Coordination Of Dual Eligible Services: July 2015
.
- 1.
What does Medicare Part D cover?
- A.
Inpatient hospital stay
- B.
Preventive Services
- C.
Doctor's Visits
- D.
Prescription Drugs
Correct Answer
D. Prescription DrugsExplanation
Medicare Part D covers prescription drugs. This means that it helps individuals pay for their necessary medications, reducing the out-of-pocket costs associated with prescription drugs. Inpatient hospital stays, preventive services, and doctor's visits are typically covered under other parts of Medicare, such as Part A and Part B. However, Medicare Part D specifically focuses on providing coverage for prescription medications.Rate this question:
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- 2.
Flora says she received a letter saying she is Medicaid eligible and she wants to choose a plan. She has been advised that the type of Medicaid she has will not allow her to enroll into a plan. Flora wants to know what kind of Medicaid she has and what she needs to do about health coverage. What information should be provided to Flora?
- A.
Tell Flora, she can't choose a plan and discontinue the call.
- B.
Advise Flora that Medicare is her primary insurance and she has limited Medicaid coverage that picks up some of the out of pocket expenses from Medicare.
- C.
Submit a discrepancy log to request for Flora to be enrolled into a plan.
- D.
Advise Flora that she can't pick a plan because she has FFS.
Correct Answer
B. Advise Flora that Medicare is her primary insurance and she has limited Medicaid coverage that picks up some of the out of pocket expenses from Medicare.Explanation
Flora should be advised that Medicare is her primary insurance and she has limited Medicaid coverage that picks up some of the out of pocket expenses from Medicare. This means that Flora cannot choose a plan, as her Medicaid type does not allow her to enroll in one. However, she should be informed about her current health coverage situation and the role of Medicaid in covering some of her expenses.Rate this question:
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- 3.
Medicare Part C is
- A.
A Medicare Advantage Plan that covers both Medicare Part A and Part B insurance benefits.
- B.
Medicare that covers prescriptions only.
- C.
Medicare that covers only inpatient hospital stay.
- D.
Medicare that covers preventative services only.
Correct Answer
A. A Medicare Advantage Plan that covers both Medicare Part A and Part B insurance benefits.Explanation
Medicare Part C, also known as a Medicare Advantage Plan, provides coverage for both Medicare Part A and Part B insurance benefits. This means that individuals who enroll in Medicare Part C will have access to hospital insurance (Part A) as well as medical insurance (Part B) which covers doctor visits, outpatient care, and other medical services. This option combines the benefits of both parts of Medicare into one comprehensive plan.Rate this question:
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- 4.
The QMB Program
- A.
Allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance.
- B.
Allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums.
- C.
Allows qualified individuals the option to enroll into Medicaid Managed Care Plans outside of their region.
- D.
Allows qualified individuals the option to hire a family member to help provide services in the home.
Correct Answer
A. Allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance.Explanation
The QMB Program allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance. This means that individuals who qualify for the program will have their healthcare costs covered by Medicaid, reducing their out-of-pocket expenses for Medicare services. This can be particularly beneficial for low-income individuals who may struggle to afford these costs on their own.Rate this question:
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- 5.
The SLMB Program
- A.
Allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums.
- B.
Allows qualified individuals the option to enroll into Medicaid Managed Care Plans outside of their region.
- C.
Allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance.
- D.
Allows qualified individuals the option to hire a family member to help provide services in the home.
Correct Answer
A. Allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums.Explanation
The SLMB Program allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums. This means that individuals who meet the eligibility criteria can have their Medicaid coverage cover the cost of their Medicare Part B premiums, which helps to reduce their out-of-pocket expenses. This program is designed to provide financial assistance to individuals who may not be able to afford the Medicare Part B premiums on their own.Rate this question:
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- 6.
According to the eligibility information in the hover, this recipient would be __________ for MMA.
- A.
Mandatory
- B.
Voluntary
- C.
Excluded
Correct Answer
C. ExcludedExplanation
Based on the given information, the recipient would be excluded from MMA eligibility.Rate this question:
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- 7.
If a member has Medicare and a MMA Plan, and wants to know who is going to cover their services, the agent should advise the member that
- A.
