Network Types
This network type is the least flexible. Members pay low premiums, but can only see in network doctors.
HMO
What cost of a PDP does NOT count towards the Out-of-pocket-max?
Premium
What is the name for a fixed cost amount for a service?
Copay
How long is the IEP window?
7 months
What is the fee for not enrolling in prescription drug coverage at the same time as OG Medicare called?
Late Enrollment Penalty
This type of network is the most flexible, with higher premiums, but the ability to go in and out of network.
PPO
What is the list of covered medications on a plan called?
The formulary
This is the only type of MA plan that you can add a standalone PDP
PFFS
What EP would you use to change your plan when you turn 65 after being on Medicare due to disability?
IEP2
Ambulance services are covered under which part of Medicare?
B
This type of network may or may not require referrals, depending on the specific plan.
HMO-POS
What is the max-out-of-pocket for prescription drugs for 2026?
$2,100
What extra benefits are covered under MAPD but NOT OG Medicare?
Dental, Vision, Hearing, and Drugs
The SEP Dual Maintaining can only be used for what type of plan?
PDP
Which part of OG Medicare covers lab services?
Part B
Prior authorization, step therapy, and quantity limits are examples of...?
Utilization Management
What are the 3 types of SNPs?
CSNP, DSNP, ISNP
What 2 types of changes can you make during OEP?
Medicare Advantage to Medicare Advantage
Medicare Advantage to PDP
What are services NOT covered under OG Medicare?
Cosmetic procedures, long-term care
This network type is generally available in rural areas to give consumers more choices.
PFFS
What are the 3 drug coverage stages?
Deductible, initial coverage, catastrophic coverage
The percentage of the cost of a service that the consumer must pay
What are the 3 scenarios where you can use SEP Change in Residence?
Moving to an area with different plan options
Being released from incarceration
Moving back to the U.S. from abroad
What is the Part B premium in 2026?
$202.90