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Medicare > Medicare > Flashcards

Medicare Flashcards

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1
Q

A fixed percentage paid by the beneficiary for the services provided:

A

Coinsurance

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2
Q

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

A

False

Client will pay the greater of 5% coinsurance or $3.30 for generics and $8.25 for brand drugs.

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3
Q

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

A

False….the penalty is 10% for every full 12 months without creditable coverage.

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4
Q

Which MA/MAPD plan(s) do we sell?

A 
PFFS
HMO
HMO-POS
PPO
SNP
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5
Q

Features of SQS?

A

Unbiased sales agent
Re-shop clients rates
Compares 25 companies
Save the client time

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6
Q

Which Part C Plan includes prescription drug coverage?

A

MAPD

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7
Q

Explain the parts of Medicare….

A

Part A = Hospital Insurance
Part B = Medical Insurance
Part C = Medicare Advantage
Part D = Prescription Drug Plan

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8
Q

$4,950 is the amount you must reach to enter catastrophic coverage. That amount is is combination of what?

A

The $3,700 retail cost of prescription drugs and $1,250 that the client paid in the gap.

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9
Q

To join Medicare when under 65 years old, you must be legally declared disabled for 24 months or have ESRD?

True or False

A

True

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10
Q

PPO’s have both in-network and out-of-network services, the client will pay less for out-of-network services?

True or False

A

False….clients typically pay more for out-of-network services.

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11
Q

The client will pay no more than what amount for brand-name drugs when on Full Extra Help?

A

$8.25

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12
Q

John turns 65 November 1st, his Part A will begin October 1st

True or False

A

True….if the clients birthday is on the first day of the month the coverage starts the first day of the month before

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13
Q

A monthly payment that enables the individual to receive insurance coverage

A

Premium

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14
Q

Initial enrollment period(IEP) entitles you to a 7 month window to sign up for Part B

True or False

A

True…3-1-3….three months before, month of birth, three months after

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15
Q

LIS/Full Extra Help recipients can only change their MAPD/PDP plan 1 time a quarter

True or False

A

False…clients with LIS/Full Extra Help can change their plan year round

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16
Q

Which MAPD election period follows the 3-1-3 rule?

OE
AEP
IEP
ICEP
SEP
none of the above
A

IEP

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17
Q

Which of the following health condition(s) keep you from getting a MA/MAPD?

Smoking
ESRD
Diabetes

A

ESRD

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18
Q

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

A

Deductible

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19
Q

Prescription Drug plan costs the customer pays are?
Select all that apply….

Copays
Annual Deductibles(if applicable)
Premium

A

Copays
Annual Deductibles(if applicable)
Premium

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20
Q

You can add standalone PDP plans to which of the following MA plans?

HMO-POS
PPO
None of them
PFFS-POS
PFFS
HMO
A

PFFS

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21
Q

LIS= low income subsidy

True or False

A

True

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22
Q

James J is turning 65 on August 21st, when will his Part A begin?

September 1st
July 1st
August 21st
July 21st
August 1st
A

August 1st

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23
Q

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

A

False….the client would be responsible for the full bill. It would not be covered by the HMO or Original Medicare

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24
Q

You must have Medicare Part B to be eligible for Medicare Part D

True or False

A

True

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25
Q

You have two months to enroll in Part B after creditable coverage ends?

True or False

A

False….the SEP would be for 8 months

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26
Q

What is the benefit period for the Part A deductible?

2 months
60 days post discharge
60 days post admittance

A

60 days post discharge and the deductible is $1316

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27
Q

The PFFS is always a network based plan

True or False

A

False….PFFS have no networks

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28
Q

What is ESRD?

A

End Stage Renal Disease….kidney failure

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29
Q

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

A

Maximum out-of-pocket limits

Might include dental, vision or drug coverage

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30
Q

Value Props should be 20-30 seconds long?

True or False

A

False. 10-20 seconds

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31
Q

MAPD/MA plans supplement Medicare

True or False

A

False MA/MAPD replace original Medicare

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32
Q

Part D/Medicare Prescription Drug plans are Medicare programs that provide prescription drug coverage regulated and provided by Medicare

True or False

A

False…it is regulated by the Federal Goverment but sold by private insurance

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33
Q

Original Medicare is Part A, B, and D

True or False

A

False….Parts A and B

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34
Q

What percentage does Sarah pay for generics in the Coverage Gap?

40%
20%
51%
5%

A

51%

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35
Q

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
A

20% coinsurance

$183 annual deductible

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36
Q

Medicare Part B is an 80/20 split and there is a maximum out for pocket of $1316

True or False

A

False….there is no out of pocket maximum

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37
Q

What is the enrollment period from October 15- December 7?

AEP
GEP
IEP

A

AEP

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38
Q

Which Part C includes prescription drug coverage?

MA
Supplemental
MAPD
PDP
Medical
A

MAPD

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39
Q

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
A

Plan C and Plan F are the only plans that cover all or some of the deductible

40
Q

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
A 
Age
County
Gender
Height and Weight
Tobacco Use
41
Q

When can we sell AARP/UHC Medigap plans to our clients?

