Aetna 2023 MA/MAPD/DSNP Already
Passed
Aetna offers a variety of Aetna Medicare Advantage plan types. Which plan type requires a
person to use only network providers? (Excluding emergency or urgently needed services)
...
Aetna 2023 MA/MAPD/DSNP Already
Passed
Aetna offers a variety of Aetna Medicare Advantage plan types. Which plan type requires a
person to use only network providers? (Excluding emergency or urgently needed services)
a.
PDP plan
b.
HMO plan
c.
PPO plan
d.
ESRD plan ✔✔b.
HMO plan
What is a Special Needs Plan (SNP)?
a.A type of Medicare Advantage Prescription Drug (MAPD) coordinated care plan that limits
enrollment to people with specific diseases or characteristics.
b.An MA plan that tailors benefits, provider choices, and drug formularies to meet specific needs
of the groups they serve.
c.An MA plan for those who are eligible for Medicare and Medicaid.
d.A MA plan required to contract with a state Medicaid agency.
e.
All of the above ✔✔e.
All of the above
Which of the following is true for Low Income Subsidy?
a.Beneficiaries pay no more than $3.95 for a covered generic and $9.85 for each brand name
drug
b.There is no coverage gap
c.There is no Late Enrollment Penalty
d.All of the above ✔✔d.All of the above
Which are attributes of the Aetna's Model of Care?
a.An Interdisciplinary Care Team approach
b.Clinical programs to improve health and well-being
c.Transition of Care Program
d.A and B
e.
All of the above ✔✔e.
All of the above
Which plan type allows members to see preferred doctors in network, doctors out-of-network,
and does not require referrals to a specialist?
a.
PDP plan
b.
Cost plan
c.
PPO plan
d.
HMO plan ✔✔c.
PPO plan
Which of the following statements are true?
a.
If PPO members see a doctor who is not in the network their cost share for services may be
higher
b.
In the Aetna Medicare Open Access HMO plan, members can go to any Aetna Medicare plan
HMO network doctor they choose for covered services, without a PCP referral, as long as the
doctor is a contracted HMO doctor.
c.
All of the Medicare Advantage plans include free monthly fitness club memberships to any
facility participating within the SilverSneakers network.
d.
All of the above ✔✔d.
All of the above
You can find a quick list of tools for Aetna Medicare plans on www.aetnamedicare.com/brokers,
which includes information about plans, medications, and doctors.
Select one:
True
False ✔✔True
Low Income Subsidy (LIS) is a Federal program that helps eligible beneficiaries with their Part
D drug costs.
Select one:
True
False ✔✔True
The difference between LIS and the Medicare Savings Program (MSP) is LIS helps reduce
prescription drug costs and MSP helps with Medicare plan premiums, as well as deductibles,
copayments and coinsurance associated with medical services.
Select one:
True
False ✔✔True
D-SNP plans are for only Medicare beneficiaries that need help with Medicare premiums
Select one:
True
False ✔✔False
LIS Medicare drug plan premium and deductible costs are based on income level.
Select one:
True
False ✔✔True
Individuals and families who earn less than the federal poverty level by up to 150% may qualify
for Extra Help.
Select one:
True
False ✔✔True
One of Aetna's Model of Care goals is to improve use of preventive health services.
Select one:
True
False ✔✔True
The DSNP care team helps to coordinate all Medicare and Medicaid covered care and services
that the member needs.
Select one:
True
False ✔✔True
Each pharmacy component of an MAPD plan consists of a formulary, a pharmacy network and
benefit designs (cost sharing and tier structure).
Select one:
True
False ✔✔True
Aetna Medicare Case Management has teams of registered nurses, social workers, behavioral
health professionals, and pharmacists who help members navigate the health care system and
access services.
Select one:
True
False ✔✔True
Aetna Medicare Advantage HMO and PPO plans have no out-of-pocket maximum.
Select one:
True
False ✔✔False
Aetna Medicare Advantage HMO and PPO plans cover routine preventive care including an
annual wellness visit, screening mammograms, and prostate cancer screenings.
Select one:
True
False ✔✔True
A member's cost share at a preferred pharmacy will usually be lower than cost share at a standard
pharmacy.
Select one:
True
False ✔✔True
All of our HMO and PPO plans include a maximum out-of-pocket limit.
Select one:
True
False ✔✔True
[Show More]
