DUAL
What does it mean when a member is a dual eligible member?
They have a Medicaid and Medicare D-SNP plan
Cost of the optional supplemental benefits comprehensive dental package
$20.20 per month
Monthly Premium Cost 2021 and 2022
2021 $40
2022 $25
Name the plans under Banner Medicare Rx
Simple, Complex, Premier
Largest Mammal in the world
A whale.
Specifically, the Blue Whale, which can be up to 100 ft in length.
Why do members need new ID cards?
New pharmacy processing information will change. Current member Id's have Medimpact information.
True or False: Prime members can obtain full time nursing care in their home
False: That service is “excluded” from Medicare coverage
Cost of Out of Network Silver and Fit Benefit
40% co-insurance for fitness benefits
Name the 4 drug payment stages for Medicare
1. Deductible
2. Initial Coverage
3. Coverage Gap
4. Catastrophic
Most ordered food in America
Fried Chicken
8 billion chickens a year are eaten in the US
Name 4 new benefit for Dual members in 2022
Transportation Services
VBID Benefits: Home modifications; Simple Therapy; Dial a Diabetes program; Healthy Food Card for SSBCI); Fitness Benefit;
Copayment for CT Scan, Complex & General
General Diagnostic $125 copayment/visit.
Complex Diagnostic $200 copayment/visit.
In Network: $20 copayment per visit. Prior authorization and/or referral may apply.
Out of Network: $27 copayment per visit
Name of the Insulin program that allows participating Part D plans to offer select insulins at a maximum $35 copay for 1 month supply during the initial coverage and coverage gap stages.
Part D Senior Savings Model
Name the fictional character whose household duties did not prevent her determination to dance
Cinderella
Benefit of $75 for qualified members with chronic conditions
SSBCI (Special Supplemental Benefits for the chronically ill) -or- Healthy Food card
Copayment for Ambulance in Pima County
$250 copayment per one-way trip.
In Network: $0 copay
Out of Network: 40% co-insurance
Annual Deductible is $480 for these plans.
This plan deductible only applies to Tiers 3, 4, 5
Simple and Classic
Classic
85%
Chiropractic covered services for 2022
Manual manipulation of the spine to correct subluxation
Routine chiropractic care: 6 visits per calendar year
This benefit has a $90 copayment and the member is covered up to $25,000 per calendar year.
Worldwide Emergency Care
"Welcome to Medicare" visit, Diabetes Screening, Vaccines, including Flu & Covid-19, Cardiovascular disease screening, Annual Wellness Exam...
These are all examples of ____________.
Preventive Care
After the yearly out of pocket is met at $7050, what is the cost during the catastrophic stage for generic drugs AND all other drugs.
You pay the greater of: • 5% of the cost or • $3.95 copay for generic (including brand drugs treated as generic) and a $9.85 copayment for all other drugs.
____________ won the Academy Award for Best Picture the year that Medicare was enacted (1965)
Sound of Music