Medicare Flashcards
Pass my final
A fixed percentage paid by the beneficiary for the services provided:
Coinsurance
During Catastrophic Coverage the client will pay the lesser of 5% coinsurance or $3.30 for generics and $8.25 for brand drugs?
True or False
False
Client will pay the greater of 5% coinsurance or $3.30 for generics and $8.25 for brand drugs.
Medicare will not penalize you if you do not sign up for your Part B when you are first turning 65. and do not have creditable coverage.
True or False
False….the penalty is 10% for every full 12 months without creditable coverage.
Which MA/MAPD plan(s) do we sell?
PFFS HMO HMO-POS PPO SNP
Features of SQS?
Unbiased sales agent
Re-shop clients rates
Compares 25 companies
Save the client time
Which Part C Plan includes prescription drug coverage?
MAPD
Explain the parts of Medicare….
Part A = Hospital Insurance
Part B = Medical Insurance
Part C = Medicare Advantage
Part D = Prescription Drug Plan
$4,950 is the amount you must reach to enter catastrophic coverage. That amount is is combination of what?
The $3,700 retail cost of prescription drugs and $1,250 that the client paid in the gap.
To join Medicare when under 65 years old, you must be legally declared disabled for 24 months or have ESRD?
True or False
True
PPO’s have both in-network and out-of-network services, the client will pay less for out-of-network services?
True or False
False….clients typically pay more for out-of-network services.
The client will pay no more than what amount for brand-name drugs when on Full Extra Help?
$8.25
John turns 65 November 1st, his Part A will begin October 1st
True or False
True….if the clients birthday is on the first day of the month the coverage starts the first day of the month before
A monthly payment that enables the individual to receive insurance coverage
Premium
Initial enrollment period(IEP) entitles you to a 7 month window to sign up for Part B
True or False
True…3-1-3….three months before, month of birth, three months after
LIS/Full Extra Help recipients can only change their MAPD/PDP plan 1 time a quarter
True or False
False…clients with LIS/Full Extra Help can change their plan year round
Which MAPD election period follows the 3-1-3 rule?
OE AEP IEP ICEP SEP none of the above
IEP
Which of the following health condition(s) keep you from getting a MA/MAPD?
Smoking
ESRD
Diabetes
ESRD
The amount you must pay for health care before Medicare begins to pay. These amounts can change every year.
Late enrollment Penalty
Gross National Average
Deductible
Medicare allowance copay
Deductible
Prescription Drug plan costs the customer pays are?
Select all that apply….
Copays
Annual Deductibles(if applicable)
Premium
Copays
Annual Deductibles(if applicable)
Premium
You can add standalone PDP plans to which of the following MA plans?
HMO-POS PPO None of them PFFS-POS PFFS HMO
PFFS
LIS= low income subsidy
True or False
True
James J is turning 65 on August 21st, when will his Part A begin?
September 1st July 1st August 21st July 21st August 1st
August 1st
If you are enrolled in a HMO plan and you go to a doctors office out-of-network, you are responsible for the Part B 20% coinsurance.
True or False
False….the client would be responsible for the full bill. It would not be covered by the HMO or Original Medicare
You must have Medicare Part B to be eligible for Medicare Part D
True or False
True
You have two months to enroll in Part B after creditable coverage ends?
True or False
False….the SEP would be for 8 months
What is the benefit period for the Part A deductible?
2 months
60 days post discharge
60 days post admittance
60 days post discharge and the deductible is $1316
The PFFS is always a network based plan
True or False
False….PFFS have no networks
What is ESRD?
End Stage Renal Disease….kidney failure
Which is/are advantages of MA/MAPD over Original Medicare?
Select all that apply…
Going to any doctor you want to
Maximum out-of-pocket limits
None of them
Might include dental, vision or drug coverage
Maximum out-of-pocket limits
Might include dental, vision or drug coverage
Value Props should be 20-30 seconds long?
True or False
False. 10-20 seconds
MAPD/MA plans supplement Medicare
True or False
False MA/MAPD replace original Medicare
Part D/Medicare Prescription Drug plans are Medicare programs that provide prescription drug coverage regulated and provided by Medicare
True or False
False…it is regulated by the Federal Goverment but sold by private insurance
Original Medicare is Part A, B, and D
True or False
False….Parts A and B
What percentage does Sarah pay for generics in the Coverage Gap?
