HMO
What does HMO stand for?
Health Maintenance Organization
What does PPO stand for?
Preferred Provider Organization
If a Cost Plan member goes out of network for care, this original, federal two-part insurance system steps in to cover the bill?
Original Medicare
What does PFFS stand for ?
PFFS stands for Private Fee-for-Service. It is a specific type of health insurance plan structure.
What two components make up a Medicare Advantage Medical Savings Account plan?
A high-deductible plan and a savings account
When can an HMO member generally receive covered care outside the network?
For emergency or urgent care and certain other exceptions
Do you need a Primary Care Physician or referral to see a specialist?
No.
Unlike Medicare Advantage, Cost Plans give members the unique flexibility to buy this standalone plan for their medications if the Cost Plan doesn't bundle it?
Medicare Part D plan
What is balance billing?
PFFS plans may permit this billing practice, where an out-of-network provider charges up to 15% more than the plan's payment amount and bills the patient for the difference.
Who deposits money into the medical savings account connected to an MSA plan?
Medicare through the plan
What could happen if an HMO member voluntarily uses an out-of-network provider for non-emergency care when the plan doesn’t authorize it?
The member may have to pay the full cost
What happens if you see a Specialist Out of Network than In Network?
Higher cost-sharing, Higher OON deductible
Federal law states that a Cost Plan must close or stop accepting new members if this competing type of private Medicare plan becomes widely available in the same area?
Part C plan
Unlike traditional HMO plans, a primary advantage of a PFFS plan is that enrollees never need one of these to see a specialist.?
They never need a referral
When does the high-deductible portion of an MSA plan generally begin paying for Medicare-covered services?
After the annual deductible is met
An HMO member is traveling and has a medical emergency. What should they do?
Seek necessary emergency care even if the provider is out-of-network
What are the two types of PPOs?
Regional and Local (PPOs)
Due to strict federal competition rules, Cost Plans are not nationwide and are heavily concentrated in rural areas of this specific U.S. region?
Midwest
PFFS plan does not include what type of coverage and it is the only type of Medicare Advantage plan that allows you to buy a separate, stand-alone Part D plan?
Prescription drug coverage
How can an MSA plan member obtain Medicare prescription drug coverage?
Join a separate Medicare Part D plan
All Medicare Advantage HMO plans have exactly the same network, copays, and referral rules. (T or F)
False
Why was the PPO plan created?
To allow people to healthcare they need with any provider , at a cheaper cost and more flexibility.
To be eligible to enroll in a Medicare Cost Plan, an individual must be enrolled in this specific part of Medicare, which carries a standard monthly premium of $202.90.?
Medicare Part B
What is the federally mandated maximum out-of-pocket spending limit for in-network services under a PFFS plan in 2026.?
$9,250?
What generally happens to money left in the MSA account at the end of the year?
It remains available for future healthcare expenses