2018 Fl Smmc Dual Eligible Quiz
Dual Eligible Quiz
- 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 pay for the cost of prescription medications that are prescribed by doctors and other healthcare providers. It is a separate part of Medicare that is offered through private insurance companies and can be added to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans. Medicare Part D helps to lower the cost of prescription drugs for individuals who are eligible for Medicare.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, so she wants to know what kind of coverage she has. You look in HealthTrack and see Flora has a QI1 active span. What can you inform Flora about her coverage?
- 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 the Medicare part B premiums.
- 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 the Medicare part B premiums.Explanation
Based on the information in HealthTrack that Flora has a QI1 active span, it indicates that Flora has limited Medicaid coverage that picks up the Medicare part B premiums. Therefore, advising Flora that Medicare is her primary insurance and explaining her limited Medicaid coverage is the correct response.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, is a comprehensive insurance plan that combines the coverage of both Medicare Part A (hospital insurance) and Part B (medical insurance) benefits. It provides additional benefits beyond what Original Medicare offers, such as prescription drug coverage, dental, vision, and hearing services. This option allows individuals to receive their Medicare benefits through private insurance companies approved by Medicare, providing them with more choices and potentially lower costs.Rate this question:
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- 4.
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 her MMA Medicaid plan will help coordinate services between Medicare and Better Health. This means that Better Health will work together with Medicare to ensure that her inpatient stay for her surgery is covered.Rate this question:
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- 5.
When reviewing a recipient’s case, you see they have an active QMB span for their Medicaid eligibility. They also have both a TPL 11 and 19 on file. What eligibility category would be listed for MMA?
- A.
• Mandatory
- B.
• Voluntary
- C.
• Excluded
Correct Answer
C. • ExcludedExplanation
The recipient's eligibility category for MMA would be listed as "Excluded" because they have an active QMB span for their Medicaid eligibility and also have both a TPL 11 and 19 on file.Rate this question:
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- 6.
If an enrollee has Medicare and a MMA Plan, and wants to know who is going to cover their services, what should the agent inform the enrollee?
- A.
• They should contact the MMA plan's case manager. The MMA plan is responsible for coordinating the enrollee'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 enrollee's care with Medicare and ensuring that the MMA plan does not authorize or provide duplicative services.Explanation
If an enrollee has both Medicare and a MMA Plan, the agent should inform the enrollee to contact the MMA plan's case manager. The MMA plan is responsible for coordinating the enrollee's care with Medicare and ensuring that the MMA plan does not authorize or provide duplicative services. This means that the case manager will be able to provide information on which services are covered by each plan and help the enrollee navigate their healthcare coverage effectively.Rate this question:
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- 7.
Irene states she has Medicare and Medicaid. She wants to know who should be covering her doctor's visit today. When reviewing the case, you see that Irene has an active SLMB span for her Medicaid Eligibility. 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.Explanation
Irene should be advised to contact Medicare to determine how her services will be covered. She has an active SLMB span for her Medicaid eligibility, which means that her Medicaid only covers Medicare Part B premiums and not services. Therefore, it is important for Irene to reach out to Medicare to understand how her doctor's visit will be covered.Rate this question:
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- 8.
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 recipient 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 meet the eligibility criteria can receive financial assistance from Medicaid to cover the costs associated with their Medicare coverage, including premiums, deductibles, and coinsurance. This can help alleviate the financial burden on individuals who may struggle to afford these expenses on their own.Rate this question:
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- 9.
The recipient says "Children and Families told me I have Medicaid, how do I use it?" When reviewing the case you see that there is an active QMB span on file. 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 recipient has mentioned that Children and Families informed them about having Medicaid. However, upon reviewing the case, it is identified that there is an active QMB span on file. The correct response is to inform the recipient that they have a limited type of Medicaid called "Qualified Medicare Beneficiary" (QMB). This type of Medicaid assists in covering some of the recipient's Medicare costs, such as premiums, deductibles, and coinsurance. Since Medicare is their primary insurance, the recipient should be advised to contact Medicare to learn how they can receive services.Rate this question:
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- 10.
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 recipient 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 correct answer is that the SLMB Program allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums. This means that individuals who qualify for the SLMB Program can have their Medicare Part B premiums covered by Medicaid, which can help alleviate the financial burden of these premiums. This program is specifically designed to assist individuals who meet certain income and asset requirements and need assistance with their Medicare Part B premiums.Rate this question:
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- 11.
An enrollee has an enrollment into Sunshine Health for both MMA and LTC. They have an MS ACWM code, and when checking the span information, you see they also have an active QMB eligibility span. 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 enrollee 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 enrollee is covered under the Qualified Medicare Beneficiary (QMB) program, which helps pay for premiums, deductibles, and coinsurance under Medicare. This answer provides a comprehensive explanation of the enrollee's coverage and the role of both Medicare and Sunshine Health.Rate this question:
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- 12.
An enrollee wants to know why their plan is ending. When reviewing their case you see that their eligibility was recently changed to QMB Medicaid eligibility. What can you advise them about their coverage?
- 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.
• Their plan is leaving the region and all enrollees are being disenrolled.
- D.
• The recipient lost full Medicaid coverage 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 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 enrollee's plan is ending because they lost their full Medicaid coverage and now only have QMB (Qualified Medicare Beneficiary) coverage. QMB is a limited coverage that assists with paying for Medicare premiums, deductibles, and coinsurance. However, recipients with QMB only cannot enroll in any other plans.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 and can enroll in whatever is being referred to.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 is used to describe individuals who are eligible for both Medicare and Medicaid and have access to the full range of benefits provided by both programs. This includes coverage for medical services, prescription drugs, long-term care, and other necessary healthcare services. Being a Full Benefit Dual Eligible allows individuals to have comprehensive coverage and access to a wide range of healthcare services.Rate this question:
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- 15.
QMB is a coverage that will cover services using straight Medicaid.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because QMB (Qualified Medicare Beneficiary) is a program that provides financial assistance to individuals with low income and limited resources to help pay for Medicare premiums, deductibles, and coinsurance. It is not related to Medicaid coverage.Rate this question:
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Current Version
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Mar 20, 2023Quiz Edited by
ProProfs Editorial Team -
Sep 20, 2017Quiz Created by
AHSFLTrainer
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