Coordination Of Dual Eligible Services

15 Questions | Total Attempts: 289

SettingsSettingsSettings
Please wait...
Coordination Of Dual Eligible Services

.


Questions and Answers
  • 1. 
    Check all that apply: Medicare is a federal health insurance program for
    • A. 

      People with disabilities who have been receiving Social Security Disability Insurance (SSDI) for more than 24 months

    • B. 

      People 65 or older

    • C. 

      Healthy children that need medical coverage

    • D. 

      People with End-Stage Renal Disease

    • E. 

      Individuals diagnosed with Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig's Disease

  • 2. 
    What does Medicare Part D cover?
    • A. 

      Inpatient hospital stay

    • B. 

      Prescription Drugs

    • C. 

      Preventive Services

    • D. 

      Doctor's Visits

  • 3. 
    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. 

      Submit a discrepancy log to request for Flora to be enrolled into a plan.

    • C. 

      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.

    • D. 

      Advise Flora that she can't pick a plan because she has FFS.

  • 4. 
    Original Medicare is Medicare services covered through a Medicare plan. True or False?
    • A. 

      True

    • B. 

      False

  • 5. 
    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.

  • 6. 
    People that receive Medicare may be responsible for cost sharing, which may include
    • A. 

      Monthly premium payments.

    • B. 

      Co-pays.

    • C. 

      Coinsurance.

    • D. 

      Deductibles.

    • E. 

      All of the above.

  • 7. 
    Medicare beneficiaries who qualify to receive all Medicaid services are called
    • A. 

      Medically Needy.

    • B. 

      Full Benefit Dual Eligibles.

    • C. 

      Qualified Medicare Beneficiaries.

    • D. 

      Partial Duals.

  • 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 that she has Better Health on file and they will cover the services.

    • B. 

      Inform Barbara, that since she has Medicare, Better Health will not cover anything for her.

    • C. 

      Advise Barbara to contact Better Health to determine how the services are going to be covered.

    • D. 

      Tell Barbara to call the Social Security Administration to find out who is going to cover services.

  • 9. 
    The QMB 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.

  • 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 member to help provide services in the home.

  • 11. 
    According to the eligibility information in the hover, this recipient would be  __________ for MMA. 
    • A. 

      Mandatory

    • B. 

      Voluntary

    • C. 

      Excluded

  • 12. 
    If a recipient has Medicare and Medicaid, Medicare is the primary insurance.
    • A. 

      True

    • B. 

      False

  • 13. 
    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 will need to contact AHCA for help with determining which insurance is going to cover their services.

    • B. 

      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.

    • 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.

  • 14. 
    Susan has Medicare and Medicaid.  She wants to know which MMA plan is affiliated with her Medicare plan.  How should the agent proceed?
    • A. 

      Refer Susan to Medicare.

    • B. 

      Advise Susan which MMA plans sounds similar to the Medicare plan she has.

    • C. 

      Refer Susan to the AHCA Medicaid Helpline.

    • D. 

      Advise Susan to contact the Social Security Administration to obtain a list of MMA plans affiliated with Medicare plans.

  • 15. 
    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.

    • B. 

      Advise Irene to contact Medicare to determine how services will be covered. Inform Irene that the type of Medicaid she has does not cover services and refer her to DCF for more information on her Medicaid coverage.

    • 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.

Back to Top Back to top