HMO Traditional Correct Answer: Network providers , PCP SELECTION, REFERRALS REQUIRED
some services are considered direct access and don't need a referral; FLU AND PNEUMONIA SHOTS
emergency and urgent care
mammograms
...
HMO Traditional Correct Answer: Network providers , PCP SELECTION, REFERRALS REQUIRED
some services are considered direct access and don't need a referral; FLU AND PNEUMONIA SHOTS
emergency and urgent care
mammograms or not in their service area.PCP COPAY WILL APPLY OR SPECIALIST CO PAY WILL APPLY
OPEN ACCESS HMO; Network providers, no PCP selection, no referrals
Visit Aetna's Once confirmed ready to sell visit indivi medicare section on Aetna's producer world
Beginning Oct. 1 indi premiums, etc. will be available Correct Answer:
Medicare Advantage Plan types Correct Answer: WE OFFER HIGH QUALITY MEDICARE ADVANTAGE PLANS (MA) HMO AND PPO AVAIL IN 46 STATES 1,874 COUNTIES
MOST ARE INTEGRATED WITH PRESCRIPTION DRUG COVERAGE MAPD PLANS Medicare ADVANTAGE PRESCRIPTION PLANS
ELIGIBILITY REQUIRMENTS for Medicare Advantage Plans Correct Answer: Have Medicare Parts A and B and lives in the service area
Under 65 and received disability benefits for 24 months from SS
Received disability benefits from Railroad Retirement Board for 24 months
Enrollment periods Correct Answer: include initial coverage election period (ICET)
Initial Enrollment Period (IEP)
Annual Enrollment Period (AEP)
Open Enrollment period (OEP)
Special Enrollment period (SEP)
Effective date 1st of Month
Definitions available on Producer World
PPO Correct Answer: OUT OF NETWORK DR HAS TO BE ELIGLE FOR MEDICARE PAYMENTS AND MUST ACCEPT THE PLAN
MEMBERS CAN GO TO ANY NETWORK PROVIDER
IF THEY GO OUT OF NETWORK THEY MAY HAVE TO PAY A HIGHER COST
has a network of providers
In a ppo plan members don't have to select a PCP
most include prescription drug coverage and a max out of pocket limits (OOP) Correct Answer: coverage for urgent /er medical care anywhere in the world
In network coverage Correct Answer: plan covers preventative care,
annual wellness visits
Glaucoma screenings
Bone Mass Measurements
Prostate Cancer Screenings
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