Prescription Advantage
Prescription Advantage is available to residents in this state
What is Massachusetts?
Medicare insurance coverage is a State or Federal benefit
What is Federal?
This is what you pay when you pick up your prescription at the pharmacy.
What is a copay?
This system captures benefit, enrollment and eligibility information for Prescription Advantage members
What is the Benefits Enrollment and Eligibility System (BEES)?
You have reached the donut hole when the amount spent on covered drugs between you AND your Part D plan reaches this dollar amount
What is $5,030?
This is the main benefit of Prescription Advantage
What is Copayment Assistance?
Most US citizens are eligible for Medicare at this age
What is 65?
This is what you pay (for expenses) before your insurance begins to pay.
Most health insurance plans include one of these.
What is a deductible?
This system is used to view pharmacy claims and to see if a member has reached the coverage gap/donut hole
What is Conduent? ( also called Xerox, OS+)
These are the 4 benefit stages of a Medicare Part D plan
Deductible (01), Initial Coverage (02), Coverage Gap (03) and Catastrophic (04)
This is the name of the client UHealthSolutions supports for Prescription Advantage
Who is the Executive Office of Aging and Independence?
Medicare is available for people under the age of 65 if they are this
What is disabled?
The acronyms PDP and MA-PD stand for these
What is a Prescription Drug Plan and a Medicare Advantage prescription drug plan?
In addition to verifying a member's information, an authorized representative also needs to verify this information about themselves
What is their name, address, and telephone number?
Open enrollment for Medicare plans is typically these dates each year
When is October 15th - Dec 7th?
SEP stands for this
What is Special Enrollment Period?
People can purchase this to fill in the gaps in their Medicare coverage
What is a Medicare Supplement Plan (Medigap)?
This is a list of covered drugs for a particular insurance plan
What is a Formulary?
When ordering an PA ID card for a member, what information (from the card) should you provide to the member? (Just in case they need to go to the pharmacy before their card arrives.)
What is the PA ID#, RXBIN, RXPCN, RXGRP #?
This is coverage is as good as or better than drug coverage offered by Medicare and is usually provided by an employer or union
What is creditable coverage?
These 2 people are allowed to make demographic changes on a member's account
Who are the member or Authorized Representative?
Name the 4 parts of Medicare and what each of them helps cover
What are Part A- Hospital insurance, Part B- Medical insurance, Part C- Medicare Advantage and Part D- Prescription Drug coverage?
CMS stands for this
Center for Medicare and Medicaid Services
This information must be verified by a member before any account information can be provided
What is their name, address, date of birth, last 4 of SSN/last 5 of HICN/PA ID#, and phone number?
These are the three types of Release of Information (ROI) authorizations
What is Spousal Designee, Verbal authorization, and Written authorization?