40%
20%
51%
5%
51%
What expenses are associated with Medicare Part B? Select all that apply…
$20 coinsurance 20% coinsurance $183 annual deductible None of the answers are correct $1316 annual deductible
20% coinsurance
$183 annual deductible
Medicare Part B is an 80/20 split and there is a maximum out for pocket of $1316
True or False
False….there is no out of pocket maximum
What is the enrollment period from October 15- December 7?
AEP
GEP
IEP
AEP
Which Part C includes prescription drug coverage?
MA Supplemental MAPD PDP Medical
MAPD
Which Medigap plans do NOT cover the Part B deductible?
Plan D Plan B Plan L Plan N Plan C Plan M Plan F Plan G Plan A Plan K
Plan C and Plan F are the only plans that cover all or some of the deductible
The monthly premiums of Medigap plans can depend on Select all that apply
Age County Family Medical History Gender Alcohol Use Height and Weight Tobacco Use
Age County Gender Height and Weight Tobacco Use
When can we sell AARP/UHC Medigap plans to our clients?
Anytime
DTE clients only
Any client that is Guaranteed Issue
DTE clients only
Plan K and L are the only plans with out of pocket limits?
True or False
True….Plan K $5120 and Plan L $2560
Plan F is known as the _________ plan?
Cadillac
What are Part B excess charges?
The amount that doctors are allowed to charge above the Medicare contracted allowable amount up to 15%
When can you get a Medicare Supplement Plan?
Open Enrollment(OE) Period
Triggered by enrolling in Medicare Part B
6 month period that starts the first month they are in rolled in Part B
No medical underwriting can enroll in any Medigap plan
Client can change plans as many times as they would like in this 6 month window
Guaranteed Issue (GI) window
Client involuntarily loses creditable coverage and already has Part B
Client GI is 60 days before and 63 days after to enroll in a Medigap plan. Can enroll in plans A, B, C, F, K and L.
NO OE = NO__?
G
If a client missed the Open Enrollment Period for Medigap, they may still purchase a Medigap plan anytime but they will be __________________; unless they have a qualifying event giving them a Guaranteed Issue window
Subject to underwriting
Which states have specific open enrollment rules for Medigap?
California and Oregon….birthday rules
Missouri….anniversary rule
What is an IEP2?
When a client already has Medicare and is turning 65…they now have IEP2 and get the same 3-1-3
What is an ICEP?
Initial coverage election period for Part B. Is a 3 month period normally triggered by GEP.
What is GEP?
General enrollment period aka late enrollment period.
January 1-March 31st
Coverage starts July 1st
This is for Part B
If you are covered under a group health plan and that plan ends or you leave the plan. What is the election period for Plan B
The election period would be a SEP that last 8 months
Explain the Part B penalty
The Part B penalty is 10% of the monthly premium for each full 12 months without creditable coverage. It never leaves you.
A list of certain drugs and their proper dosages for which a drug plan will cover
Formulary
What is a dosage?
A specific quantity of a medication to be taken by a patient within a specified period or interval
Things to know about Part D
It is optional, if you want it you must enroll in Part D
If you do not enroll in creditable coverage when first available a Part D penalty may be added to your Part D premium
What is the Part D late penalty?
The Part D penalty is 1% of the national average(which is $35.63) for every month without creditable coverage
Explain the benefit periods of coverage in a Part D plan
Initial Coverage - beneficiary pays the deductible(if applicable), co-pays
Coverage Gap aka Donut Hole - when retail cost of drugs has reached $3700 you enter the donut hole. Here the beneficiary will pay 40% of the retail cost for brand name drugs and 51% of the cost for generic drugs
Catastrophic Coverage - the beneficiary has reached $4950 which is $1250 in the donut hole. Now the beneficiary will pay the greater amount of 5% of retail, $3.30 for generic drugs or $8.25 for brand name drugs
What are the election periods for Part D?
IEP initial enrollment period 3-1-3 when client first becomes eligible for medicare
AEP annual enrollment period the plan can be switched October 15 - December 7 change takes affect January 1st
SEP if they have moved, loss of creditable coverage, dual eligible, released from prison 2 months
What is a HMO
Health Maintenance Organization
What is a PPO
Preferred Provider Organization
HMO-POS is a hybrid of which two services
HMO and PPO
Which Special Needs Plans do we have
Dual D-SNP and chronic C-SNP
What is PFFS
Private Fee For Service
Which Carriers do we represent for Chronic needs plans?
