UHC 2024 AHIP - MEDICARE BASICS ASSESSMENT
(MEDICARE ADVANTAGE [NON-SNP], PRESCRIPTION
DRUG AND MEDICARE SUPPLEMENT PLANS)
Lisa turned 65 and is now eligible for Medicare. She already receives Social Security
benefits. How does she enroll in Original Medicare? - Answers -Her enrollment in
Medicare Parts A and B is generally automatic if she meets all eligibility requirements.
Which statement is true about a member of a Medicare Advantage (MA) Plan who
wants to enroll in a Medicare Supplement Insurance Plan? - Answers -When a
consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically
disenrolled from their MA Plan.
Being 65 or older, being under 65 years of age with a qualifying disability or being any
age with ESRD or ALS are each eligibility requirements for which program? - Answers -
Original Medicare
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - Answers
--An MA Plan is part of Medicare and is also called Part C.
-An MA Plan is a health plan option approved by Medicare and offered by private
insurance companies.
-An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and
Part B) and often includes Medicare prescription drug coverage (Part D).
To be eligible for this plan type, consumers must meet the following requirements: be
entitled to Medicare Part A and enrolled in Part B, and reside in the plan's service area.
Which plan is being described? - Answers -Medicare Advantage
Which of the following best defines Medicare Part D? - Answers -It is a government
program, offered only through a private insurance company or other private company
approved by Medicare, which provides prescription drug coverage.
A consumer with only Part A residing in the plan's service area can enroll in which plan
type to get Part D coverage? - Answers -A stand-alone Part D Plan.
Which of the following statements is NOT true about the Coverage Gap? - Answers -All
members reach the Coverage Gap.
Which of the following best describes the Late Enrollment Penalty (LEP)? - Answers -
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.
, How does a consumer who qualifies for Low Income Subsidy receive financial
assistance for their part of Medicare Part D costs? - Answers -Through subsidies such
as lower or no monthly plan premiums and lower or no copayments.
Formulary is defined as: - Answers -A list of medications covered within the benefit plan,
based on CMS guidelines and developed in collaboration with physicians and
pharmacists.
When is a Medicare Supplement Insurance consumer subject to underwriting and
screened for eligibility? - Answers -When the consumer is not in their Medicare
Supplement Open Enrollment or does not meet Guaranteed Issue criteria.
Which of the following is true about Medicare Supplement Insurance Plans? - Answers -
Plan benefit amounts automatically update when Medicare changes cost sharing
amounts, such as deductibles, coinsurance and copayments.
Which statement is true about members of a Medicare Advantage (MA) Plan who want
to enroll in a Medicare Supplement Insurance Plan? - Answers -The consumer must be
in a valid MA election or disenrollment period.
Which of the following statements is correct about HMO MA Plans? - Answers -
Members must receive covered services from contracted network providers with limited
exceptions.
A consumer currently has Original Medicare and is enrolled in a stand-alone
Prescription Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan
that has integrated prescription drug coverage? - Answers -The consumer will be
automatically disenrolled from their stand-alone PDP upon enrollment in the MA Plan
that has integrated prescription drug coverage
Which of the following is a fact about Medicare Prescription Drug Plans? - Answers -To
enroll, the consumer must reside in the plan's service area.
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-
eligible consumer get Part D prescription drug coverage? - Answers -They could enroll
in a Medicare Advantage Plan or other Medicare health plan that includes prescription
drug coverage.
Which of the following is a correct statement about in-network provider services? -
Answers -HMO Plans 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.
Which of the following is NOT a correct statement about in-network provider services? -
Answers -HMO-POS Plans only cover in-network services.
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