UHC certification Study Guide Complete
2023/2024
Medicare - Correct Answer Federal health insurance program Medicare is administered by whom? - Correct Answer CMS ( Centers for medicare and medicaid services) Parts A & B of medicare are - Correct Answer federal health insurance program referred to as original medicare Part A? - Correct Answer Hospital insurance Part B? - Correct Answer Medical insurance What doesnt medicare cover? - Correct Answer routine dental, eye care hearing exam,deductibles, coinsurance and copayments Part C? - Correct Answer Medicare Advantage Plans MA covers? - Correct Answer Part A &B coverage, and some part D coverage MA plans are not? - Correct Answer Medicare supplement insurance plans What offers lower monthly premiums MADP or supplement? - Correct Answer MADP do MAP's have a annual maximum OOP maximum that limits the amount of money a member must spend every year for covered services? - Correct Answer YES MA plans integrate what type of additonal coverage? - Correct Answer part D prescription drug coverage If a customer wants to keep their stand alone prescription drug plan, what may the customer want to enroll in? - Correct Answer MA-only PFFS plan What is a stand alone drug plan called? - Correct Answer PDP WHat is PFFS? - Correct Answer Private Fee for Service (PFFS) - Plans that allow you to go to any doctor or hospital that accepts their terms If a customer lives in a rural area, what type of plan may they want because it gives them freedom to access doctors that may not be in their network? - Correct Answer PFFS plan Do HMO's require referals? - Correct Answer Yes 1 / 2
Do PPO's require a referal? - Correct Answer No When a member enrolls in a MA plan, they receive their coverage from medicare or the MA plan? - Correct Answer MA plan When a customer is enrolled in a MA plan, they must continue paying their premiums for what other plan? - Correct Answer Part B MA plans have a maxium annual limit on OOP costs called a? - Correct Answer MOOP amount ( Maxium out of pocket) When a member is enrolled in a MA plan, they are automatically disenrolled from any other MA plan or PDP( prescription drug plan) in which they are enrolled as of the new plans_____? - Correct Answer effective date An exception exisits for MA-only PFFS plans as a member can also be enrolled in a what? - Correct Answer Stand alone PDP If a member enrolls in a MA plan, what must the member do? - Correct Answer Cancel in writing their medicare supplement insurance policy with the carrier after their request to enroll in MA plan has been approved.Medicare supplement insurance policies cannot be used in conjunction with what type of plan? - Correct Answer MA plan A medicare supplement insurance plan helps to cover some of the OOP costs associated with? - Correct Answer original medicare.A medicare supplement insurance plan does NOT pay the cost-sharing of what type of plan? - Correct Answer MA plan when a client enrolls in a MA plan, will it automatically terminate their MA plan? - Correct Answer NO Can a customer call to terminate their Med Sup plan? - Correct Answer no it must be done in writing What are the different types of MA plans? - Correct Answer HMO, POS, PPO, RPPO, PFFS, SNP, and MSA For an HMO, they customer must us IN network providers, what are the exceptions to their rule? - Correct Answer Emergencies, Urgent care, and renal dialysis services.In a HMO plan, does a member have to choose a PCP? and do they require referrals to see a specialist? - Correct Answer Yes
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