Coverage stages
How do we call to the amount of money that a member will pay trough out the 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: 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.
Deductible stage
What does it mean when we call a member dual eligible?
That they are eligible for both Medicare and Medicaid
What doe we call the plan when we add Part C to it?
Medicare advantage.
The copay/coinsurance a member's pays for a medications will depend on the:
Tier or level of the drug.
**Remember the higher the tier, the cost is higher
Give us an example of what a provider is...
What is the name of the last stage of coverage of Part D?
Catastrophic stage
What is the main function of a Primary Care Physician?
They Manage the patients health.
Provide one example of the Part B Coverage
Medical Services
Outpatient services
Medical Supplies
Preventative Care
Name the plan that doesn't have Part D coverage?
CareSalute
What are the 3 types of plans we reviewed?
HMO, PPO AND POS