Medicare 101
Consumer is age 65 or older, under 65 with certain disabilities and all ages with ESRD or ALS
What is Medicare eligibility criteria?
Health Maintenance Organization, Preferred Provider Organization, and Special Needs Plans
What are types of Medicare Advantage plans?
CMS publishes these each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans).
What are Star Ratings?
Role within within UHC that helps members to understand their plan benefits and navigate the health system
Who are advocates or who is member services?
Organism that eats both plants and animals.
What is an omnivore?
Annually from October 15 to December 7
What is open enrollment
Providers contracted by a Medicare Advantage plan to provide services to members
What are in-network providers?
This rapid risk assessment tool is used to quickly identify members at high risk for inpatient hospitalizations and those who may benefit from clinical programs.
What is the Health Risk Assessment Tool?
A new UHC wellness program to improve the overall well-being of members which is currently offered to select clients.
What is Let's Move?
Style of singing without musical accompaniment.
What is acapella?
The 3 months prior to the participants 65th birthday, the month of their birthday and the 3 months following their 65th birthday
What is the initial Medicare enrollment period?
A limit to help members manage overall costs, including copays, coinsurance, and deductible
What is the Out-of-Pocket Maximum?
A comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance.
What are HEDIS measures?
Integrity, compassion, relationships, innovation and performance
What are the UHC core values?
What is the official nickname of Texas?
What is the Lone Star State?
This is a plan that offers additional coverage to Original Medicare with low to no out-of-pocket costs
What is a Medicare Supplemental Plan?
A score that provides a relative measure of the predicted costs to meet the healthcare needs of the member which is based on the member's health conditions, as well as demographic factors.
What is Medicare risk adjustment factor (RAF) score?
This 30-day period begins on a patient’s inpatient discharge date and continues for the next 29 days.
What is transitional care management (TCM) period?
Information sent to all members prior to benefit beginning, that includes the ID card.
What is the Quick Start Guide?
In which play by Shakespeare do three witches say, “Double, double, toil and trouble?"
What is Macbeth?
Legal document delivered to members that provides comprehensive plan details for the plan year such as benefits information, out of pocket costs, and a member’s rights and responsibilities.
What is the Evidence of Coverage?
The third level of appeal for a Medicare Advantage plan denial.
What is an Administrative Law Judge Hearing?
Stay Healthy, Return to Health, Living with illness, and Serious illness care
What is the the URS clinical approach or care continuum?
A health care delivery model under which providers are paid based on the health outcomes of their patients and the quality of services rendered.
What is value-based care?
First West Point graduate to become President.
Who is Ulysses S. Grant?