2025 - Anthem HMO, PPO, DSNP, CSNP
Study online at https://quizlet.com/_gz3nwq
1. The beneficiary must continue to pay the Medicare Part B premium in order
to be eligible for the HMO plan.: True
2. Which of the following statements regarding eligibility criteria for Medicare
Advantage HMO plans is true?: All of the above statements are true.
3. If the member obtains preventive care and screening tests from out-of-net-
work providers, neither Medicare nor the HMO plan will be responsible for the
costs. The member will be responsible for the costs in this case.: True
4. Some plans may have narrow or select networks. With these plans, if the
enrollee chooses a PCP that is part of an IPA or medical group, the specialists,
ancillary providers, and hospitals available to them may be limited to only those
contracted with the PCP's IPA or medical group.: True
5. Coinsurance is defined as:: A percentage
6. Prescription drug costs under Part D apply toward the medical out-of-pocket
maximum.: False
7. For a beneficiary who enrolled in a MA-only plan during the Annual Election
Period, they will not be able to enroll in a plan that offers prescription drug
coverage until the following Annual Election Period; unless the beneficiary
chooses to use their one-time election during the Open Enrollment Period or
qualifies for a Special Election Period.: True
8. Once a member reaches their annual maximum out of pocket, they are still
subject to pay their medical care copayments for the remainder of the calendar
year.: False
9. Which statement about rules on rates is NOT true?: Rates vary, depending on gender or
age
10. The Medicare Advantage (MA) Program, sometimes called "Part C", com-
bines coverage for Parts A & B benefits and is administered by private health
plans.: True
11. A PPO is a plan in which enrollees pay less if they use doctors, hospitals, and
providers that belong to the network. Services obtained from doctors, hospitals
and providers outside the network will result in additional costs to the member
- unless the services are classified as an emergency.: True
1/4
Study online at https://quizlet.com/_gz3nwq
1. The beneficiary must continue to pay the Medicare Part B premium in order
to be eligible for the HMO plan.: True
2. Which of the following statements regarding eligibility criteria for Medicare
Advantage HMO plans is true?: All of the above statements are true.
3. If the member obtains preventive care and screening tests from out-of-net-
work providers, neither Medicare nor the HMO plan will be responsible for the
costs. The member will be responsible for the costs in this case.: True
4. Some plans may have narrow or select networks. With these plans, if the
enrollee chooses a PCP that is part of an IPA or medical group, the specialists,
ancillary providers, and hospitals available to them may be limited to only those
contracted with the PCP's IPA or medical group.: True
5. Coinsurance is defined as:: A percentage
6. Prescription drug costs under Part D apply toward the medical out-of-pocket
maximum.: False
7. For a beneficiary who enrolled in a MA-only plan during the Annual Election
Period, they will not be able to enroll in a plan that offers prescription drug
coverage until the following Annual Election Period; unless the beneficiary
chooses to use their one-time election during the Open Enrollment Period or
qualifies for a Special Election Period.: True
8. Once a member reaches their annual maximum out of pocket, they are still
subject to pay their medical care copayments for the remainder of the calendar
year.: False
9. Which statement about rules on rates is NOT true?: Rates vary, depending on gender or
age
10. The Medicare Advantage (MA) Program, sometimes called "Part C", com-
bines coverage for Parts A & B benefits and is administered by private health
plans.: True
11. A PPO is a plan in which enrollees pay less if they use doctors, hospitals, and
providers that belong to the network. Services obtained from doctors, hospitals
and providers outside the network will result in additional costs to the member
- unless the services are classified as an emergency.: True
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