2015 Medical Associates - #1 Test

Explanation
MAHP has a cost contract with the Centers for Medicare and Medicaid Services (CMS). This means that MAHP is paid a set amount by CMS to provide healthcare services to Medicare beneficiaries. The cost contract model allows MAHP to receive a predetermined payment for each enrolled beneficiary, rather than being paid based on the actual cost of providing care. This type of contract provides financial stability for MAHP and helps to ensure that Medicare beneficiaries have access to affordable healthcare services.

Explanation
MAHP stands for Medicare Advantage Health Plan, which is an alternative to Original Medicare provided by private insurance companies. While MAHP plans typically cover the Medicare Part B premium, members are still required to pay the Medicare Part B premium in addition to their MAHP plan premium. This is because Medicare Part B covers medical services and outpatient care, and the premium for this coverage is separate from the premium for the MAHP plan. Therefore, the statement that the MAHP Cost Plan member must continue to pay the Medicare Part B premium in addition to the MAHP plan premium is true.

Explanation
MAHP only accepts premium payment methods that are not credit cards. This means that automatic withdrawal from a checking account, automatic withdrawal from a savings account, and coupon booklet are all acceptable methods of payment for premiums. However, credit card payments are not accepted by MAHP.

Explanation
An application cannot be completed and submitted more than 90 days prior to the effective date.

Explanation
The correct answer is $0 because if a member has the MAHP Community Plan, they do not have to pay any copayment for office visits with a network physician. This means that the member can visit a network physician without any out-of-pocket cost.

Explanation
The submission cut-off date for a beneficiary to be effective by the first of one month is the last working day of the preceding month. This means that any submissions made after the last working day of the preceding month will not be processed in time for the beneficiary to be effective by the first of the following month.

Explanation
If MAHP receives an enrollment form on the 1st of a month with a requested effective date of the current month, the member's coverage cannot start on the requested effective date. This is because there is typically a processing time required for the enrollment form to be reviewed and processed. Therefore, the member's coverage would start on a later date, not on the requested effective date.

Explanation
MAHP Cost Plan members have the flexibility to switch to another MAHP plan at the beginning of any month. To do so, they need to complete a new enrollment form before the last working day of the preceding month. This means that members have the opportunity to review and change their plan if they find it necessary or more suitable for their needs. Therefore, the statement is true.

Explanation
The statement is true because MAHP's Service Area is indeed approximately a 60 mile radius of Dubuque, Iowa. Additionally, MAHP is licensed in only certain counties in Iowa, Illinois, and Wisconsin.

Explanation
The statement is true because it clearly states that MAHP is a local health plan owned and operated by the physicians of Medical Associates Clinic. This suggests that the health plan is specifically designed and managed by medical professionals who are part of the clinic, ensuring a higher level of expertise and understanding of healthcare needs.

Explanation
The correct answer is "All of the above". This means that all three services mentioned - routine eye exam, routine podiatry visits, and routine hearing exam - are eligible above and beyond Medicare with a network provider under all three MAHP plans. This implies that individuals covered by these plans can avail these services without any additional cost or limitations.

Explanation
The correct answer is $75 copay. This means that under the Freedom Plan, if a same day surgery service is received out-of-network, the individual would be required to pay a copayment of $75. This copayment is the amount that the individual is responsible for paying out-of-pocket for the service, while the insurance plan covers the remaining costs.

Explanation
MAHP, which stands for Medicare Advantage Health Plan, provides coverage for emergency services to beneficiaries whether they are traveling within the U.S. or outside of the United States. This means that if a beneficiary requires emergency medical attention while traveling, they can receive coverage and assistance under their MAHP plan. Therefore, the statement is true.

Explanation
In urgent or emergent situations when the beneficiary is outside the MAHP Service Area, it is important for them to seek care at the nearest facility. After seeking care, they should then contact the MAHP Health Care Services Department to report the out-of-area emergency. This is necessary to ensure that the beneficiary receives the necessary care and that the MAHP is aware of the situation and can provide any necessary support or assistance.

Explanation
Prescription Drug coverage is not available with MAHP Freedom Plan.

Explanation
If a beneficiary is covered under the MAHP SmartPlan and sees a physician who is not in the network and did not have any authorized referral, the beneficiary would have Original Medicare cost sharing on this claim. This means that the beneficiary would be responsible for paying the cost sharing amounts associated with Original Medicare, such as deductibles, copayments, and coinsurance. The MAHP SmartPlan would not cover these costs since the physician is out of network and there was no authorized referral. Therefore, the statement is true.

Explanation
The correct answer is $15. This means that if a MAHP Freedom Plan beneficiary chooses to go out of network for an office visit, they would have to pay a copay of $15. This suggests that there is a set fee for out-of-network office visits, and it is $15 in this case.

Explanation
Cost Plan beneficiaries are not locked into a plan for the calendar year. This means that they have the flexibility to switch to a different plan at any time during the year if they wish to do so. They are not bound by any contractual obligations that would prevent them from changing their plan. This allows beneficiaries to make changes to their healthcare coverage as their needs and preferences change throughout the year.

Explanation
As a CMS 5 Star Plan, MAHP has the ability to enroll a beneficiary who is currently enrolled in a non 5 Star Plan to a MAHP Plan using the Special Enrollment Period (SEP). This means that beneficiaries have the option to switch to a MAHP Plan if they are currently enrolled in a plan that does not have a 5 Star rating.

Explanation
The statement is false because MAHP Medicare Plans do not cover hearing aids.