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Night CAP
100

The Donut Hole is a common name for this stage of Medicare D

What is the Coverage Gap

100

A supplemental plan pays for which Medicare Part expenses (A-J)

What is part A and B

100

The stage after the coverage gap

What is catastrophic coverage 

100

When reaching catastrophic coverage, X% of prescription copays will change

What is 100%

100

What is the Medicare Part B out of pocket maximum

What is there is no out of pocket maximum

200

The stage before the "donut hole" 

What is Initial Coverage

200

The name of the entity which is the only unbiased service who helps patients select Medicare Plans 

What is the SHIP Office

200

This is the day that Medicare plan stages reset 

What is 12/31

200

The % OOP for an infusion drug for a patient who has traditional Medicare 

20%

200

In 2024, this is the maximum copay $ charged if you have LIS 

What is $11.20

300

The name of CMS assistance and/or plan type that helps to pay the patient OOP through the donut hole (either provided by the government or an additional plan purchased by the patient). 

What is LIS 

300

Name one thing that is covered in each Part: A, B, C, D, E, F, G


Part

A- Inpatient care in hospitals, critical access hospitals, and skilled nursing facilities 

B- Office visits, Infusion (Part B) drugs, Lab tests, Ambulances

C- A + B + D, sometimes includes dental care, vision, OTC 

D- Prescription Drugs

E- MediGap (no longer available for new enrollees) 

F- Supplemental

G- Supplemental - PartB deductible 

300

This is the copay amount for patients in 2024 who reach catastrophic coverage. 

What is $0

300

Name the website to assist a patient with seeing if he/she qualifies for LIS. 

What is SSA.Gov

300

Name the Medicare parts that have a patient OOP max

C and D

400

This is the amount in 2024 that is estimated a patient would pay to get to catastrophic coverage

What is $3,300 

400

If a patient has an advantage plan, they cannot have a ____. 

What is a supplemental 

400

The act that reformed catastrophic coverage from a %5 co-insurance to $0 this year 

What is the Inflation Act

400

Certain groups are the exception to traditional OOP % and copays- name one 

What is an EGWP (Employer Group Waiver Plan): Railroad workers, Indigenous/protected populations, disability, unions, teachers with pensions, employers who offer health plans with pensions


https://www.urban.org/sites/default/files/2024-01/Medicare%20Advantage%20Employer%20Group%20Waiver%20Plans.pdf

400

In 2025, this amount will be the annual limit for prescription drug costs covered under part C or D

What is $2000

500

In the donut hole for 2024, who pays and at what percent?  Which payee's contribute towards the amount to catastrophic coverage?

What are

-Patients 25% (Contributes)

-Drug Manufacturers- 70% (Contributes)

-Medicare- 5% (Does not contribute)

500

The Part B deductible is dependent on the patient's income. What is the Part D deductible based on? 

What is The Plan He/She chooses. 

500

This is how you tell what stage a patient is in when you have a paid claim

What is in the Claim Response- Benefit Stage Count 

500

In 2020, it is estimated that X number of Medicare enrollees did not receive LIS but were potentially eligible 

500

What is the only Medicare part that sets a max OOP based on the plan and not based on CMS

What is Part C (Advantage plan) 

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