Enrollment Basics
Joe Smith turned 65 on Aug 24th and enrolls in a Medicare Advantage plan on Oct 1st, which enrollment period is he using?
IEP or ICEP or the "3-1-3 Rule"
Private Rooms and TV's upon request
Not covered
Only pre service cost share. monthly amount
Premium
Part D Drugs or Prescription Drugs
Which Florida blue plan has the most restrictions like requires a pcp, needs to be in network, and requires referrals?
HMO
what is the rule for the IEP or ICEP called?
3-1-3 Rule
Nose job because i dont like the way my nose looks
No not covered
Post service cost share, Amount that must be paid by the member before the insurance pays their part.
Deductible
Beneficiaries who’s income falls below the limits of _______ are not required to pay the “Extra Amount”.
Low Income Subsidy (LIS)
Which one of these PPO plan is a plan Florida Blue offers that serves an area of one or more states as determined by CMS
Local PPO
Regional PPO
Florida PPO
Out of state PPO
What factors are used to determine Medicare Eligibility?
Age, Disability, Diagnosis of ALS, Diagnosis of ESRD
Hospice Care if i am terminally ill and have 6 months or less to live
Yes it is covered
Post Service Cost share that is a fixed amount
Copay
True or False
Health insurance usually provides financial assistance for preventative services as well as unexpected medical costs.
True
what is the other name for medicare supplement plan?
Medigap or Gap Coverage
Jody Anne is currently in a medicare advantage plan, and applies for a new plan on 11/24/2025. which Enrollment period is she using?
Annual Enrollment Period (AEP)
October 15th - December 7th
Long term care, not in a hospital, like a nursing home, or private duty nurse
No not covered
Post service cost share that is a percentage
Co-insurance
Optional Medicare Advantage coverage include? (Select all that apply)
Wellness (fitness)
Urgent care
Emergency Care
Vision
HMO and PPO plans are known as what type of plans?
Medicare Advantage (Med Adv or Part C)
What options does someone turning 65 have when enrolling in Medicare?
Enrolling in Original Medicare.
Enrolling in OM, and a Med Adv plan.
Enrolling in OM, Sup plan, and PDP
Extra benefits like vision, dental, hearing, and Fitness(wellness) on a med advantage plan
Yes it is covered
The dollar amount the member spends on all applicable copays, coinsurance, and deductibles during a benefit period before insurance begins to pay covered costs at 100% for remainder of benefit period
Out of pocket max
True or false
Medicare Advantage (Part C) plans provide the same level of coverage as Original Medicare (Parts A and B) and often include Part D prescription drug coverage and other extras.
True
Complete Rx and Premier Rx are known as what type of plans?
Rx plans or PDP plans or Stand Alone Drug plans