Medicare advantage plans Study guides, Class notes & Summaries

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 enrollmen...

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...

AHIP 2024 final exam | Questions and Verified Answers | Mrs. Park | Latest Version Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance? -----Correct Answer---- -She should contact her state Medicaid agency to see if she qualifies forprograms that can help with Medicare costs for which she is responsible. Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medica...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS |A+ GRADE Q: Agent Jacob learns that Emily, the consumer with whom he is meeting, is the authorized legal representative for her father. What must Jacob explain to Emily when completing an Enrollment Application for her father? Answer: Jacob must explain that Emily will sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indic...

UHC 2024 AHIP - Medicare Basics Assessment (Medicare Advantage [non-SNP], Prescription Drug and Medicare Supplement Plans)

AHIP 2023/2024 TEST BANK 200 QUESTIONS WITH ANSWERS Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program? - ANSWER They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs (W) Mr...

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...

UNITED HEALTHCARE (UHC) – ETHICS AND COMPLIANCE LATEST 2023-2024 EXAM| ACTUAL QUESTIONS AND VERIFIED ANSWERS Version 2 |A+ GRADE Q: John has Power of Attorney to act on behalf of his mother. What does that mean when it comes to his mother enrolling in a Medicare Advantage Plan? Answer: John may sign the Enrollment Application and must be able to provide documentation upon request by the Plan that indicates his authority under state law to enroll his mother. Q: In which of the...

UHC certification Exam Questions & Answers 2023/2024 Medicare - ANSWER-Federal health insurance program Medicare is administered by whom? - ANSWER-CMS ( Centers for medicare and medicaid services) Parts A & B of medicare are - ANSWER-federal health insurance program referred to as original medicare Part A? - ANSWER-Hospital insurance Part B? - ANSWER-Medical insurance What doesnt medicare cover? - ANSWER-routine dental, eye care hearing exam,deductibles, coinsurance and copayme...

Exam 1: NUR257/ NUR 257 (New 2023/ 2024 Update) Aging and Chronic Illness in Nursing Exam Review| 100% Correct- Galen QUESTION are eligibility? does medicare cover Answer: be eligible for social security t services & must be medically necessary QUESTION costs of medicare Answer: ed by employer & employee tax of 2.9% iciary in form of premiums, deductibles, co-pays QUESTION medicare part A Answer: care or short term rehab if receive social sec...