Medicare cost plans - Study guides, Class notes & Summaries

AHIP 2025 Final Exam Questions and Answers (2024 / 2025) (Verified Answers).1. PPO, HMO, MSA, Cost Plan, PFFS ANS Types of Medicare Advantage Plans 2. Serve both Medicare and Medicaid individuals. Include Part D coverage. Individuals sometimes referred to as dual eligibles ANS Medicare-Medicaid plans 3. Type of Medicare health plan. Have Part B to enroll. Can join anytime plan is accepting new members. A non network provider will can charge higher coin- surances and deuctibles. Different enr...

Dual special needs plans are defined as? Medicare advantage plans uniquely designed for consumers enrolled in both Medicare and Medicaid. Meredith a d- snp member loses Medicaid eligibility. What impact does this have on her D-SNP enrollment? She will enter a grace period during which she is responsible for plan, cost sharing and she will be disenrolled at the end of the grace. If she does not re-establish Medicaid eligibility. Brainpower Read More Previous Play Next Rewin...

Which statement is true about the Medicare Advantage (MA) Out- of pocket Maximum? correct answer: All MA plans have an Out- of Pocket maximum to help limit the member's out of pocket cost for Medicare-covered services. A consumer currently has Original Medicare and is enrolled in a stand alone PDP. What will happens if the consumer enrolls in a n MA Plan that has integrated PDP coverage? correct answer: The consumer will be automatically disenrolled from their stand-alone PDP upon enrollme...

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 Steps used to control costs of managed care include: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage HMO Conventional PPO and POS H...

A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do? - Answer-You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion. Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citi...

UHC Certification 2023/2024 Exam| Actual Questions and Verified Answers| A Grade Q: A government program, offered only through a private insurance company or other private company approved by Medicare, that provides prescription drug coverage describes which of the following: Answer: Medicare Parts A and B Q: Which of the following statements is true about eligibility requirements for Medicare Prescription Drug Plans? Answer: A consumer must be entitled to Medicare Part A ...

Steps used to control costs of managed care include: - ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...

LA Life, Health & Accident Insurance Series 103 Practice Exam Questions and Answers Already Passed Under which situation must insurable interest exist between the applicant and insured at the time of application? When a third-party applicant names themselves beneficiary. Which of the following is true about a decreasing term life policy? The face amount reaches zero at policy expiration. Which of the following occurs immediately after the application is submitted and the initial premium paid?...

Pharmacy Billing and Reimbursement PTCB Practice Test Questions and Answers Latest Rated A+. Which government insurance plans offers 4 different parts or areas of different coverage? A. MedicareB. Medicaid C. TRICARE D. CHAMPVA 2. DAW/DNS stand for which of the following? A. Dispense as written B. Distribute and work C. Distribution and working D. Dispense as well 3. Which of the following third party plans requires the patient to designate a primary care physician (PCP)? A. Health ...

Multi-Line Insurers - CORRECT ANSWER-________-______ Insurers are insurance carriers that offer more than one line of insurance. False - CORRECT ANSWER-True or False? Stock Insurance Companies are "participating" in that the policyholders receive dividends. Attorney-In-Fact - CORRECT ANSWER-Reciprocal Insurers are managed by an ___________________. Association - CORRECT ANSWER-Contrary to popular opinion, Lloyd's of London is not an insurer but rather an ____________. Limits Catas...