Part A and B
What is the General Enrollment Period?
The period each year when you can sign up for Medicare Part A and/or Part B, if you chose not to sing up when first eligible or if you missed your Special Enrollment Period.
Medigap typically pay only after:
Original Medicare approves the charges and processes the claim
Mrs. Jones has a SSA income of $900 and has spent all of her savings but lives in a $2 Million home which is paid for. What programs would she be eligible for?
MSP and extra help
What percentage will the beneficiary pay for name brand drugs when in the coverage gap in 2017
40% (60% discount)
How does Medicare's Limited Income Newly Eligible Transition Program (LINET) help Beneficiaries?
It provides temporary prescription drug coverage for eligible beneficiaries who are not yet enrolled in a Part D plan
This ends when a patient is discharged from a hospital or SNF for 60 consecutive days.
What is a benefit period
Access fees can be up what percent?
15%
The correct order of the Part D Levels of Coverage?
What is Deductible>Initial Coverage>Coverage Gap>Catastrophic
Which of the following will Part B never pay for: Diagnostic Tests Inpatient mental health services Medications administered in a physicians office
Inpatient mental health services
Under what conditions can a member of a Medicare Advantage Plan go outside a network of providers without paying the bill out of pocket?
To receive emergency services.
Which drugs are not covered by Part D? Barbiturates, Drugs to treat Anorexia Drugs approved by the FDA
Drugs to treat Anorexia
What does it mean if a provider “takes assignment?”
The provider accepts Medicare’s approved amount for a service as payment in full.
It is January and Helen is 66 years old and has part A. Her job was recently terminated and she decided to take the 18 months of COBRA her employer offered to her. What will happen when her COBRA ends and she decides to sign up for Medicare?
Because COBRA is not considered insurance based on current employment, Helen will have to wait until the General Enrollment period (January-March) to sign up for Part B and it will not begin until July. She will also be penalized for not have Part B. She can, however, sign up for Part D without penalty.
What are qualifying reasons for a Medigap guaranteed issue right?
You are in a Medicare Advantage Plan, and your plan is leaving the area You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending. (Trial Right) You dropped a Medigap policy to join a Medicare Advantage Plan for the first time; you have been in the plan less than a year, and you want to switch back. Your Medigap insurance company goes bankrupt and you lose your coverage
When you have a complicated question about who pays first, Medicare or private insurance, what is the best resource for an official answer? Employer's Human Resource Department The private insurance plan 1-800-Medicare Benefits Coordination & Recovery Center (COB)
Benefits Coordination and Recovery Center
Medicare pays for a "one time only"__________ within the first twelve months a person has Part B
What is a Physical exam
The facility that provides surgical services that do not require a hospital stay.
What is Ambulatory Surgical Center
it is November Jill just became eligible for Medicare. She has been without insurance for the past 5 months since she left her job. She has savings, so is not eligible for Medicaid, but she does not want to spend it all on Medical care. What is the best course of action for her to take to enroll in a plan to cover her medical needs?
Enroll in a plan offered through the Health Insurance Marketplace now (during open enrollment) with coverage effective January 1)