PDP
True or False
Coverage of Medicare Part D benefits is provided by private companies
-Medicare pays a share of the program costs.
True
What factors are considered when determining a plan's star rating?
1. Staying healthy; screenings, tests, and vaccines
2. Managing Chronic conditions
3. Plan responsivness and care
4. Member complaints, problems getting services, and choosing to leave the plan
5. Health plan customer service
What is North Dakota rating
IA
Individuals who were not eligible for a MA or PDP because they had been out of the U.S. and have now moved back
RUS
Government EntityDeclared Disaster or Other Emergency
DST
Part D plan formularies must include?
-at least two drugs in each therapeutic category
-generic and brand name drugs.
What are the Medicare Advantage Prescription Drug Utilization management?
-Quantity limits
-Prior Authorization
-Step Therapy
What does AA, IA, and CR mean?
Issued age, Attained age, and Community rated
Individuals who were incarcerated and now have released
INC
PDP SEP for individuals involuntarily disenrolled from a MAPD plan due to loss of Part B
OTH and enter: Disenrolled from a MAPD due to loss of Part B
What is the purpose of Medication therapy Management?
Medicare Part D medical therapy management programs seek to provide individuals taking medication for chronic diseases with an optimal regiment of treatment for their conditions
**MTM is a patient-centered and comprehensive approach to improve medication use, reduce the risk of adverse events, and improve medication adherence.
Mrs. Thompson went to her local pharmacist to fill prescription written by her physician. When she went to pick it, her pharmacist told her that he is unable to fill the prescription because she needs approval from her MAPD. Her pharmacist is referring to:
Prior Authorization
How is Main rated?
CR
Program of All-inclusive Care for the Elderly
PAC
Non-U.S. Citizens who become Lawfully Present
LAW
Types of Part D plans
1. Stand-alone PDP to work with Original Medicare
2. Medicare Advantage (MA-PD) plan
**an MA health plan that also covers Part D
3. Cost-PD Plan
**a Medicare health plan that covers Part D as an optional supplement benefit.
PFFS is a hybrid of?
Medigap and Medicare Advantage Plan
How many states are rated CR with CIGNA?
7
2nd ICEP for beneficiaries who have Medicare due to disability upon turning age 65
MRD
For CMS and StateInitiated Enrollments (Passive Enrollments, etc.)
DIF
What does not count towards the Coverage Gap?
Drug Plan Premium
Drugs that are not on a plan's formulary
Part B drugs
Roleplay 3 three needs Dental, Vision, and transportation under 2 mins GO
Go!!!
What states do not offer standard 1 and 2?
AS, CA, CON, DC, FL, HI, ID, IW, ME, MA, MIN, MI, NJ, ND, OR, VE, VA, and WA,
Enrolled in Part B during the Part B General Enrollment Period when NOT entitled to free Part A
GEP
MA/MAPD/PDP Contract non-renewal of plan effective Jan. 1
EOC