UHC 2022(Questions and Answers)

Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate? A. All Out-of-Pocket costs she pays toward her health care and prescription drug expenses would count toward the Out-of-Pocket Maximum. B. Jennifer's costs for prescription drugs and any benefits not covered by Original Medicare will count toward the Out-of-Pocket Maximum. C. The Out-of-Pocket Maximum includes any costs she pays toward the plan, such as plan premiums and health care expenses. D. The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B services. a Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? a. When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA plan. b. The consumer will be automatically disenrolled from the MA plan when the Medicare Supplement plan takes effect. c. The member who is leaving the MA Plan does not need a valid election period to disenroll from the MA Plan. d. An MA Plan and a Medicare Supplement Insurance Plan work together. a 01:03 01:23 Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? a. Medicaid b. Low Income Subsidy c. Original Medicare c Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) a. An MA Plan is part of Medicare and is also called Part C. b. An MA Plan does not have to provide benefits equivalent to Original Medicare. c. An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often includes Medicare prescription drug coverage (Part D). d. An MA Plan is a health Plan option approved by Medicare and offered by private insurance companies. a, c, d Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? a. Does not have any pre-existing conditions such as diabetes or End Stage Renal Disease (ESRD) b. IS enrolled in Medicare part B c. Is entitled to Medicare Part A d. Resides in the plan's service area a When is Mary's Medicare Supplement Open Enrollment period if she turns 65 on September 23, 2021, and her Medicare Part B effective date is September 1, 2021? a. The month of September 2021 b. October 15, 2021, through December 7, 2021 c. June 2021 through December 2021 d. September 2021 through February 2022 d Which of the following statements is correct about HMO MA Plans? a Most benefits are covered out-of-network but at a higher cost. b There are no exceptions to the provider neuork requirement for obtaining certain services from out-of-network providers. c Members that use out-of-network providers for routine office visits must pay a penalty in addition to any copayment. d Members must receive covered services from contracted network providers. d Which of the following is a fact about Medicare Prescription Drug Plans? a Medicare Part D is part of Medicare Supplement Insurance Plans b To enroll, the consumer must reside in the plan's service area c All drugs are covered d Benefits never vary by plan b Which of the following statements is NOT true about the Coverage Gap? a Some plans offer additional coverage through the coverage gap, usually at a higher monthly plan premium The use of lower cost generic medications may prevent the member from reaching the coverage gap b For 2022, the coverage gap begins when the member has incurred $4,430 in medication spending for the year c If a member reaches the coverage gap, they will have access to the Plan's negotiated pharmacy discount rate for Medicare Part D medications d All members reach the Coverage Gap d Which of these statements is NOT true about the drug utilization management (UM) rules? a If a member or the prescriber believes that one of the coverage rules should be waived, they can ask the plan for an exception. b Prior authorization, quantity limit, and step therapy are some examples of UM rules. c If a medication has a UM rule, the member will not be able to get that medication. d If a medication has a UM rule, it must be disclosed to the consumer. c What is 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? a Late Enrollment Deductible (LED) b Late Election Penalty (LEP) c Late Enrollment Premium (LEP) d Late Enrollment Penalty (LEP) d Which of the following best defines Medicare Part D? a It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. b It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical and hospitalization coverage. c It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical coverage. d It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides hospitalization coverage. a How does a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? a Through a combination of subsidies and annual refund checks b Such financial assistance will no longer be available as of January 1, 2022 c Through subsidies such as lower or no monthly plan premiums and lower or no copayments d By receiving annual checks with a refund based on a predetermined percentage of Part D costs c Which of the following is true about Medicare Supplement Insurance Plans? a They can only be purchased during the Annual Election Period (AEP). b Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. c To see a specialist, insured members must obtain referrals from a primary care provider. d They are regulated by the Centers for Medicare & Medicaid Services (CMS). b 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? a Parts B and D b Parts A and D c Parts A and B d Parts C and D c Which of the following consumers are eligible for Medicare if other eligibility requirements are met? a Only