2015 Health Alliance - Il Private Exchange Exam - Medicare
15 Questions
| Attempts: 1245
Questions and Answers
- 1.Health Alliance Medicare received a CMS Star Rating on our HMO plan of:
- A.
4 stars
- B.
3 stars
- C.
3.5 stars
- D.
4.5 stars
- 2.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
- 3.A Medicare Advantage member has rights to file an Appeal or Grievance for any level of dissatisfaction with a plan.
- A.
True
- B.
False
- 4.The HMO 20 copayments have changed for 2015 plans. Which of the following accurately reflects the pharmacy copayments?
- A.
Tier 1 = $6; Tier 2 = $20; Tier 3 = $40; Tier 4 = 33%; Tier 5 = 30%
- B.
Tier 1 = $6; Tier 2 = $30; Tier 3 = $72; Tier 4 = 33%
- C.
Brand Deductible: $220; Tier 1 = $0 at Walmart/$10 others; Tier 2 = $33; Tier 3 = $45; Tier 4 = $95; Tier 5 = 27%
- D.
Tier 1 = $6; Tier 2 = $36; Tier 3 = $76; Tier 4 = 20%
- 5.Health Alliance Medicare does not have a yearly medical deductible on the HMO plans and PPO plans.
- A.
True
- B.
False
- 6.The ambulance copayment on PPO 10 Rx for in-network and out-of-network is
- A.
$0
- B.
$100
- C.
$50
- D.
10%
- 7.Health Alliance Medicare has a closed formulary for all Part D individual plans.
- A.
True
- B.
False
- 8.An individual beneficiary can enroll in our Medicare Advantage HMO and a different plan’s PDP:
- A.
True
- B.
False
- 9.The Basic PDP monthly premium is?
- A.
%51
- B.
%107
- C.
$75.90
- D.
$120
- 10.The Out-of-Pocket Maximum on the HMO Basic plan option is:
- A.
$1,500
- B.
$2,600
- C.
$4,500
- D.
$5,050
- 11.The HMO 20 plan has a deductible:
- A.
True
- B.
False
- 12.The Specialty Office Visit copayment on PPO10 in-network is:
- A.
$10
- B.
$15
- C.
$20
- D.
$30
- 13.What is the Inpatient Hospitalization copayment on HMO 40?
- A.
$250 per admission
- B.
$500 per admission
- C.
$175 a day for days 1-7
- D.
$100 a day for each day in hospital
- 14.Beneficiaries who want Medicare Advantage HMO or PPO and Medicare Part D must enroll in both with the same company.
- A.
True
- B.
False
- 15.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
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