2015 Health Alliance - Il Private Exchange Exam - Medicare

15 Questions | Total Attempts: 1201

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2015 Health Alliance - Il Private Exchange Exam - Medicare

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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