2015 The Health Plan Test

All of the statements provided in the question are true regarding Medicare Supplement plans. Applicants who are not in a guaranteed issue period must complete a health question section. However, if a person is in a guaranteed issue period, they will not be subject to medical underwriting. Additionally, if enrollment in a Medicare Supplement plan is approved by THP, Pre-Ex (pre-existing condition) will not be imposed.

In 2014, SecureCareHMO received a 4-star rating in both the Ohio Valley/Mountaineer regions and the HomeTown region.

The statement is true because the SecureChoicePPO plan includes tertiary hospitals in its network. This means that individuals with this plan can receive medical services from these hospitals without having to pay out-of-network fees. Tertiary hospitals are typically large medical centers that offer specialized and advanced care, making them an important part of the network for individuals who require complex medical treatments or procedures.

The in-network copay/coinsurance for chemotherapy on the SecureCareHMO and SecureChoicePPO plans is 20%. This means that the insured individual will be responsible for paying 20% of the cost of chemotherapy treatment, while the insurance plan will cover the remaining 80%.

SecureCareHMO members are required to obtain a referral in order to visit a tertiary hospital for non-urgent or non-emergent situations. This means that they cannot directly go to a tertiary hospital without a referral from their primary care physician or another healthcare provider. This referral system helps to ensure that members receive appropriate and necessary care, and also helps to manage healthcare costs by directing patients to the most appropriate level of care.

The initial limit for Part D prescription drugs in 2015 was $2,960. This means that beneficiaries would have to pay out of pocket for their prescription drugs until they reach this amount. Once they reach the initial limit, they would enter the coverage gap, also known as the "donut hole," where they would be responsible for a percentage of the drug costs until they reach the catastrophic coverage threshold.

In 2015, only the Ohio Valley/Mountaineer regions' SecureChoice Option II PPO offers coverage for Tier 1- Preferred Generic, Part D drugs through the coverage gap. This means that individuals in these regions who have this specific plan will have their Tier 1- Preferred Generic, Part D drugs covered even during the coverage gap. The other plans mentioned, HomeTown region's SecureCareHMO Option II & IV and all other SecureCareHMO or SecureChoicePPO plans, do not offer any coverage for Part D drugs through the coverage gap.

The statement is false because it states that The Health Plan/THP will continue to offer SecureChoice PPO and SecureAdvantage RX PDP plans in all regions, but it does not specify whether this is for the year 2015 or any other year. Therefore, we cannot determine if the statement is true or false based on the given information.

The correct answer states that only certain benefits have a POS (in-network/out-of-network) option. This means that not all benefits under the SecureCare POS plan offer the choice of going in-network or out-of-network. Some benefits may only be available in-network, while others may have the option to choose between in-network and out-of-network providers. Additionally, the answer does not mention anything about an out-of-network deductible, so we cannot conclude that there is one based on the given information.

All of the statements provided in the options are true. The first statement states that there are Medicare Supplement Plans that require the insured to pay copays. The second statement mentions that THP Medicare Supplement plans are standardized policies, with the only difference being the offered plans and monthly premiums compared to other insurance carriers. The third statement confirms that there are Medicare Supplement plans that require the insured to pay the Part A and/or Part B deductible. Therefore, all of the statements are correct.

The correct answer is HomeTown region’s SecureCareHMO Option IV. This plan does not include a routine Vision Benefit.

Medicare Advantage plans are specific to certain service areas, and enrollees must reside within the designated service area for their selected plan in order to be eligible for coverage. This requirement ensures that individuals have access to the healthcare providers and services included in their plan's network within their local area. Therefore, the statement is true.

In 2015, the Ohio Valley, Mountaineer, and HomeTown regions will not offer the SecureCare POS plan.

The out-of-pocket maximum is the maximum amount that a member will have to pay in copays or coinsurance for medical expenses in a calendar year. Once the member reaches this maximum, their insurance plan will cover 100% of the remaining medical costs for the rest of the year. This means that after reaching the out-of-pocket maximum, the member will not have to pay any more copays or coinsurance for the rest of the year. Therefore, the statement is true.

The SecureCare POS plan is available in Kanawha county, West Virginia.

The 2015 annual out-of-pocket maximum for a SecureCareHMO plan member could be $3,600 or $6,700, depending on the plan they choose. This means that regardless of the total cost of medical expenses incurred throughout the year, the maximum amount the member would have to pay out of their own pocket is either $3,600 or $6,700, depending on the plan. Option A and C are both correct because they include the possible out-of-pocket maximum amounts.

The given answer is correct because it includes SecureCareHMO Option I, II, and IV, which were mentioned in the options available in 2015. Additionally, it also includes Medicare Supplement plans, which were not explicitly mentioned but can be assumed to be included as it states "All of same plans offered in 2014." Therefore, the answer includes all the mentioned plans and is the correct choice.

The correct answer is County. In 2015, the Ohio Valley and Mountaineer Regions were split into two segments, and these segments were determined by the county. This means that the division of the regions was based on the specific counties within them. Zip codes and cities were not the determining factors for the segmentation.

The Skilled Nursing Facility copay on all Health Plan Medicare Advantage plans for days 1-20 is $0. This means that there is no copay required for the first 20 days of skilled nursing facility care under these plans.

