Chapter Six

Questions

1.    Which of the following are considered Medicare gaps or out-of-pocket cost?

A. _______ Medicare Part A and Part B Premium.

B. _______ Copayments and Coinsurance

C. _______ Deductibles

D. _______ Cost of services that Medicare does not cover

E. _______ All of the Above

2.    Medicare + Choice refers to any Medicare plan option that is a contract between a private insurance company or corporation and the Medicare program. If a person joins an M+C plan, they are considered to be out of Original Medicare.

True _________ False ___________

3.    Which is true of Medigap policies?

A. ______ There are 10 plans.

B. ______ There are two high deductible plans

C. ______ Medigap is sold by County and ZIP Code

D. ______ All of the above.

4.    The Medicare supplement high deductible plans require that the beneficiary first pay the annual deductible ($1,620 in 2002) before Medicare pays any of the costs?

True _________ False ___________

5.    What are the Medicare deductibles?

C. _______________

6.    Which beneficiary would have an out of pocket cost if they accessed a service that is now billed under the Medicare Part B Prospective Payment System?

A. ______ A person with a Medigap Plan A

C. ______ A person who has Medicare and a retirement group plan.

7.    Only Medicare supplement plans H, I and J offer prescription coverage.

8.    Where would a complaint about a Medigap company’s failure to pay a claim be submitted?

______ to the Medicare carrier that pays the claims

______ to the Center for Medicare & Medicaid Services

______ to the Medigap company

______ to the Texas Department of Insurance

9. Before buying a Medicare supplement policy, the beneficiary should

A. ______ Make sure that they have Medicare Part A and Part B

B. ______ Review if they are entitled to group insurance through their employer or as a retirement plan from their former employer.

C. ______ Find out if they might qualify for the Medicare savings programs.

D. ______ Find out if there is a Medicare + Choice option available.

10.    In Texas, a person with disabilities under age 65 has a six-month open enrollment period just like persons over 65, and can buy any Medicare supplement plan and the company must sell it to them regardless of their pre-existing condition?

True ______ False ______

11.    Guaranteed Issue Protection refers to a special right to buy one of four Medicare supplement policies (Plans A, B, C or F) outside an initial enrollment period. The company if they sell the plan must sell it to the applicant. There are numerous circumstances when a person could have this right.

True ______ False ______

12. Which of the following apply to Medigap insurance plans.

A. _______ Premiums are approved by CMS.

B. _______ The only reasons for canceling a policy after it has been issued, is for fraud or non-payment of premium.

C. _______ The agent or company selling the policy has the responsibility for verifying that there is no duplication of coverage.

D. _______ The company can impose an elimination period for pre-existing conditions.

E. _______ All of the Above

13.    Employer group plans or retirement plans are not regulated by either the Texas Department of Insurance or CMS. Therefore someone with one of these plans does not have recourse should the group plan not pay a claim.

True _________ False ___________

14.    A person, who is still working at the point that they become eligible for Medicare, can delay enrollment in Medicare if their employer allows them to.

True _________ False ___________

15.    Which do not apply to employer group plans?

A. ______ The benefits will coordinate with Medicare and a person will not need any other coverage.

B. ______ There is usually an option to cover a dependent spouse that may not be eligible for Medicare at the same time as the policyholder.

C. ______ A person has the right to try another Medicare options such as a Medicare HMO with the right to get their group plan back either at the annual enrollment or if they decide they want out of the HMO or Medigap plan.

16.    Medicare + Choice plans, if they are available are probably the best option for most beneficiaries. They provide more benefits and cost nothing in comparison to a Medigap policy.

True _________ False ___________

17.    Name at least three sources for where a benefits counselor can seek information about which M+C plans are available in their service area.

A. _______________

B. _______________

C. _______________

18.    The appeals process in an M+C plan is the same as with Original Medicare.

True _________ False ___________

19.    Which doe not apply within a Medicare+ Choice managed care plan.

A. ______ A person must have Medicare Part A + Part B to enroll

B. ______ An enrollee must use the plans network of providers and needs a referral to see a specialist.

C. ______ A person must disenroll from the plan in writing.

D. ______ A person should use the Medicare Summary Notice send by the Medicare carrier to review if charges were correctly billed.

E. ______ All of the above.

20.    In a M+C plan the appeals process includes an independent review process, outside the HMO.

21.    Number the steps to handling a Medicare HMO complaint?

A. ______ Contact the provider to address the problem

B. ______ File a written complaint and submit it to the HMO

C. ______ Review the member handbook for filing complaints

D. ______ Determine if the issue is a complaint or denial of service or payment of service.

22.    The M+C Private Fee-for-Service (PFFS) has the same elegibility requirements as an M+C mananged care plan.

23.    Which of the following individuals would not be a good candidate for the PFFS plan?

A. ______ Newly enrolled beneficiary who is very healthy, does not have access to employer or group insurance, and is budgetting because there is a spouse who is not yet Medicare eligible.

B. ______ A beneficiary who has frequent hospitalizations and has difficulty remembering even who his regular doctor is.

24.    The new rules for changing Medicare plans, apply only to Medicare + Choice plans and are a way of stopping beneficiaires from enrolling and disenrolling from one HMO to try another.

True ______ False ______

25.    All providers that accept reimbursement from Medicare, must accept the PFFS plan.

True ______ False ______