2015 Summacare Mapd

19 Questions | Total Attempts: 562

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2015 Summacare Mapd


Questions and Answers
  • 1. 
    Mr. Flanagan is interested in enrolling the Ruby plan in 2015. However, he wants to know what his monthly premium will be. What must be confirmed before being able to advise this member what his premium amount will be?
    • A. 

      County Residence - Either Northeast or Northwes

    • B. 

      Eligibility for a Special Election Period

    • C. 

      Payment Method via Auto Debit

  • 2. 
    A Sapphire plan member will pay the same out-of-pocket cost regardless if the service is rendered in or out-of-network.
    • A. 

      True

    • B. 

      False

  • 3. 
    SummaCare Medicare Advantage members are not financially responsible for Medicare's Part B premium because they are enrolled in a Medicare Advantage plan, not Original Medicare.
    • A. 

      True

    • B. 

      False

  • 4. 
    All Ruby plan members will have the same monthly premium amount, regardless of county residence.
    • A. 

      True

    • B. 

      False

  • 5. 
    Individuals who enroll in the Topaz plan will have a $100 Part D deductible for Tier 3 and Tier 4 prescriptions.
    • A. 

      True

    • B. 

      False

  • 6. 
    Medicare's Annual Election (AEP) period is from ___ through ___.
    • A. 

      October 1 - December 31

    • B. 

      October 15 - December 7

    • C. 

      October 15 - December 31

    • D. 

      October 15 - January 31

  • 7. 
    The services covered under the four SummaCare Medicare Advantage plan options are identical. The main difference is in the premium and out-of-pocket amounts.
    • A. 

      True

    • B. 

      False

  • 8. 
    SummaCare's Medicare Advantage plans are individual plans.
    • A. 

      True

    • B. 

      False

  • 9. 
    SummaCare Medicare Advantage members may select a Primary Care Physician (PCP) and may change their PCP at any time. However, members do not have to obtain a PCP referral to see a specialist.
    • A. 

      True

    • B. 

      False

  • 10. 
    Services rendered by any provider, regardless of network affiliation, will be covered at the in-network benefit rate as long as the service is provided within the 41-county service area.
    • A. 

      True

    • B. 

      False

  • 11. 
    Services rendered by an out-of-network provider will result in the out-of-network benefit under the Emerald and Sapphire plans and no benefit under the Ruby plan except for which of the three following services? Please check all that apply.
    • A. 

      Emergency Room Services

    • B. 

      Urgent Care Services

    • C. 

      Dialysis

    • D. 

      Home Health Care

  • 12. 
    SummaCare's Medicare Advantage network service area consists of 41 counties in northern Ohio.
    • A. 

      True

    • B. 

      False

  • 13. 
    SummaCare's Medicare Advantage plans do not have a wrap provider network outside of the 41-county service area and members should confirm that providers accept Medicare assignment when accessing service outside the service area to avoid being balance billed.
    • A. 

      True

    • B. 

      False

  • 14. 
    SummaCare's Medicare Advantage plans use a formulary that is a list of prescription drugs, deemed Part D by CMS, which are covered by the plan.
    • A. 

      True

    • B. 

      False

  • 15. 
    Network pharmacies exist nationwide. However, there is out-of-network drug coverage under SummaCare's Medicare Advantage plans.
    • A. 

      True

    • B. 

      False

  • 16. 
    During the Part D initial coverage limit, members will typically pay various co-pay amounts for their prescriptions based on the prescription's tier level.
    • A. 

      True

    • B. 

      False

  • 17. 
    Once a member's total drug charges reaches $2,960, the member will enter into the drug coverage gap, or sometimes referred to the 'donut hole', where members will have to pay 65% of the cost for Tier I and II drugs and 45% for Tier Ill, IV and V drugs.
    • A. 

      True

    • B. 

      False

  • 18. 
    The shingles vaccine, Zostavax, is covered under the Part D benefit.
    • A. 

      True

    • B. 

      False

  • 19. 
    One routine physical exam is covered per year under SummaCare's Medicare Advantage plans.
    • A. 

      True

    • B. 

      False