Humana and Cigna
Which carriers do we represent for dual eligible special needs plans?
Humana, Cigna and United Health Care
How to reach Medicare
1-800-MEDICARE or 1-800-633-4227
What is the Part B premium?
$134 for 2017 or $109
When does Medicare take effect?
As soon as you apply The day after you apply The first day of the month The last day of the month The week after you apply
The first day of the month
When is the general election period and for which part of Medicare does it apply?
January 1 - March 31, Part B
January 1 - February 14, Part A
January 1 - February 14, Part B
January 1 - March 31, Part A
January 1 - March 31, Part B
What are the possible factors that cause the Part A premium to be $0?
Must have worked 45 quarters
Must have worked 40 quarters
Been married for 10 years to a spouse that worked the required quarters
Been married for 5 years to a spouse that worked the required quarters
Must be paying the Part B premium
Must have worked 40 quarters
Been married for 10 years to a spouse that worked the required quarters
The value proposition should only come at the start of the call?
True or False
False…it should come throughout the call
The case specialist team sells our ancillary products?
True or False
False
All MAPD plans offer additional benefits (i.e.: dental, vision, health club membership)
True or False
False…some not all offer the additional benefits
If the PFFS plan is a MA(medical only), you can pair it with a PDP?
True or False
True
Which plan is normally “best” to put a cost-share protected member on?
HMO
CSNP
PPO
DSNP
DSNP
Medicare Advantage plans are also called Medicare Part C?
True or False
True
All MAPD plans are network based?
True or False
False
Medicare Advantage plans replace Original Medicare?
True or False
True
How does one qualify for an MAPD?
Pick all that apply
Must continue to pay the Part B Premium(if applicable)
Must be eligible for Medicare
Cannot have End Stage Renal Disease
Must pay your MA/MAPD Plan Premium(if applicable)
Must continue to pay the Part B Premium(if applicable)
Must be eligible for Medicare
Cannot have End Stage Renal Disease
Must pay your MA/MAPD Plan Premium(if applicable)
List the 8 Medicare Advantage carriers….
Aetna Humana Anthem-Blue Cross Blue Shield Cigna Coventry United Health Care BCBS of KC and Michigan Blue Shield of California
List the 6 PDP Carriers
Humana Coventry Silverscript Aetna Anthem BCBS AARP
List the Medi-Gap carriers….
Aetna(American Continental, Continental Life)
ARLIC, Cigna Loyal American
Humana
MOO(Omaha Insurance Company, United of Omaha, United World)
Blue Shield of California
AARP/United Health Care(DTE Only)
How do you qualify for Medigap?
You must be eligible for Medicare
Must continue to pay Part B premium
Must pay Medigap plan premium
Depending on the circumstances the client might have to pass medical underwriting
How many Medigap plans are there?
Ten
What are the co-pays for Plan N?
Doctor visit $20 or less
Emergency room $50 or less
Does not cover excess charges
What factors are used to determine monthly premiums for Med Supps?
Gender Age Tobacco use County Sometimes height and weight
What are Part B excess charges?
The amount that doctors are allowed to charge above the Medicare contracted allowable amount up to 15%
How many states do not allow Part B excess charges?
Eight
What are the enrollment periods for Medicare Supplement plans?
Open enrollment - Part B effective month and 5 months after
Guaranteed Issue - Loss of creditable coverage, 60 days before and 63 days after qualifying event
Any time - with medical underwriting
Medigap Supplement Rating Methods?
Attained-age rated
Community-rated
Issue-age rated
Medigap plans that pay the Part B deductible
Plan C and Plan F
Medigap plans that cover excess charges?
Plan G and Plan F
List the disclosures to discuss MAPD or PDP
May I have your permission to discuss Medicare Advantage plans with you?
Before we continue, please be aware that you are not required to provide me with any information that you do not want to, and that any information you provide during this call will not affect your ability to request enrollment or affect your current plan membership
Have you ever been diagnosed with end stage renal disease
List the 8 states where Part B excess charges are not allowed.
CT, MA, MN, NY, OH, PA, RI and VT
