ennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate? A. All Out-of-Pocket costs she pays toward her health care and prescription drug expenses would count toward the Out-of-Pocket Maximum. B. Jennifer's costs for prescription drugs and any benefits not covered by Original Medicare will count toward the Out-of-Pocket Maximum. C. The Out-of-Pocket Maximum includes any costs she pays toward the plan, such as plan premiums and health care expenses. D. The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B services. ✔✔a Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? a. When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA plan. b. The consumer will be automatically disenrolled from the MA plan when the Medicare Supplement plan takes effect. c. The member who is leaving the MA Plan does not need a valid election period to disenroll from the MA Plan. d. An MA Plan and a Medicare Supplement Insurance Plan work together. ✔✔a Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program? a. Medicaid b. Low Income Subsidy c. Original Medicare ✔✔c Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) a. An MA Plan is part of Medicare and is also called Part C. b. An MA Plan does not have to provide benefits equivalent to Original Medicare. c. An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often includes Medicare prescription drug coverage (Part D). d. An MA Plan is a health Plan option approved by Medicare and offered by private insurance companies. ✔✔a, c, d Which of the following is NOT an eligibility requirement for enrollment in a Medicare Advantage Plan? a. Does not have any pre-existing conditions such as diabetes or End Stage Renal Disease (ESRD) b. IS enrolled in Medicare part B c. Is entitled to Medicare Part A d. Resides in the plan's service area ✔✔a When is Mary's Medicare Supplement Open Enrollment period if she turns 65 on September 23, 2021, and her Medicare Part B effective date is September 1, 2021? a. The month of September 2021 b. October 15, 2021, through December 7, 2021 c. June 2021 through December 2021 d. September 2021 through February 2022 ✔✔d Which of the following statements is correct about HMO MA Plans? a Most benefits are covered out-of-network but at a higher cost. b There are no exceptions to the provider neuork requirement for obtaining certain services from out-of-network providers. c Members that use out-of-network providers for routine office visits must pay a penalty in addition to any copayment. d Members must receive covered services from contracted network providers. ✔✔d Which of the following is a fact about Medicare Prescription Drug Plans? a Medicare Part D is part of Medicare Supplement Insurance Plans b To enroll, the consumer must reside in the plan's service area c All drugs are covered d Benefits never vary by plan ✔✔b Which of the following statements is NOT true about the Coverage Gap? a Some plans offer additional coverage through the coverage gap, usually at a higher monthly plan premium The use of lower cost generic medications may prevent the member from reaching the coverage gap b For 2022, the coverage gap begins when the member has incurred $4,430 in medication spending for the year c If a member reaches the coverage gap, they will have access to the Plan's negotiated pharmacy discount rate for Medicare Part D medications d All members reach the Coverage Gap ✔✔d Which of these statements is NOT true about the drug utilization management (UM) rules? a If a member or the prescriber believes that one of the coverage rules should be waived, they can ask the plan for an exception. b Prior authorization, quantity limit, and step therapy are some examples of UM rules. c If a medication has a UM rule, the member will not be able to get that medication. d If a medication has a UM rule, it must be disclosed to the consumer. ✔✔c What is the amount added to the member's monthly plan premium if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for 63 or more continuous days? a Late Enrollment Deductible (LED) b Late Election Penalty (LEP) c Late Enrollment Premium (LEP) d Late Enrollment Penalty (LEP) ✔✔d Which of the following best defines Medicare Part D? a It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. b It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical and hospitalization coverage. c It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical coverage. d It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides hospitalization coverage. ✔✔a How does a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? a Through a combination of subsidies and annual refund checks b Such financial assistance will no longer be available as of January 1, 2022 c Through subsidies such as lower or no monthly plan premiums and lower or no copayments d By receiving annual checks with a refund based on a predetermined percentage of Part D costs ✔✔c Which of the following is true about Medicare Supplement Insurance Plans? a They can only be purchased during the Annual Election Period (AEP). b Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. c To see a specialist, insured members must obtain referrals from a primary care provider. d They are regulated by the Centers for Medicare & Medicaid Services (CMS). ✔✔b In which two parts of Medicare is enrollment generally automatic for eligible consumers who are receiving Social Security benefits, UNLESS they choose to delay their coverage? a Parts B and D b Parts A and D c Parts A and B d Parts C and D ✔✔c Which of the following consumers are eligible for Medicare if other eligibility requirements are met?