Random
WHO CAN APPLY FOR PACE/PACE NET?
ANYONE 65 & OVER
Medicare pays for a "one time only"__________ within the first twelve months a person has Part B.
What is a Welcome to Medicare Exam
When does Open Enrollment Begin
OCT 15-DEC 7TH
Can a person purchase Marketplace insurance if on Medicare
no
what is the amount for Medicare Part A
What is $1696
What does the ACA stand for?
What is Affordable Care Act
Name two of the most common SEP periods for the ACA
What is No: Declined medicaid
Loss of coverage
Moved out of the plan service area
Name one hardship that someone over the age of 30 can get a catastrophic plan
What is : Natural disaster
Bankruptcy
Domestic Violence
Utility shut off notice
Forecloser
!!!!DOUBLE JEOPARDY!!!!!!
ON A MARKET PLACE ELIGIBILITY AND IT INDICATES THE MEMBER IS ELIGIBLE FOR ADDITIONAL COST SHARE. WHAT PLANS SHOULD YOU LOOK AT FIRST?
(METAL LEVEL)
What is Silver
What is the enrollment code used for someone turning 65 and wants to enroll in a Medicare Advantage Plan (Part C)?
What is ICEP
Name 4 essential health benefits
What is
When reviewing a Drug Formulary what do you have to tell the clients
What is: Tier level
any restrictions such as QL or ST
Coverage gap
Co-pays
preferred or standard pharmacy or mail order
What are out of pocket maximum limits for the 2020 ACA plans
What is: The 2020 ACA maximum is $8,150 for individual and $16,300 family (versus $7,900 individual and $15,800 family in 2019
What happens to the kids on a marketplace application the majority of the time? Such as are the found eligible or not and if not what happens
What is : the majority of the time the kids are found ineligible and their information is sent to the state medicaid system. Once the kids are found ineligible for medicaid they can be added to the marketplace plan
name one type of Prescription Drug Part B will cover?
( will take type as a answer as well)
What is : Shots (vaccinations): Medicare covers flu shots, pneumococcal shots, Hepatitis B shots, and some other vaccines when they’re related directly to the treatment of an injury of illness
Drugs used with an item of durable medical equipment (DME): Medicare covers drugs infused through DME, like an infusion pump or a nebulizer.
Injectable osteoporosis drugs: Medicare helps pay for an injectable drug if you’re a woman with osteoporosis who meets the criteria for the Medicare home health benefit and has a bone fracture that a doctor certifies was related to post-menopausal osteoporosis. A doctor must certify that you can’t give yourself the injection or learn how to give yourself the drug by injection. The home health nurse or aide won’t be covered to provide the injection unless family and/or caregivers are unable or unwilling to give you the drug by injection.
Name 4 items covered by Part B
What is : Welcome to medicare exam
Annual wellness visit
Laboratory test
Medical Equipment
!!!! DOUBLE JEPORDAY !!!!!!
Tell us an example of what a member can do during OEP
What is make like Plan changes such as MAPD to MAPD or PDP to PDP or MA to MA
What counts toward TROOP ( True Out Of Pocket)?
What is: Deductible
Cost-Sharing
Extra help
Manufacturer Discount
Money paid on the beneficiary behalf
What is the monthly premium for a full medicaid eligible (QMB) beneficiary for the D-SNP for Florida Blue
What is $0
How Long does the Enrollment last for someone that is institutionalized ( Like a long term hospital or Skill nursing Facility)?
Your chance to join, switch, or drop coverage lasts as long as you live in the institution and for 2 full months ( directly from CMS.Gov) after the month you move out of the institution.
Do all IRA withdraws count as income
What is : No
Withdrawals from a Roth IRA does not count toward the income count
!!!!Triple Jeopardy!!!!!
What is considered a grandfathered plan in regards to a ACA plan?
What is: Grandfathered Health Plan. An individual health insurance policy purchased on or before March 23, 2010. These plans weren't sold through the Marketplace, but by insurance companies, agents, or brokers. They may not include some rights and protections provided under the Affordable Care Act
what is the percentage that the different metal levels cover when it comes to medical expenses
Ex: Bronze covers %
Silver covers %
Gold covers %
Platinum covers %
What is : Bronze 60%
Silver 70%
Gold 80%
Platinum 90%
What are the 4 levels of Dual Eligible beneficiaries?
What is : QMB(Qualified Medicare Beneficiary)
SLMB(Specified Low-Income Medicare beneficiary)
QI(Qualifying Individual)
QDWI(Qualified Disable working Individual)
Can a person over the age of 30 purchase a catastrophic plan?
What is : Yes..as long as they have an approved hardship