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In which two parts of Medicare is enrollment generally automatic for eligible consumers who are receiving Social Security benefits, UNLESS they choose to delay their coverage? - ✔✔Parts A and B Which statement is true about members of a Medicare Advantage (MA) Plan who want to enroll in a Medicare Supplement Insurance Plan? - ✔✔The consumer must be in a valid MA election or disenrollment period.
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In which two parts of Medicare is enrollment generally automatic for eligible consumers who are receiving Social Security benefits, UNLESS they choose to delay their coverage? - ✔✔Parts A and B Which statement is true about members of a Medicare Advantage (MA) Plan who want to enroll in a Medicare Supplement Insurance Plan? - ✔✔The consumer must be in a valid MA election or disenrollment period. Provided other eligibility requirements are met, who is eligible for Medicare? - ✔✔Consumers age 65 or older, consumers under 65 years of age with a qualifying disability and consumers of all ages with ESRD or ALS who are receiving Social Security Disability Insurance (SSDI) for ALS. Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - ✔✔-An MA Plan is a health plan option approved by Medicare and offered by private insurance companies.
What costs count toward the out-of-pocket maximum for Medicare Advantage (MA) Plans? - ✔✔The Out-of-Pocket Maximum includes costs the member pays for any Medicare-covered Part A or B services but does not include the cost of any plan premiums. A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated prescription drug coverage? - ✔✔The consumer will be automatically disenrolled from their stand-alone PDP upon enrollment in the MA Plan that has integrated prescription drug coverage What is Medicare Part D? - ✔✔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 consumer is eligible for a stand-alone Medicare Prescription Drug Plan? - ✔✔Joseph, who is enrolled in Medicare Part A and Medicare Part B and resides in the plan's service area. A consumer with only Part A residing in the plan's service area can enroll in which plan type to get Part D coverage? - ✔✔A stand-alone Part D Plan. Which of the following statements accurately describes a prescription drug stage? - ✔✔Starting in 2024, the catastrophic coverage stage is when the member will pay nothing for covered drugs for the remainder of the plan year. Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all examples of what? - ✔✔Utilization Management Rules 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 ______________. - ✔✔63 or more continuous days
When is a Medicare Supplement Insurance consumer subject to underwriting and screened for eligibility? - ✔✔When the consumer is not in their Medicare Supplement Open Enrollment or does not meet Guaranteed Issue criteria. Which of the following statements is true about using a 5-Star Special Enrollment Period (SEP)? - ✔✔It can be used once from December 8 through November 30 to enroll in a 5-Star plan and coverage will start the first of the month following receipt of the enrollment application. 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? - ✔✔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? - ✔✔When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA plan. Which of the following are eligibility requirements for enrollment in a Medicare Advantage Plan? (Select
Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? - ✔✔She would be disenrolled automatically from her MAPD Plan. Which of the following best describes eligibility to enroll in a stand-alone Prescription Drug Plan? - ✔✔Entitled to Part A and/or enrolled in Part B and reside in the plan service area. Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare-eligible consumer get Part D prescription drug coverage? - ✔✔They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP). Which of the following statements is NOT true about the Coverage Gap? - ✔✔All members reach the Coverage Gap. Which of these statements is NOT true about the drug utilization management (UM) rules? - ✔✔ Which of the following best describes the Late Enrollment Penalty (LEP)? - ✔✔The amount added to the member's monthly plan premium 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 63 or more continuous days. Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? - ✔✔Through subsidies such as lower or no monthly plan premiums and lower or no copayments. Formulary is defined as: - ✔✔A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect January 1, 2020, applies to all carriers offering Medicare supplement plans. - ✔✔True What kind of financial assistance does a consumer receive who qualifies for Low Income Subsidy - ✔✔Lower or no monthly plan premiums and lower or no copayments