2015 Health Alliance - Wa Private Exchange Exam - Medicare

20 Questions | Total Attempts: 1042

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2015 Health Alliance - Wa Private Exchange Exam - Medicare

Questions and Answers
  • 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 Companion 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 Companion HMORx plan under Health Alliance Medicare does not have a yearly medical deductible.
    • A. 

      True

    • B. 

      False

  • 5. 
    The outpatient surgery copayment on Companion PlusRx (HMO):
    • A. 

      $0

    • B. 

      $100

    • C. 

      $150

    • D. 

      10%

  • 6. 
    Health Alliance Medicare has a closed formulary for both Companion and Companion Plus Rx Part D individual plans.
    • 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 Companion PlusRx monthly premium is?
    • A. 

      $95

    • B. 

      $75

    • C. 

      $150

    • D. 

      $50

  • 9. 
    The Out-of-Pocket Maximum on the Companion HMO plan option is:
    • A. 

      $2,500

    • B. 

      $3,400

    • C. 

      $1,500

    • D. 

      $4,900

  • 10. 
    The Companion HMORx plan has a Part D deductible on brand drugs:
    • A. 

      True

    • B. 

      False

  • 11. 
    The Specialty Office Visit copayment on Companion PlusRx (HMO) is:
    • A. 

      $10

    • B. 

      $15

    • C. 

      $20

    • D. 

      $30

  • 12. 
    What is the Inpatient Hospitalization copayment on Companion HMO?
    • A. 

      $250 per admission

    • B. 

      $500 per admission

    • C. 

      $270 a day for days 1-7

    • 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. 
    Companion HMO and Companion PlusRx HMO both have a $65 Emergency Room copayment?
    • A. 

      True

    • B. 

      False

  • 16. 
    What is the copayment for diagnostic laboratory services on Companion HMO?
    • A. 

      $50

    • B. 

      $30

    • C. 

      $10

    • D. 

      $40

  • 17. 
    What is the Companion PlusRx HMO Skilled Nursing Facility copayment for days 1-20?
    • A. 

      $0

    • B. 

      $25

    • C. 

      $30

    • D. 

      $10

  • 18. 
    What is the copayment for Primary Care services under the Companion PlusRx plan?
    • A. 

      $30

    • B. 

      $25

    • C. 

      $40

    • D. 

      $10

  • 19. 
    What is the 2015 premium for the Companion HMO plan?
    • A. 

      $39

    • B. 

      $22

    • C. 

      $77

    • D. 

      $52

  • 20. 
    An enrollee must continue to pay his or her Part B premium.
    • A. 

      True

    • B. 

      False

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