Aetna MA/MAPD/DSNP Mastery Test 100% correct

Aetna offers a variety of Aetna Medicare Advantage plan types. Which plan type requires a person to use only network providers? A) PDP plan B) HMO plan C) PPO plan D) ESRD plan - ANSWER B) HMO 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 - ANSWER C) PPO Most Aetna Medicare Advantage plans are integrated with prescription drug coverage, so they are called MAPD plans. True or False - ANSWER True Aetna case management consists of registered nurses, social workers, behavioral health professionals and pharmacists who help members navigate the health care system and access services. True or False - ANSWER True Aetna Medicare Advantage HMO and PPO plans have no out-of-pocket maximum. True or False - ANSWER False Aetna Medicare Advantage HMO and PPO plans cover routine preventative care including an annual wellness visit, screening mammograms, and prostate cancer screenings. True or False - ANSWER True A member's cost share at a preferred pharmacy will usually be lower than cost share at a standard pharmacy. True or False - ANSWER True All MAPD plans have a prescription drug component. True or False - ANSWER True Which of the following are true? A) The PPO plans provide access to services from doctors in the PPO network at a lower out-of-pocket cost. B) In the 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 - ANSWER D) All of the above You can find a quick list of tools for Aetna Medicare plans on True or False - ANSWER True What is a Dual eligible Special Needs Plan (D-SNP)? A) A type of MAPD plan designed to provide targeted care and services to individuals with specific needs. B) A MA plan that tailors benefits, provider choices and drug formularies to meet specific needs of the groups they serve. C) A 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 - ANSWER E) All of the above Low Income Subsidy (LIS) is a Medicare financial assistance program that helps to reduce prescription drug costs. True or False - ANSWER 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, deductibles and copayments/coinsurance with medical services. True or False - ANSWER True Which of the following is true for LIS? A) Beneficiaries pay no more than $3.60 for a covered generic and $8.95 for each brand name drug. B) There is no coverage gap C) There is no Late Enrollment Penalty D) All of the above - ANSWER D) All of the above A full dual eligible means an individual has Medicare, but is only eligible for assistance with Medicare premiums and sometimes cost share through the Medicare Saving Program. True or False - ANSWER False LIS Medicare drug plan premium and deductible costs are based on income level. True or False - ANSWER True Full benefit duals meet state Medicaid eligibility requirements and are entitled to receive the Medicaid services they need. True or False - ANSWER True One of Aetna's Model of Care goals is to improve use of preventive health services. True or False - ANSWER True 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 - ANSWER E) All of the above The Aetna DSNP care manager and care team provide a single point-of-contact to help coordinate all Medicare and Medicaid covered care and services that the member needs. True or False - ANSWER True