They should contact the MMA plan's case manager. The MMA plan is responsible for coordinating the member's care with Medicare and ensuring that the MMA plan does not authorize or provide duplicative services.
- B.
They will need to contact AHCA for help with determining which insurance is going to cover their services.
- C.
They can just give all of their health plan cards to the provider they are seeing and let them figure it out.
- D.
They need to contact Medicare to determine what they don't cover and compare that information to what the MMA plan does cover.
Correct Answer
A. They should contact the MMA plan's case manager. The MMA plan is responsible for coordinating the member's care with Medicare and ensuring that the MMA plan does not authorize or provide duplicative services.Explanation
The correct answer is that the member should contact the MMA plan's case manager. This is because the MMA plan is responsible for coordinating the member's care with Medicare and ensuring that the MMA plan does not authorize or provide duplicative services. By contacting the case manager, the member can get accurate information about who will cover their services and avoid any confusion or duplication of services.Rate this question:
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- 8.
Barbara states she needs to know who is going to cover her inpatient stay for her surgery coming up next month. Barbara has Medicare and Better Health for her MMA Medicaid plan. What information should be provided to Barbara?
- A.
Advise Barbara to contact Better Health;the MMA plan will help coordinate services between Medicare and Better Health.
- B.
Advise Barbara that she has Better Health on file and they will cover the services.
- C.
Inform Barbara, that since she has Medicare, Better Health will not cover anything for her.
- D.
Tell Barbara to call the Social Security Administration to find out who is going to cover services.
Correct Answer
A. Advise Barbara to contact Better Health;the MMA plan will help coordinate services between Medicare and Better Health.Explanation
Barbara should be advised to contact Better Health because the MMA plan will help coordinate services between Medicare and Better Health. This means that Better Health will work together with Medicare to ensure that Barbara's inpatient stay for her surgery is covered. By contacting Better Health, Barbara can get the necessary information and assistance regarding the coverage of her services.Rate this question:
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- 9.
Irene states she has Medicare and Medicaid. She wants to know who should be covering her doctor's visit today. What information should be provided to Irene?
- A.
Inform Irene that Medicare will be primary and her Medicaid will be secondary for any visits to the doctor or hospital.
- B.
Advise Irene to contact Medicare to determine how services will be covered. Inform Irene that she has limited Medicaid that covers Medicare part B premiums only, not services.
- C.
Tell Irene that her services will be covered by straight Medicaid.
- D.
Advise Irene that she does not have coverage to receive any services.
Correct Answer
B. Advise Irene to contact Medicare to determine how services will be covered. Inform Irene that she has limited Medicaid that covers Medicare part B premiums only, not services. -
- 10.
The recipient says "Children and Families told me I have Medicaid, how do I use it?" How should you respond?
- A.
"You are covered under a share of cost program. You have to spend a certain amount of your own money before Medicaid will pay. Call DCF for more information on your share of cost."
- B.
"We are just the enrollment broker, call DCF to get an explanation of the type of Medicaid you have. If you need providers call the Medicaid Helpline."
- C.
"You have QMB Medicaid and are covered under straight Medicaid. Call DCF for more information."
- D.
"You have a limited type of Medicaid called "Qualified Medicare Beneficiary" that helps you pay for some of your Medicare costs such as premiums, deductibles and coinsurance. Medicare is your primary insurance, so you'll need to call Medicare to find out how you can receive services."
Correct Answer
D. "You have a limited type of Medicaid called "Qualified Medicare Beneficiary" that helps you pay for some of your Medicare costs such as premiums, deductibles and coinsurance. Medicare is your primary insurance, so you'll need to call Medicare to find out how you can receive services."Explanation
The correct answer explains that the recipient has a limited type of Medicaid called "Qualified Medicare Beneficiary" which helps pay for some of their Medicare costs. It also states that Medicare is their primary insurance and advises them to contact Medicare to find out how they can receive services. This response provides specific information about the recipient's Medicaid coverage and directs them to the appropriate authority for further assistance.Rate this question:
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- 11.
Choose the correct explanation of coverage.
- A.
"You are covered under Sunshine Health. It covers your long-term care and medical services. Medicare will cover any other services that Sunshine does not cover."