In both Segment 1 (S1) and Segment 2 (S2), the benefits offered by SecureCareHMO and SecureChoicePPO plans are the same. However, the premiums charged for these plans differ between the two segments.

The annual out of pocket maximum for the SecureChoicePPO plans is $6,700 in-network and $10,000 in and out-of-network combined. This means that once a person reaches $6,700 in out-of-pocket expenses for in-network services or $10,000 for both in and out-of-network services, the insurance plan will cover 100% of the remaining costs for the rest of the year. This ensures that individuals are protected from excessive medical expenses and have a limit on their financial responsibility.

Both the SecureChoicePPO and SecureAdvantageRX PDP plans have been eliminated in the HomeTown region.

The explanation for the given correct answer is that diagnostic radiology procedures such as MRI, CT, MRA, PET, and SPECT do require a copay when performed in a plan physician's office. This means that if a person undergoes any of these procedures in the office of a physician who is part of their insurance plan, they will have to pay a copay as part of their medical expenses. Unlike labwork and x-rays, which may not require a copay in certain situations, diagnostic radiology procedures always have a copay when done in a plan physician's office.

The correct answer states that SecureChoicePPO is a local Medicare Advantage PPO offered in the Ohio Valley and Mountaineer regions. This means that the plan is available only in these specific regions and not in other areas such as Pennsylvania or West Virginia.

THP Medicare Supplement plans are offered in Ohio and West Virginia. This means that residents of these two states have the option to enroll in THP Medicare Supplement plans.

A member would pay 20% for preventive services in the situation of SecureChoicePPO out-of-network preventive services. This means that if a member chooses to receive preventive services from a provider who is not in the network of the SecureChoicePPO plan, they would be responsible for paying 20% of the cost of those services.

The correct answer is that in 2015 there are 4 tiers of prescription drug copays. This is because the statement mentions that there are only 4 tiers: Tier 1 for Preferred Generic drugs, Tier 2 for Non Preferred Generic drugs, Tier 3 for Preferred Brand drugs, and Tier 4 for Specialty drugs. The statement does not mention a Tier 5 for Specialty drugs, so the correct answer is that there are only 4 tiers in total.

The SecureCareHMO and SecureChoicePPO plan coverage limit for the VSP routine eyewear benefit is $100 every two years. This means that individuals covered under these plans can receive up to $100 towards the cost of their eyewear every two years.

The correct answer is 100. This means that for the preferred diabetic supplies, a $7.50 co-payment is applicable for a one month supply up to a quantity of 100 without requiring prior authorization. Beyond this quantity, prior authorization may be necessary for the co-payment to apply.

SecureCareHMO members cannot get their non-Medicare covered eyeglasses at any provider and still get the plan benefits.

The copay for a one month supply of a Tier 2 Non-Preferred Generic drug under the SecureCareHMO Opt II plan in the Ohio Valley/Mountaineer region (H5151-011) is $20.

The correct answer is Day 21. This means that on the 21st day of a Skilled Nursing Facility stay, all SecureCareHMO and SecureChoicePPO plans will start applying a copay to the Skilled Nursing benefit. This implies that for the first 20 days, there will be no copay applied to the benefit.

Premiums for THP Medicare Supplement plans cannot increase at any time during the year. Once an individual enrolls in a Medicare Supplement plan, the premium is typically locked in for a specific period, usually one year. The premium may increase after this initial period, but the increase is typically based on factors such as age, location, and inflation, rather than being able to increase at any time. Therefore, the statement that premiums can increase at any time during the year is false.

The Primary Care Physician (PCP) copay under the SecureCareHMO Opt IV plan in the HomeTown region (H3672-018) is $15.

The explanation for the given correct answer, which is False, is that while all Medicare Supplement Plans offered by THP cover Part A and B deductibles, enrollees may still be subject to other deductibles or costs such as co-payments, coinsurance, and excess charges depending on the specific plan they choose. The statement that enrollees are not subject to any other deductibles or costs other than their plan premium is incorrect.

Both the SecureChoice PPO and Medicare Supplement plans require the use of a provider network. However, the given answer states that neither option requires a provider network, which is incorrect. Therefore, the correct answer should be "Both a and b."

The correct answer is "Plans A, C, D, F, High Deductible F, G and N." This is because these are the Medicare Supplement plans that were available in 2015.

The Silver Sneakers Fitness program is offered to plan members of HomeTown region SecureCareHMO plans and all Medicare Supplement plans.

To enroll in a THP Medicare Supplement plan, the applicant must be age 65 and enrolled in both Medicare A and B. This requirement ensures that the individual meets the eligibility criteria for the supplemental plan, as it is designed to provide additional coverage and benefits to those who already have Medicare. Being enrolled in both Medicare A and B ensures that the applicant has the basic coverage provided by Medicare, and the supplemental plan can then provide additional coverage for services and expenses that are not fully covered by Medicare.

The statement is false because not all tiers of Part D prescription drug plans offer the option for a 90 day supply at either the retail or mail order pharmacy. Some plans may offer this option, but it is not a universal feature across all tiers of Part D plans.