ANSWERS AND QUESTIONS ASSURED SUCCESS
John, 68, is currently enrolled in a medicare supplement plan
with a stand-alone prescription drug plan. Newly diagnosed
with a chronic condition, he calls agent charles on may 3 to
ask if there are plans that will help him manage his condition.
Can john enroll in a chronic special needs plan (c-snp) that
covers his chronic condition?
Yes, he can enroll using his special election period (sep-
special need/chronic)
The chronic condition verification form/questionnaire
authorizes the plan to do what?
It authorizes the plan to contact the provider identified on the
form/questionnaire in order to verify that the consumer has at
least one of the qualifying chronic conditions covered by the c-
snp.
Which statement is true about the medicaid program?
It helps pay medical costs for certain groups of people with
limited income and resources.
Which statement is true of d-snp members?
, Members who are full dual-eligible are not required to pay
copayments for medicare-covered services obtained from a d-
snp in-network provider. Their provider should bill the state
medicaid program, as appropriate, for these costs.
How long do plans using the c-snp pre-enrollment verification
process have to verify the qualifying chronic condition until
they must deny the enrollment request?
Which of the following is a correct statement about in-network
provider services?
Hmo plans generally cover only in-network services. In most
cases, members pay the full cost of any out-of-network
services received, with a few important exceptions.
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.
Which of the following best describes eligibility to enroll in a
stand-alone prescription drug plan?