Original Medicare
What part of Medicare covers inpatient hospital care, skilled nursing facility care, and hospice?
Bonus: What does a client pay for Day 1-60 of a hospital stay?
Part A
Bonus: $1632
What parts of Medicare does a client have to be eligible for to purchase a supplement?
Bonus: A Medicare supplement may also be called this?
Part A AND Part B
Bonus: Medigab
Medicare Advantage is also known as?
Bonus: Advertised as "free" but the client still pays what?
Part C or MA Plans
Bonus: Part B monthly premium
When is Medicare Annual Enrollment Period (AEP)?
Bonus: If a client enrolls in a new plan during AEP, when is their effective date?
October 15th-December 7th
Bonus: January 1st
Part D covers what?
Part D may also be called this.
Prescription Drugs
Bonus: PDP
What part of Medicare covers services from doctors, outpatient care, durable medical equipment, and preventative care.
Bonus: What is the cap for the client's 20% coinsurance?
Part B
Bonus: There is NO cap!
What does a supplement cover?
Bonus: What does a supplement NOT cover?
Part A and B coinsurance (amount depends on the plan type)
Bonus: Long term care, dental, hearing, vision, and prescriptions.
The set amount the client must pay for covered services before the health plan begins paying for those services is called?
Bonus: The percentage of the cost of services the client must pay is called?
Deductible
Bonus: Coinsurance
Seven month period, including the three months before, the month of, and the three months following the client's 65th birthday.
Bonus: If a client's birthday is 7/10/1959 and you enroll them May 1st, what is their effective date?
Initial Enrollment Period (IEP)
Bonus: 7/1/2024
What are the 6 drug tiers?
Bonus: If a plan has an annual deductible, which Tiers will it apply to?
Preferred Generic, Generic, Preferred Brand, Brand, Specialty, Select Care
Bonus: Tier 3, 4, and 5
Who gets Part A and B automatically?
Bonus: When does it begin if your birthday is on the first of the month?
1. Receiving SSI or RR retirement
2. On disability for 2 years
3. ALS
Bonus: 1st of the month prior to birth month
What supplement plans are no longer available?
Bonus: When did these plans become unavailable?
Plan C and Plan F
Bonus: after 1/1/2020
Most MA plans include these benefits.
Bonus: What is the benefit of having a maximum out of pocket (MOOP)?
Drug coverage, dental, vision, hearing, and flexible extras.
Bonus: Once a client has paid the MOOP, the health plan pays 100% of covered services for the remainder of the year.
One time election from January 1st to March 31st
Bonus: Who can make a change during this time, and what change can they make?
MA Open Enrollment Period (OEP)
Bonus: Clients enrolled in MA plans can change MA plans or return to Original Medicare and join a PDP.
Actual drug cost will vary depending on?
Bonus: What is a formulary?
Formulary, Tier, benefit phase, pharmacy, LIS status
Bonus: A list of prescription drugs covered by the plan
Who pays a $0 premium for Part A?
Bonus: What is the cost for Part A if a client or their spouse have not worked 40 quarters?
Client or their spouse who worked 40 quarters.
Bonus: $278 or $505 monthly.
What plan is the most popular?
Bonus: What does this plan NOT cover?
Plan G
Bonus: Part B annual deductible
Types of MA Plans?
Bonus: Why would you NOT recommend a HMO plan, assuming it had the best benefits and the client's doctors are in network?
HMO, HMO-POS, PPO, PFFS, MSA
Bonus: If the client travels regularly.
Able to make a change once per quarter during the first nine months of the year
Bonus: If you change a client's dual plan on 4/10/2024, what will the effective date be?
Dual Eligible/LIS Eligible
Bonus: 5/1/2024
What are the first two drug plan stages?
Bonus: What is the maximum Part D deductible?
Deductible and Initial Coverage
Bonus: $545
What is the typical cost for Part B?
Bonus: How can a client pay for Part B?
$174.70 monthly
Bonus: SS deduction, quarterly bill, bank draft, online through their Medicare account.
What plan is the second most popular?
Bonus: What does this plan NOT cover?
Plan N
Bonus: Part B annual deductible and Part B excess charge
What are the types of Special Needs Plans (SNP)?
Bonus: What conditions would make someone eligible for CSNP?
CSNP, DSNP, and ISNP
Bonus: Diabetes, ESRD, HIV/AIDS, chronic heart failure, dementia, and cancer
Outside of OEP, IEP, and AEP, what opportunities should you look for to enroll a client who is not eligible for Medicaid or LIS?
Bonus: When can a Five Star Plan SEP be used?
5 star plan, moved, disaster
Bonus: Once from December 8th to November 30th
What are the last two drug plan stages?
Bonus: What is the total amount a client spends inside the donut hole?
Coverage Gap (Donut Hole) and Catastrophic
Bonus: $8000