MA vs Marketplace
What is the general period when most people can enroll in a Marketplace plan?
What is the annual open enrollment period?
Which part of Original Medicare covers inpatient hospital stays?
What is Medicare Part A?
What ACA provision helps lower-income individuals and families pay for their monthly health insurance premiums?
What are premium tax credits?
What is the general term for the process of determining which insurer pays first when a person has more than one health insurance plan?
What is coordination of benefits?
hich plan provides Medicare benefits through a private company, often including extra services like dental or vision?
What is a Medicare Advantage (MA) plan?
What is the term for a specific event, like losing other coverage or having a baby, that allows someone to enroll outside of the regular period?
What is a Qualifying Life Event (QLE)?
What part of Original Medicare covers medically necessary doctors' services, outpatient care, and durable medical equipment?
What is Medicare Part B?
What ACA provision helps lower-income individuals by reducing their out-of-pocket costs for deductibles, copayments, and coinsurance?
What are cost-sharing reductions?
When a client has an ACA plan and becomes eligible for Medicare, which plan generally pays first?
What is Medicare?
What is the acronym for the private health insurance plans available to those with low income in participating states?
What is Medicaid?
When does a Special Enrollment Period (SEP) for losing employer coverage begin?
What is up to 60 days after the loss of coverage?
True or False: In Original Medicare, there is an annual limit on your out-of-pocket costs for covered services.
What is false?
What is the minimum income level for individuals to be eligible for premium subsidies in states that did not expand Medicaid?
What is 100% of the federal poverty level?
If a client is working for a large company (20 or more employees), is age 65, and keeps their employer's plan, which plan pays first?
What is the employer's plan?
True or False: You can have a Medicare Advantage plan and a Marketplace plan at the same time.
What is false?
What document might an individual need to provide to confirm a life event, such as a marriage or loss of coverage?
What are supporting documents (e.g., marriage certificate, letter from former employer)?
What is the term for an additional amount a provider can charge if they do not accept Medicare assignment?
What is an excess charge?
What is the monthly income-related adjustment that some higher-income Medicare beneficiaries pay for their Part B and Part D coverage?
What is IRMAA (Income-Related Monthly Adjustment Amount)?
A client is turning 65 but is covered by a small employer (fewer than 20 employees). Which plan typically pays first?
What is Medicare?
What is the term for a type of Medicare Advantage plan that requires a beneficiary to be entitled to both Medicare and Medicaid?
What is a Dual-Eligible Special Needs Plan (D-SNP)?
What specific Qualifying Life Event allows someone to enroll in a Marketplace plan with a Special Enrollment Period if they lose their employer-sponsored coverage, even if they have the option to continue it through COBRA?
What is a Qualifying Life Event? There is a special rule for COBRA—a beneficiary's choice to take COBRA does not prevent them from using a Special Enrollment Period to enroll in a Marketplace plan
In Original Medicare, if a beneficiary is hospitalized and then requires a Skilled Nursing Facility (SNF) stay, how many continuous days must they be in the hospital for the SNF stay to be covered?
What is a minimum of three consecutive days?
For higher-income Medicare beneficiaries, what is the acronym for the monthly income-related adjustment that can increase their Part B and Part D premiums?
Answer: What is Medicare? For employers with 20 or more employees, the employer's plan typically pays first.
Beginning in 2025, the Medicare Part D prescription drug benefit includes an annual out-of-pocket spending cap. What is that cap set at?
Answer: What is $2,000 in 2025?