Coverage stages
Terminology
Medicare
Medicare part D
Health insurance
100

What is called by the maximum amount a member can pay during the plan year?

Maximum out of pocket

100

(Two answers)
After a member meets their deductible, they will have to start paying:

Copays and coinsurances

100

Who is eligible for medicare?

-People 65 or older

-Younger people with certain disabilities

-People with ESRD

100

Level 1 agents DO NOT handle prescription orders.

They should transfer to:

The member's pharmacy.

100

What are the 3 main components of the healthcare system?

Providers, patiens and insurance

200

On Part D plans: If a plan does not include a deductible in which stage of coverage does the member starts at the beginning of the year?

Initial coverage stage

200

It is a federal program offered to eligible people

Medicare and/or medicaid
(Both answers are ok!)

200

What does medicare part a covers?

Inpatient care // Hospital insurance
(any of the answers is ok!)

200

Level 1 agents DO NOT handle prescription issues calls.

This calls must be transferred to:

Level 2

200

What happens at the beginning of each plan year?

Everything resets on January 1st, which means the coverage stages restarts.

300

Is the stage where a member has to pay a certain amount of money for their medical expenses before the insurance starts to share the costs.

First coverage stage or deductible.

300
What means if we say that a person is dual-eligible?

They are eligible for both medicare and medicaid

300

What is another name we can call Medicare part c by?

Medicare advantage.

300

The copay/coinsurance a patient pays will depend on the:

Tier or level of the drug.

**Remember higher tiers will have a more expensive copay!

300

Give us an example of what a provider is...

Trainer will determine if it is correct.
400

Is the amount a member has to reach out of their pocket before their healthcare insurance starts to cover the full amount of their medical expenses

Maximum out of pocket

400

What is the main function of a Primary Care Physician?

They Manage the patients health.

400

What does medicare part b cover?

Outpatient services

400

What is the name of the last coverage stage?

Catastrophic stage

400

What are the 3 types of plans we reviewed today?

HMO, PPO AND POS

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