Original Medicare
What coverage does Original Medicare include
Part A (hospital) and Part B (Medical)
What is another name for a Part C plan?
Medicare Advantage
What does a Supplemental plan do?
Covers the out-of-pocket costs not covered by original medicare (the 20% the member is responsible for paying typically)
This carrier covers the cost of lenses for their members
United Healthcare
What is a Hospital Indemnity plan
A supplemental insurance plan that pays a fixed amount to member when they are hospitalized
What are all Medicare beneficiaries required to have in addition to Original Medicare?
Drug coverage
If a member has a Part C plan and Original Medicare, which coverage is considered the primary coverage?
Part C
What are 2 other names for a Medicare Supplement plan?
Medigap
Plan F
Plan G
Plan N
This carrier allows you to use the OTC card for Dental Vision and Hearing
Wellcare
What is the age range for a Guarantee Issue HI policy?
60-74
What does Part D cover?
Prescription drugs
List 3 additional benefits a Medicare Advantage plan would offer that Original Medicare doesnt
Dental
Vision
Hearing
Drug coverage
OTC
Gym memberships
Food card
Utility card
Part B giveback
What are 2 pros and 2 cons to only having Original Medicare with a PDP plan?
Pros:
Nationwide coverage
No referrals/networks (can see any doctor that accepts OG Medicare)
Cons:
20% coinsurance for medicale services
Uncapped expenses
No coverage for DVH
This carrier offers Caregiver Support
HeathSpring
Betty's MAPD charged her $375 per day in the hospital for the first 4 days. She has an HI policy that will pay her $400 for 3 days in the hospital. If she spends 4 days in the hospital, how much money will she have to pay out of pocket for her bill after receiving her check from her policy
$300
Hospital bill: $1500
HI policy pays out: $1200
leftover cost: $300
How much does Part B cost per month?
$202.90 per month
What are the 3 eligibility requirements for Part C?
Must have Part A and B
Must live in the service area
Must continue to pay Part B premium and Part C premium (where applicable)
Name 3 types of coverage that would disqualify someone from enrolling into a Medicare Advantage plan
Pace plan
Retirement coverage
Tricare
ChampVA
What is something unique about Zing?
Created by Chicago doctor
Insulin savings program ($0 on certain insulins)
Should you pitch an HI to someone with Medicaid? Why or why not?
No, since member copays are $0 for their coverage they would have no need for a HI plan.
Who under 65 would qualify for Original Medicare
Anyone with certain disabilities for 2 years
Anyone with ESRD or ALS
Which members would be required to pay for Part A?
Any member who did not work 40 quarters (10 years)
What are 3 differences between a Supplemental plan and a Medicare Advantage plan?
Medigap:
high premium, no copays
Freedom to choose docs
No routine services
No drug cov
Covered anywhere in US
MAPD
Low/no premium, copays
Restricted network
May need referrals
Extra benefits included
Which carrier(s) allow you to use the over the counter card for Gas at the pump(on Special Needs Plans)?
Wellcare
Aetna
List 3 optional benefits/riders you can add to your HI policy apart from Inpatient hospital stay
Cancer
Outpatient Drugs
Er/urgent care
Skilled Nursing Facility
Outpatien surgery
Outpatient Major Diagnostic
Ambulance
Wellness