Coverage stages
What is called by the maximum amount a member can pay during the plan year?
Maximum out of pocket
(Two answers)
After a member meets their deductible, they will have to start paying:
Copays and coinsurances
Who is eligible for medicare?
-People 65 or older
-Younger people with certain disabilities
-People with ESRD
Level 1 agents DO NOT handle prescription orders.
They should transfer to:
The member's pharmacy.
What are the 3 main components of the healthcare system?
Providers, patiens and insurance
On Part D plans: If a plan does not include a deductible in which stage of coverage does the member starts at the beginning of the year?
Initial coverage stage
It is a federal program offered to eligible people
Medicare and/or medicaid
(Both answers are ok!)
What does medicare part a covers?
Inpatient care // Hospital insurance
(any of the answers is ok!)
Level 1 agents DO NOT handle prescription issues calls.
This calls must be transferred to:
Level 2
What happens at the beginning of each plan year?
Everything resets on January 1st, which means the coverage stages restarts.
Is the stage where a member has to pay a certain amount of money for their medical expenses before the insurance starts to share the costs.
First coverage stage or deductible.
They are eligible for both medicare and medicaid
What is another name we can call Medicare part c by?
Medicare advantage.
The copay/coinsurance a patient pays will depend on the:
Tier or level of the drug.
**Remember higher tiers will have a more expensive copay!
Give us an example of what a provider is...
Is the amount a member has to reach out of their pocket before their healthcare insurance starts to cover the full amount of their medical expenses
Maximum out of pocket
What is the main function of a Primary Care Physician?
They Manage the patients health.
What does medicare part b cover?
Outpatient services
What is the name of the last coverage stage?
Catastrophic stage
What are the 3 types of plans we reviewed today?
HMO, PPO AND POS