- B.
"You have Medicare coverage which is your primary insurance. However, you are enrolled with Sunshine Health which will cover long-term care and medical services that are not covered by Medicare. You are also covered under a 'Qualified Medicare Beneficiary' program that helps pay for premiums, deductibles and coinsurance under Medicare."
- C.
"You have Medicare as your primary insurance. Call Medicare to find out how you will receive services."
- D.
"Since you have QMB, you are not eligible to enroll. QMB is a 'Qualified Medicare Beneficiary' program that helps pay for premiums, deductibles and coinsurance under Medicare. Call Medicare to find out how you can receive services."
Correct Answer
B. "You have Medicare coverage which is your primary insurance. However, you are enrolled with Sunshine Health which will cover long-term care and medical services that are not covered by Medicare. You are also covered under a 'Qualified Medicare Beneficiary' program that helps pay for premiums, deductibles and coinsurance under Medicare."Explanation
The correct answer explains that the individual has Medicare coverage as their primary insurance. However, they are also enrolled with Sunshine Health, which provides coverage for long-term care and medical services that are not covered by Medicare. Additionally, the individual is covered under a 'Qualified Medicare Beneficiary' program, which helps pay for premiums, deductibles, and coinsurance under Medicare.Rate this question:
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- 12.
Why is the plan ending on 7/31/2015?
- A.
The recipient does not have Medicaid anymore.
- B.
The recipient now has QMB Medicaid which means they can use FFS/straight Medicaid to receive their services. Refer to the Medicaid Helpline for a list of providers.
- C.
Staywell is leaving the region and all members are being disenrolled.
- D.
The recipient lost full Medicaid coverage (MII) and now only has QMB. QMB is limited coverage that will help pay for Medicare premiums, deductibles and coinsurance. Recipients with QMB only cannot enroll.
Correct Answer
D. The recipient lost full Medicaid coverage (MII) and now only has QMB. QMB is limited coverage that will help pay for Medicare premiums, deductibles and coinsurance. Recipients with QMB only cannot enroll.Explanation
The plan is ending on 7/31/2015 because the recipient lost full Medicaid coverage (MII) and now only has QMB. QMB is limited coverage that helps pay for Medicare premiums, deductibles, and coinsurance. Recipients with QMB only cannot enroll, so the current plan cannot continue for the recipient.Rate this question:
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- 13.
All QMB recipients are Excluded for enrollment.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement "All QMB recipients are excluded for enrollment" is false. This means that QMB recipients are not excluded from enrolling in something.Rate this question:
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- 14.
A Medicare beneficiary who qualifies to receive all Medicaid services is called a :________________.
- A.
Special Low Income Medicare Beneficiary
- B.
Full Benefit Dual Eligible
- C.
Partial Dual
- D.
Qualified Medicare Beneficiary
Correct Answer
B. Full Benefit Dual EligibleExplanation
A Medicare beneficiary who qualifies to receive all Medicaid services is called a Full Benefit Dual Eligible. This term refers to individuals who are eligible for both Medicare and Medicaid and are entitled to receive the full range of benefits from both programs. They typically have low incomes and may also have certain disabilities or chronic conditions that qualify them for Medicaid coverage. As Full Benefit Dual Eligibles, these individuals have access to comprehensive healthcare coverage and may receive assistance with medical expenses that are not covered by Medicare alone.Rate this question:
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- 15.
This recipient has QMB coverage that will cover services using straight Medicaid.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because QMB coverage does not cover services using straight Medicaid. QMB (Qualified Medicare Beneficiary) coverage is a Medicaid program that helps pay for Medicare premiums, deductibles, copayments, and coinsurance for individuals who are eligible for both Medicare and Medicaid. However, it does not provide coverage for services that are solely covered by straight Medicaid.Rate this question:
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.PNG "According to the eligibility information in the hover, this recipient would be __________ for MMA.")
.JPG "The recipient says \"Children and Families told me I have Medicaid, how do I use it?\" How should you respond?")
.JPG "Why is the plan ending on 7/31/2015?")
.JPG "This recipient has QMB coverage that will cover services using straight Medicaid.")
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