Donut Hole/Coverage Gap
Define Medicare Donut Hole
What is the gap inside of all Part D plans
It is TRUE or FALSE that a Medicare advantage beneficiary can travel throughout the United States and continue to use coverage as long as doctors are in network.
What is TRUE
Medicare Part A offers ______ coverage
Medicare Part B offers ______ coverage
What is Hospital Part A
What is Medical Part B
Do you need to put the doctors name on a Aetna Value PPO plan?
What is NO? Only for HMO plans or a plan that specifically requires you to write one on the application.
All types of VA coverage (3)
What is TRICARE, CHAMP-VA, VA?
The Part D penalty is calculated by
What is 1% for every month went without Part D coverage x 2024 National base beneficiary premium (rounded to nearest $.10) ($34.70 in 2024)
It is TRUE or FALSE that a member can receive coverage on any Humana HMO plan as long as the doctor is in Network
What is TRUE?
Number one risk of only having Original Medicare
Member is responsible for 20% of all medical bills with no Max out of Pocket (MOOP) / OR paying the $1632 each benefit period (deductible Part A)
Major difference between an HMO and PPO
What is In-Network Only coverage vs. option to go outside of network?
Three types of SNP plans
What is Institutional, Dual, and Chronic?
Lindsey is on a Wellcare Explore HMO-POS plan with prescription drug coverage. Lindsey has LIS Level One and has went without drug coverage for 5 years. The plan premium is $0. What is her monthly premium?
What is ZERO DOLLARS? (no Part D penalty because of LIS status)
Three types of Durable Medical Equipment (DME)
What are...?
Three things covered under Original Medicare
What are:
Part A:
Part B:
TRUE or FALSE you need a referral to see a specialist with an HMO advantage plan
What is TRUE
Three requirements to be on D-SNP plan
What are:
1) Dual eligible
2) Right level of Medicaid
3) Plan available in their Service area
The person exempt from the coverage gap
What is Extra Help beneficiary?
7 possible SEP's
What are
-5 Star Plan
-L.I.S
-Lost Medicaid Coverage
-FEMA
-Moving
-ICEP
-OEP
-AEP
-C-SNP
-Losing Employer Coverage
-Signing up for Part B
-Plan is not renewed/terminated
Four things that are not covered under Original Medicare
What are
-Long Term Care/Custodial Care
-Dental/Dentures
-Eye Exams
-Cosmetic Surgery
-Acupuncture
-Hearing Aids/Exams
-Routine Foot Care
-MOOP
HMO and PPO are two types of networks. What are two others?
What is HMO-POS? (point-of-service) and PFFS
Three Levels of Medicaid for D-SNP
What is
-QMB
-QMB+
-SLMB
-QDWI
-QI
-FBDE
When the coverage gap begins
What is
Once you and your plan have spent (EX. $5,030) on covered drugs in that set year (2024)
Three U.S. territories covered under Original Medicare are
-Puerto Rico
-U.S. Virgin Islands
-Guam
-American Samoa
-Northern Mariana Island
What is 10% for each full 12-month period when you should have had Part B but didn't.
What does HMO and PPO stand for?
What is Preferred Provider Organization? What is Health Maintenance Organization?
Who qualifies for CHAMP-VA
What is families/spouse of a veteran that died as a result of service or a veteran that is 100% disabled as a result of service