2015 Health Alliance - Midwest Private Exchange Exam - Medicare
- 1.The Choice90Rx program means members can receive a 90-day supply of certain drugs at:
- A.
Two copayments for 90 day supply at Walmart and Sam’s (preferred pharmacy)
- B.
Three copayments for 90 day supply at any other contracted pharmacies
- C.
All the above
- 2.A Medicare Advantage member has rights to file an Appeal or Grievance for any level of dissatisfaction with a plan.
- A.
True
- B.
False
- 3.Which of the following accurately reflects the pharmacy copayments for the Guide HMORx plan?
- A.
Tier 1 = $6; Tier 2 = $20; Tier 3 = $40; Tier 4 = 33%; Tier 5 = 30%
- B.
Brand Deductible $310; Tier 1 = $6; Tier 2 = $30; Tier 3 = $72; Tier 4 = 33%
- C.
Brand Deductible: $70; Tier 1 = $0 at Walmart/$8 others; Tier 2 = $33; Tier 3 - $45; Tier 4 = $95; Tier 5 = 31%
- D.
Tier 1 = $6; Tier 2 = $36; Tier 3 = $76; Tier 4 = 20%
- 4.The Guide HMORx plan under Health Alliance Medicare does not have a yearly medical deductible.
- A.
True
- B.
False
- 5.The outpatient surgery copayment on Guide Plus HMORx:
- A.
$175
- B.
$100
- C.
20%
- D.
10%
- 6.Health Alliance Medicare has a closed formulary for the both the Guide HMORx plan and the Guide Plus HMO Rx plan.
- A.
True
- B.
False
- 7.An individual beneficiary can enroll in our Medicare Advantage HMO and a different plan’s PDP:
- A.
True
- B.
False
- 8.The Guide Plus HMORx monthly premium is?
- A.
$0
- B.
$39
- C.
$45
- D.
$50
- 9.The Out-of-Pocket Maximum on the Guide HMORx plan option is:
- A.
$3,400
- B.
$4,500
- C.
$1,500
- D.
$6,700
- 10.The Guide PPORx plan has a Part D deductible on brand drugs:
- A.
True
- B.
False
- 11.The Specialty Office Visit copayment on Guide HMORx is:
- A.
$10
- B.
$15
- C.
$30
- D.
$50
- 12.What is the in-network Inpatient Hospitalization copayment on Guide PPORx?
- A.
$250 a day for days 1-8
- B.
$500 per admission
- C.
$225 a day for days 1-8
- D.
$100 a day for each day in hospital
- 13.Beneficiaries who want Medicare Advantage HMO or PPO and Medicare Part D must enroll in both with the same company.
- A.
True
- B.
False
- 14.A beneficiary can be in only one Medicare Advantage/Part D plan at a time. Successful enrollment in one plan will automatically terminate enrollment in another Medicare health plan or prescription drug plan.
- A.
True
- B.
False
- 15.Guide Plus HMORx has a $65 Emergency Room copayment?
- A.
True
- B.
False
- 16.What is the copayment for diagnostic laboratory services on Guide HMORx?
- A.
10%
- B.
$30
- C.
20%
- D.
$40
- 17.What is the Guide PPORx Skilled Nursing Facility copayment for days 1-20?
- A.
$25
- B.
$50
- C.
$30
- D.
$0
- 18.What is the copayment for Primary Care services under the Guide HMORx plan?
- A.
$30
- B.
$25
- C.
$40
- D.
$20
- 19.What is the 2015 premium for the Guide PPORx plan?
- A.
$39
- B.
$95
- C.
$77
- D.
$56
- 20.An enrollee must continue to pay his or her Part B premium.
- A.
True
- B.
False
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