consumers age 65 or older with certain disabilities and consumers of all ages with ESRD or ALS b Consumers age 65 or older and consumers under 65 years of age with certain disabilities except for ESRD or ALS c Consumers age 65 or older, consumers under 65 years of age with certain disabilities for more than 24 months and consumers of all ages with ESRD or ALS d Consumers age 62 or older, consumers under 62 years of age with certain disabilities and consumers of all ages with ESRD or ALS c Which type of MA Plan is an HMO plan that also covers some benefits out-of-network, generally at a higher cost? a Private Fee-for-Service (PFFS) b Point-of-Service (POS) Plan c Medicare Supplement Insurance Plan d Preferred Provider Organization (PPO) b When does Medicare Supplement Open Enrollment take place? a During the first three months a consumer is 65 or older and enrolled in Medicare Part B. b During the three months prior to the consumer's 65th birthday, the month of their birthday, and the three months following the month of their 65th birthday and enrolled in Medicare Part B. c Annually from October 15 to December 7. d During the first six months a consumer is 65 or older and enrolled in Medicare Part B. d Roger wants to know what counts toward the Out-of-Pocket Maximum on the Medicare Advantage Plan he is considering. Which statement is accurate? a The Out-of-Pocket Maximum includes any costs paid toward the plan, such as plan premiums and health care expenses. b All Out-of-Pocket costs paid toward health care and prescription drug expenses would count toward the Out-of- Pocket Maximum. c The Out-of-Pocket Maximum includes any amount the member pays toward their prescription drug expenses as well as any benefits not covered by Original Medicare. d The Out-of-Pocket Maximum includes costs the member pays for any Medicare-covered Part A or B services. d When is a Medicare Supplement Insurance consumer subject to underwriting and screened for eligibility? a Only when the consumer is in their Medicare Supplement Open Enrollment. b When the consumer is not in their Medicare Supplement Open Enrollment or does not meet Guaranteed Issue criteria. c Only when the consumer meets Guaranteed Issue criteria applicable in their state. d Always to determine their acceptance. b Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F? a Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to purchase Medicare Supplement Insurance Plans C or F. b Consumers already enrolled in Plans C or F are required to change plans. c Consumers eligible for Medicare Part A before January 1, 2020, can enroll in Plan C or F even after 2020 and can keep their plans as long as they choose. b Which of the following lists drug tiers from least expensive cost share to most expensive cost share? a Preferred Generics, Preferred Brand (and some higher-cost generics), Generics, Non-Preferred Drug (and some higher-cost generics), Specialty b Specialty, Non-Preferred Drug (and some higher-cost generics), Preferred Brand (and some higher-cost generics), Generics, Preferred Generics c Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty d Generics, Preferred Generics, Non-Preferred Drug (and some higher-cost generics), Brand (and some higher cost generics), Specialty a Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan? a When a member enrolls in the MA Plan their current Medicare Supplement Insurance Plan will automatically cancel. b Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member must cancel their Medicare Supplement Insurance policy according to their carrier's rules. c The member should not cancel their Medicare Supplement Insurance Plan because Medicare Supplement Insurance can be used in conjunction with an MA Plan. d The member must submit a written request to cancel their Medicare Supplement Insurance Plan the same day they submit their MA Plan enrollment application. b A government program, offered only through a private insurance company or other private company approved by Medicare, that provides prescription drug coverage describes which of the following: a Medicare Part D b Medicare Parts A and B c Medicare Part A d Medicare Part B a Which of the following is a fact about Medicare Prescription Drug Plans? a To enroll, the consumer must reside in the plan's service area b All drugs are covered c Benefits never vary by plan d Medicare Part D is part of Medicare Supplement Insurance Plans a What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2) a Enroll in a Medicare Supplement Insurance Plan b Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage c Enroll in a stand-alone Medicare Prescription Drug Plan (PDP) d Sign up for a Pharmacy savings card through their local pharmacy b c In what order do the four prescription drug coverage stages occur? a Deductible, Initial Coverage, Catastrophic Coverage, Coverage Gap b Initial Coverage, Deductible, Coverage Gap, Catastrophic Coverage c Coverage Gap, Deductible, Initial Coverage, Catastrophic Coverage (0) d Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage d 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. Medications that are covered in a Plan's formulary have various levels of associated member cost-sharing (copayments or coinsurance). What are these drug levels called? a Formulary prescriptions b Drug tiers c Out-of-Pocket expenses d Deductible b