DUAL SPECIAL NEEDS PLANS fully solved graded A+ 2023

DUAL SPECIAL NEEDS PLANSWhat are Dual Special Needs Plans (D-SNP)? - correct answer Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid. When does the Special Election Period for Dual/LIS Change in Status begin for D-SNP members that lose Medicaid eligibility? - correct answer Upon notification or effective date of the loss, whichever is earlier The consumer states they currently pay a percentage of charges when they receive medical care. This means: - correct answer The consumer is enrolled in a Medicare Supplement Insurance Plan. WRONG The following is a characteristic of consumers for whom a C-SNP may be most appropriate: - correct answer Consumers who have a qualifying chronic condition, are focused on their health issues and may have concerns with having to manage their illness or dealing with multiple providers John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans that will help him manage his condition. Can John enroll in a Chronic Special Needs Plan (C-SNP) that covers his chronic condition? - correct answer Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic) Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic) - correct answer All of the responses are correct. Which statement is true about provider information on the Chronic Condition Verification Form? - correct answer The provider indicated on the form must be a specialist. WRONG Which statement is true about the Medicaid program? - correct answer It helps pay medical costs for certain groups of people with limited income and resources. You must advise consumers enrolling in a D-SNP that: - correct answer They are not required to pay copayments for Medicare-covered services received from a D-SNP network provider if they are Full Dual-Eligible or determined D-SNP eligible by our plan agreement with the state in which they reside. Their provider should bill the state Medicaid program. How long do plans using the C-SNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request? - correct answer Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer). Members who lose their eligibility for the D-SNP due to a change or loss of Medicaid status are responsible for what cost sharing? - correct answer All, such as premiums, deductibles, copayments, and coinsurance A D-SNP might be in the best interest of which of these consumers? - correct answer Joe, whose low income qualifies him for full Medicaid coverage Which statement best describes a care management program that varies depending upon the level of the member's health risk? - correct answer Support provided to C-SNP and D-SNP members that may have unique health care needs Which statement is true about CSNPs, DSNPs, and prescription drug coverage? - correct answer CSNPs and DSNPs include Medicare Part D prescription drug coverage Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of: - correct answer Selling DSNPs The consumer states they currently pay a percentage of charges when they receive medical care. This means: - correct answer The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in another type of plan. The following is a characteristic of consumers for whom a C-SNP may be most appropriate: - correct answer Consumers who have a qualifying chronic condition, are focused on their health issues and may have concerns with having to manage their illness or dealing with multiple providers