Anytime
DTE clients only
Any client that is Guaranteed Issue

A

DTE clients only

42
Q

Plan K and L are the only plans with out of pocket limits?

True or False

A

True….Plan K $5120 and Plan L $2560

43
Q

Plan F is known as the _________ plan?

A

Cadillac

44
Q

What are Part B excess charges?

A

The amount that doctors are allowed to charge above the Medicare contracted allowable amount up to 15%

45
Q

When can you get a Medicare Supplement Plan?

A

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

46
Q

Guaranteed Issue (GI) window

A

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.

47
Q

NO OE = NO__?

A

G

48
Q

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

A

Subject to underwriting

49
Q

Which states have specific open enrollment rules for Medigap?

A

California and Oregon….birthday rules

Missouri….anniversary rule

50
Q

What is an IEP2?

A

When a client already has Medicare and is turning 65…they now have IEP2 and get the same 3-1-3

51
Q

What is an ICEP?

A

Initial coverage election period for Part B. Is a 3 month period normally triggered by GEP.

52
Q

What is GEP?

A

General enrollment period aka late enrollment period.
January 1-March 31st
Coverage starts July 1st
This is for Part B

53
Q

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

A

The election period would be a SEP that last 8 months

54
Q

Explain the Part B penalty

A

The Part B penalty is 10% of the monthly premium for each full 12 months without creditable coverage. It never leaves you.

55
Q

A list of certain drugs and their proper dosages for which a drug plan will cover

A

Formulary

56
Q

What is a dosage?

A

A specific quantity of a medication to be taken by a patient within a specified period or interval

57
Q

Things to know about Part D

A

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

58
Q

What is the Part D late penalty?

A

The Part D penalty is 1% of the national average(which is $35.63) for every month without creditable coverage

59
Q

Explain the benefit periods of coverage in a Part D plan

A

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

60
Q

What are the election periods for Part D?

A

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

61
Q

What is a HMO

A

Health Maintenance Organization

62
Q

What is a PPO

A

Preferred Provider Organization

63
Q

HMO-POS is a hybrid of which two services

A

HMO and PPO

64
Q

Which Special Needs Plans do we have

A

Dual D-SNP and chronic C-SNP

65
Q

What is PFFS

A

Private Fee For Service

66
Q

Which Carriers do we represent for Chronic needs plans?

A

Humana and Cigna

67
Q

Which carriers do we represent for dual eligible special needs plans?

A

Humana, Cigna and United Health Care

68
Q

How to reach Medicare

A

1-800-MEDICARE or 1-800-633-4227

69
Q

What is the Part B premium?

A

$134 for 2017 or $109

70
Q

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
A

The first day of the month

71
Q

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

A

January 1 - March 31, Part B

72
Q

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

A

Must have worked 40 quarters

Been married for 10 years to a spouse that worked the required quarters

73
Q

The value proposition should only come at the start of the call?

True or False

A

False…it should come throughout the call

74
Q

The case specialist team sells our ancillary products?

True or False

A

False

75
Q

All MAPD plans offer additional benefits (i.e.: dental, vision, health club membership)

True or False

A

False…some not all offer the additional benefits

76
Q

If the PFFS plan is a MA(medical only), you can pair it with a PDP?

True or False

A

True

77
Q

Which plan is normally “best” to put a cost-share protected member on?

HMO
CSNP
PPO
DSNP

A

DSNP

78
Q

Medicare Advantage plans are also called Medicare Part C?

True or False

A

True

79
Q

All MAPD plans are network based?

True or False

A

False

80
Q

Medicare Advantage plans replace Original Medicare?

True or False

A

True

81
Q

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)

A

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)

82
Q

List the 8 Medicare Advantage carriers….

A 
Aetna
Humana
Anthem-Blue Cross Blue Shield
Cigna
Coventry
United Health Care
BCBS of KC and Michigan
Blue Shield of California
83
Q

List the 6 PDP Carriers

A 
Humana
Coventry
Silverscript
Aetna
Anthem BCBS
AARP
84
Q

List the Medi-Gap carriers….

A

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)

85
Q

How do you qualify for Medigap?

A

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

86
Q

How many Medigap plans are there?

A

Ten

87
Q

What are the co-pays for Plan N?

A

Doctor visit $20 or less
Emergency room $50 or less
Does not cover excess charges

88
Q

What factors are used to determine monthly premiums for Med Supps?

A 
Gender
Age
Tobacco use
County
Sometimes height and weight
89
Q

What are Part B excess charges?

A

The amount that doctors are allowed to charge above the Medicare contracted allowable amount up to 15%

90
Q

How many states do not allow Part B excess charges?

A

Eight

91
Q

What are the enrollment periods for Medicare Supplement plans?

A

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

92
Q

Medigap Supplement Rating Methods?

A

Attained-age rated
Community-rated
Issue-age rated

93
Q

Medigap plans that pay the Part B deductible

A

Plan C and Plan F

94
Q

Medigap plans that cover excess charges?

A

Plan G and Plan F

95
Q

List the disclosures to discuss MAPD or PDP

A

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

96
Q

List the 8 states where Part B excess charges are not allowed.

A

CT, MA, MN, NY, OH, PA, RI and VT

Medicare (1 decks)

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