Coordination Of Dual Eligible Services: July 2015

15 Questions | Total Attempts: 257

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Coordination Of Dual Eligible Services: July 2015

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Questions and Answers
  • 1. 
    What does Medicare Part D cover?
    • A. 

      Inpatient hospital stay

    • B. 

      Preventive Services

    • C. 

      Doctor's Visits

    • D. 

      Prescription Drugs

  • 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.

  • 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.

  • 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.

  • 5. 
    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.

  • 6. 
    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.

  • 7. 
    According to the eligibility information in the hover, this recipient would be  __________ for MMA. 
    • A. 

      Mandatory

    • B. 

      Voluntary

    • C. 

      Excluded

  • 8. 
    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.

  • 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.

  • 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."

  • 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."

  • 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.

  • 13. 
    All QMB recipients are Excluded for enrollment.
    • A. 

      True

    • B. 

      False

  • 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

  • 15. 
    This recipient has QMB coverage that will cover services using straight Medicaid.
    • A. 

      True

    • B. 

      False

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