True/False
Alpha-Betcha
It's Supplemental
I Want Drugs!!
What's Your Number?
100
Blue Cross/Blue Shield's Medigap Plan A covers more services than Humana's Medigap Plan A.
What is False: Plans with the same letter offer identical coverage in each Medicare Supplemental Plan (Medigap)
100
Pays for 20 days with no co-pay in a skilled nursing facility (with a 3-day *inpatient* hospital stay).
What is Medicare Part A. *Hospital stay MUST be coded as "INPATIENT" and not "Under Observation" Days 21-100-$144.50 per day. Over 100 days-You pay total amount.
100
With this, you are automatically eligibility for LIS Extra Help. No premiums, deductibles, or gaps. Must join a part D plan or one will be assigned to you.
What is Medicaid and/or MSP (QMB, SLMB, QI)
100
When your drug expenses exceed $2,930.00 in a Medicare Part D plan, you are considered to be in this
What is The Donut Hole or Coverage Gap
100
Medicare Part B premium monthly amount
What is $99.90.
200
A Medicare Advantage Plan (MAP) is cheaper than a Medicare Supplemental Plan for someone who has many doctors visits.
What is False: Although Medicare Advantage Plans (MAPs) are cheaper than Medicare Supplemental Plans or Medigap plans, you do have to pay a co-pay for every time you see a doctor. Multiple co-pays can rack up to $$.
200
Pays for "Preventive Care" Services
What is Mecicare Part B. Deductibles and co-pays for most preventive services have been eliminated in 2011.
200
New to individuals who have straight Medicaid only Must enroll in one of two HMO Managed Care Plans or one will be assigned to you
What is Medicaid Integrated Care Program. -Aetna Better Health. -IlliniCare Health Plan. No longer Medicaid-this program is run by Medicaid.
200
Provides low cost or free medications from the drug manufacturers
What is Patient Assistance Programs (PAPs). www.rxassist.org. www.needymeds.org. www.benefitscheckup.org.
200
October 15th to December 7th
What is Medicare Part D open enrollment period.
300
Estate recovery is not a concern for someone considering applying for a Medicare Savings Program (MSP).
What is True: No more estate recovery for people in MSPs (QMB, SLMB, QI)
300
Also known as a Medicare Advantage Plan (MA)
What is Medicare Part C. This is the same as original Medicare A & B plans. Must choose one or the other, can't have both. www.medicare.gov-can compare premium costs & deductibles of different MA plans.
300
Works like an insurance deductible. Must show what you owe or have paid in medical expenses.
What is Medicaid Spenddown. Also have the option of "Pay-In Spenddown"-pay in advance spenddown amount in the form of a "premium" to meet spenddown requirement. You must enroll in this program. You can choose which months to use. Must use every 3 months to keep Medicaid status active.
300
The order which you should check for a client's eligibility in a prescription coverage program
What is 1) Medicaid 2) MSP 3) LIS Extra Help 4) PAP Programs 5) Charities
300
When a person is eligible for initial enrollment (related to their age of eligibility)
What is 3 months before 65th birthday. Month of 65th birthday. 3 months after 65th birthday. 3-1-3.
400
If you have a higher income, you will pay a higher premium for your Medicare part B.
What is True: Beneficiaries with higher incomes ($85,000-single or $170,000-double) will also pay higher Part D monthly premiums as well. (Effective Jan 1, 2011).
400
Average monthly premiums of $53.34. A yearly deductible ranging from $0-$320*. Three phases of coverage.
What is Medicare Part D. *AARP is only Part D plan with NO deductible. Phase 1-Initial Coverage-drug costs $320-$2930. Phase 2-Donut Hole-drug costs $2,930-$6,657.50. (you pay 50% on brand name & 14% on generics). Phase 3-Catastrophic-drug costs over $6,657.50. (you pay 5% on all drugs). Can either have a "Stand Alone" part D plan or a Medicare Advantage Plan that includes drug coverage.
400
If qualified, pays for Medicare part B monthly premium
What is Medicare Savings Program (MSP). QMB also pays for Medicare co-pays and deductibles and automatically qualifies you for LIS Extra Help program.
400
You may file an appeal with your drug plan for drugs that are not covered under these three circumstances
What is 1.)Prior Authorization 2.)Step Therapy 3.)Quantity Limits PRIOR AUTHORIZATION: You must get prior authorization, or your plan doesn't cover a drug that is "medically necessary" for you. Doctor must contact plan and show it is medically necessary and other formulary medications are not as effective. STEP THERAPY: Your plan requires you to try a different drug first. Doctor can request a formulary exception if you have tried similar drugs and they did not work. QUANTITY LIMITS: Has a limit on the amount prescribed.
400
Number of days in hospital eligible to receive at 0 copay under Medicare A
What is 60 days-$0 co-insurance. 61-90 days-$289 co-insurance per day. 91-150 days-$578 co-insurance per day. You can check your Medicare coverage at www.mymedicare.gov.
500
If you do not enroll in Medicare Part B during initial enrollment period, you will pay a 10% of part B premium penalty every month for the rest of your life.
What is True: Also, if you do not enroll in Medicare D plan when you are first eligible, you will pay a 1% extra premium for each month you were eligible but did not enroll. However, If you are eligible for LIS Extra Help, this penalty & Premium is waived. You must be in a Medicare part D plan to receive extra help. If you do not choose one, one will be chosen for you.
500
Private health insurance with 10 different variations all of which cover the same "Core Benefits"
What is Medigap or Medicare Supplemental Plans A,B,C,D,F,G,K,L,M, and N. Plans M and N are new plans. Plans E, H, I, and J are no longer being sold. Medicare Select Plans are cheaper than regular Medigap plans-they work like an HMO. There is a higher deductible for Plan F. A more expensive plans does not necessarily mean better plan.
500
Do not have to wait for open enrollment period (October 15-December 7) to enroll in a Medicare Part D plan
What is Special Enrolment Period. -You qualify for LIS Extra Help. -Select a Part D plan for the first time. -Switch Part D plans if you are already in one.
500
You do not have to pay a penalty for enrolling later in a Medicare Part D plan in these three circumstances
What is 1.) Creditable Coverage. 2.) Special Enrollment Periods (SEPs). 3.) Receive Medicare & Medicaid, MSP. CREDITABLE COVERAGE: If the benefits under your current plan are "Creditable" (as good as Medicare's) ex. VA drug coverage, some employment coverage plans. SPECIAL ENROLMENT PERIODS (SEPs): 1.)Accepted into Extra Help or IL Cares Rx. 2.)Move into or out of a nursing home. 3.)Joined a Medicare Advantage Plan based on misleading or inaccurate information.
500
$1.10 or $3.30.
What is LIS Extra Help copay for generics and brand name.
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