2015 Medical Associates - #1 Test

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Quizzes Created: 42 | Total Attempts: 28,531
Questions: 20 | Attempts: 763

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Medical Quizzes & Trivia

Questions and Answers
  • 1. 

    MAHP has what type of contract with the Centers for Medicare and Medicaid Services (CMS):

    • A.

      Cost

    • B.

      Private Fee for Service

    • C.

      Medigap

    • D.

      No Contract

    Correct Answer
    A. Cost
    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.

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  • 2. 

    The MAHP Cost Plan member must continue to pay the Medicare Part B premium in addition to the MAHP plan premium

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    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.

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  • 3. 

    MAHP only can accept premium payment methods except:

    • A.

      Automatic withdrawal from a checking account

    • B.

      Coupon booklet

    • C.

      Automatic withdrawal from a savings account

    • D.

      Credit Card

    Correct Answer
    D. Credit Card
    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.

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  • 4. 

    An application can be completed and submitted more than 90 days prior to the effective date.

    • A.

      True

    • B.

      False

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

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  • 5. 

    If a member has the MAHP Community Plan, the office visit copayment with a network physician is:

    • A.

      $0

    • B.

      $10

    • C.

      $15

    • D.

      $20

    Correct Answer
    A. $0
    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.

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  • 6. 

    For a beneficiary to be effective by the first of one month, what is the submission cut-off date?

    • A.

      1st of the month

    • B.

      15th of the month

    • C.

      25th of the month

    • D.

      Last working day of the preceding month

    Correct Answer
    D. Last working day of the preceding month
    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.

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  • 7. 

    If MAHP receives an enrollment form on the 1st of a month (i.e. Nov 1st) with a requested effective date of the current month (i.e. Nov 1st), the member’s coverage can start on the requested effective date.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    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.

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  • 8. 

    MAHP Cost Plan members can change to another MAHP plan for the first of any month provided a new enrollment form is completed by the last working day of the preceding month.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    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.

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  • 9. 

    MAHP’s Service Area is approximately a 60 mile radius of Dubuque, Iowa and is licensed in only certain counties in Iowa, Illinois and Wisconsin.

    • A.

      True

    • B.

      False

    Correct Answer
    A. 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.

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  • 10. 

    MAHP is local health plan which is owned and operated by the physicians of Medical Associates Clinic.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    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.

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  • 11. 

    Under all three MAHP plans, the following services are eligible above and beyond Medicare with a network provider:

    • A.

      1 routine eye exam per calendar year

    • B.

      6 routine podiatry visits per calendar year

    • C.

      1 routine hearing exam per calendar year

    • D.

      All of the above

    Correct Answer
    D. All of the above
    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.

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  • 12. 

    Under the Freedom Plan, a same day surgery service received out-of-network would have the following copay:

    • A.

      $0 copay

    • B.

      $15 copay

    • C.

      $75 copay

    • D.

      $100 copay

    Correct Answer
    C. $75 copay
    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.

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  • 13. 

    MAHP covers emergency services for beneficiaries if they travel both within the U.S. and outside the United States.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    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.

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  • 14. 

    In an urgent or emergent situation when the beneficiary is out of the MAHP Service Area, the beneficiary should seek care at the nearest facility and call the MAHP Health Care Services Department after seeking care to report the out of area emergency.

    • A.

      True

    • B.

      False

    Correct Answer
    A. 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.

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  • 15. 

    Prescription Drug coverage is available with MAHP Freedom Plan:

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Prescription Drug coverage is not available with MAHP Freedom Plan.

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  • 16. 

    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.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    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.

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  • 17. 

    The office visit copay for a MAHP Freedom Plan beneficiary who chooses to go out of network would be:

    • A.

      $0

    • B.

      $10

    • C.

      $15

    • D.

      $25

    Correct Answer
    C. $15
    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.

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  • 18. 

    Cost Plan beneficiaries are not locked into a plan for the calendar year.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    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.

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  • 19. 

    As a CMS 5 Star Plan, MAHP can enroll a beneficiary who is in a non 5 Star Plan to a MAHP Plan using the Special Enrollment Period (SEP).

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    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.

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  • 20. 

    MAHP Medicare Plans cover hearing aids.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement is false because MAHP Medicare Plans do not cover hearing aids.

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