WRONG - After the grace period ends Which consumer might benefit the most by enrolling in a DSNP? - ANSWER Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+) 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 Melanie wants to enroll in a DSNP. Which of the following must her agent do? - ANSWER Confirm that Melanie is entitled to Medicare Part A, enrolled in Part B, and her Medicaid level Which consumer may be a good candidate for a DSNP? - ANSWER WRONG - Larry, who has a qualifying chronic condition and wants a plan that will help him manage his illness and health care costs 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 Which service will a CSNP or DSNP member in the high risk care management category receive? - ANSWER Case Management (telephonic, digital and/or face-to-face) according to individual needs 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. NEXT QUESTION 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. Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the DSNP in which she is enrolled. What is her responsibility for cost sharing? - ANSWER WRONG - No change occurs during the grace period WRONG - Only deductibles and copayments The three types of Special Needs Plans are: - ANSWER Dual, Chronic Condition and Institutional/Institutional-Equivalent. Which statement is true about how loss of Medicaid affects a member's enrollment in a DSNP? - ANSWER Special Election Period (SEP Dual/LIS Change in Status) is available for DSNP members that lose their 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 statement is true about CSNPs, DSNPs, and prescription drug coverage? - ANSWER CSNPs and DSNPs include Medicare Part D prescription drug coverage Which of the following consumers may not be a good candidate for a DSNP? - ANSWER Which of the following consumers may not be a good candidate for a DSNP? Which of the following consumer characteristics demonstrates a good fit for a CSNP? - ANSWER A consumer with a qualifying chronic condition who wants a plan that will help them manage their illness and health care costs How is a CSNP or DSNP member's care management health risk levels determined initially? - ANSWER The member completes a Health Assessment that asks a series of questions about their health status and assistance they may need with activities of daily living.