2015 Health Alliance - Wa 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 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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