UHC 2024 AHIP - Medicare Basics Assessment
(Medicare Advantage [non-SNP], Prescription Drug and
Medicare Supplement Plans)
Medicare - ANSWERFederal health insurance program
Medicare is administered by whom? - ANSWERCMS ( Centers for medicare and
medicaid services)
Parts A & B of medicare are - ANSWERfederal health insurance program referred to
as original medicare
Part A? - ANSWERHospital insurance
Part B? - ANSWERMedical insurance
What doesnt medicare cover? - ANSWERroutine dental, eye care hearing
exam,deductibles, coinsurance and copayments
Part C? - ANSWERMedicare Advantage Plans
MA covers? - ANSWERPart A &B coverage, and some part D coverage
MA plans are not? - ANSWERMedicare supplement insurance plans
What offers lower monthly premiums MADP or supplement? - ANSWERMADP
do MAP's have a annual maximum OOP maximum that limits the amount of money a
member must spend every year for covered services? - ANSWERYES
MA plans integrate what type of additonal coverage? - ANSWERpart D prescription
drug coverage
If a customer wants to keep their stand alone prescription drug plan, what may the
customer want to enroll in? - ANSWERMA-only PFFS plan
What is a stand alone drug plan called? - ANSWERPDP
WHat is PFFS? - ANSWERPrivate Fee for Service (PFFS) - Plans that allow you to go to
any doctor or hospital that accepts their terms
If a customer lives in a rural area, what type of plan may they want because it gives
them freedom to access doctors that may not be in their network? - ANSWERPFFS
plan
Do HMO's require referals? - ANSWERYes
, Do PPO's require a referal? - ANSWERNo
When a member enrolls in a MA plan, they receive their coverage from medicare or
the MA plan? - ANSWERMA plan
When a customer is enrolled in a MA plan, they must continue paying their
premiums for what other plan? - ANSWERPart B
MA plans have a maxium annual limit on OOP costs called a? - ANSWERMOOP
amount ( Maxium out of pocket)
When a member is enrolled in a MA plan, they are automatically disenrolled from
any other MA plan or PDP( prescription drug plan) in which they are enrolled as of
the new plans_____? - ANSWEReffective date
An exception exisits for MA-only PFFS plans as a member can also be enrolled in a
what? - ANSWERStand alone PDP
If a member enrolls in a MA plan, what must the member do? - ANSWERCancel in
writing their medicare supplement insurance policy with the carrier after their
request to enroll in MA plan has been approved.
Medicare supplement insurance policies cannot be used in conjunction with what
type of plan? - ANSWERMA plan
A medicare supplement insurance plan helps to cover some of the OOP costs
associated with? - ANSWERoriginal medicare.
A medicare supplement insurance plan does NOT pay the cost-sharing of what type
of plan? - ANSWERMA plan
when a client enrolls in a MA plan, will it automatically terminate their MA plan? -
ANSWERNO
Can a customer call to terminate their Med Sup plan? - ANSWERno it must be done
in writing
What are the different types of MA plans? - ANSWERHMO, POS, PPO, RPPO, PFFS,
SNP, and MSA
For an HMO, they customer must us IN network providers, what are the exceptions
to their rule? - ANSWEREmergencies, Urgent care, and renal dialysis services.
In a HMO plan, does a member have to choose a PCP? and do they require referrals
to see a specialist? - ANSWERYes
(Medicare Advantage [non-SNP], Prescription Drug and
Medicare Supplement Plans)
Medicare - ANSWERFederal health insurance program
Medicare is administered by whom? - ANSWERCMS ( Centers for medicare and
medicaid services)
Parts A & B of medicare are - ANSWERfederal health insurance program referred to
as original medicare
Part A? - ANSWERHospital insurance
Part B? - ANSWERMedical insurance
What doesnt medicare cover? - ANSWERroutine dental, eye care hearing
exam,deductibles, coinsurance and copayments
Part C? - ANSWERMedicare Advantage Plans
MA covers? - ANSWERPart A &B coverage, and some part D coverage
MA plans are not? - ANSWERMedicare supplement insurance plans
What offers lower monthly premiums MADP or supplement? - ANSWERMADP
do MAP's have a annual maximum OOP maximum that limits the amount of money a
member must spend every year for covered services? - ANSWERYES
MA plans integrate what type of additonal coverage? - ANSWERpart D prescription
drug coverage
If a customer wants to keep their stand alone prescription drug plan, what may the
customer want to enroll in? - ANSWERMA-only PFFS plan
What is a stand alone drug plan called? - ANSWERPDP
WHat is PFFS? - ANSWERPrivate Fee for Service (PFFS) - Plans that allow you to go to
any doctor or hospital that accepts their terms
If a customer lives in a rural area, what type of plan may they want because it gives
them freedom to access doctors that may not be in their network? - ANSWERPFFS
plan
Do HMO's require referals? - ANSWERYes
, Do PPO's require a referal? - ANSWERNo
When a member enrolls in a MA plan, they receive their coverage from medicare or
the MA plan? - ANSWERMA plan
When a customer is enrolled in a MA plan, they must continue paying their
premiums for what other plan? - ANSWERPart B
MA plans have a maxium annual limit on OOP costs called a? - ANSWERMOOP
amount ( Maxium out of pocket)
When a member is enrolled in a MA plan, they are automatically disenrolled from
any other MA plan or PDP( prescription drug plan) in which they are enrolled as of
the new plans_____? - ANSWEReffective date
An exception exisits for MA-only PFFS plans as a member can also be enrolled in a
what? - ANSWERStand alone PDP
If a member enrolls in a MA plan, what must the member do? - ANSWERCancel in
writing their medicare supplement insurance policy with the carrier after their
request to enroll in MA plan has been approved.
Medicare supplement insurance policies cannot be used in conjunction with what
type of plan? - ANSWERMA plan
A medicare supplement insurance plan helps to cover some of the OOP costs
associated with? - ANSWERoriginal medicare.
A medicare supplement insurance plan does NOT pay the cost-sharing of what type
of plan? - ANSWERMA plan
when a client enrolls in a MA plan, will it automatically terminate their MA plan? -
ANSWERNO
Can a customer call to terminate their Med Sup plan? - ANSWERno it must be done
in writing
What are the different types of MA plans? - ANSWERHMO, POS, PPO, RPPO, PFFS,
SNP, and MSA
For an HMO, they customer must us IN network providers, what are the exceptions
to their rule? - ANSWEREmergencies, Urgent care, and renal dialysis services.
In a HMO plan, does a member have to choose a PCP? and do they require referrals
to see a specialist? - ANSWERYes
