2015 - Adp - Mapd/Pdp - Mv/Training | Attempts: 702

1.

Medicare Advantage plans use which type of Networks?

A.

PPOs
B.

HMOs
C.

PFFS
D.

All of the above

Correct Answer
D. All of the above

Explanation
Medicare Advantage plans use different types of networks, including PPOs (Preferred Provider Organizations), HMOs (Health Maintenance Organizations), and PFFS (Private Fee-for-Service) plans. These networks offer varying levels of flexibility and coverage options for beneficiaries. PPOs allow individuals to see both in-network and out-of-network providers, while HMOs typically require individuals to choose a primary care physician and obtain referrals for specialist care. PFFS plans allow beneficiaries to see any healthcare provider that accepts the plan's payment terms. Therefore, the correct answer is "All of the above" as Medicare Advantage plans can utilize any of these network types.

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2.

Enrolling in Medicare Part D coverage is optional. However, if the customer chooses not to enroll when first eligible they will be penalized...

A.

10% of the national base beneficiary premium for each 12-month period they go without part D
B.

1% of the national base beneficiary premium for each month they go without Part D
C.

5% of the national base beneficiary premium for each 12-month period they go without Part D
D.

3% of the national base beneficiary premium for each month they go without Part D

Correct Answer
B. 1% of the national base beneficiary premium for each month they go without Part D

Explanation
If the customer chooses not to enroll in Medicare Part D coverage when first eligible, they will be penalized with 1% of the national base beneficiary premium for each month they go without Part D. This means that for every month the customer does not have Part D coverage, they will have to pay an additional 1% of the premium.

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3.

What does HMO stand for?

A.

Health Maintenance Organization
B.

Health Management Organization
C.

Holistic Medicine Organization
D.

Happy Management Organization

Correct Answer
A. Health Maintenance Organization

Explanation
HMO stands for Health Maintenance Organization. This type of healthcare plan provides comprehensive medical services to its members for a fixed fee. HMOs typically require members to choose a primary care physician who coordinates their healthcare and refers them to specialists when necessary. The main goal of an HMO is to promote preventive care and manage the overall health of its members.

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4.

What does PCP stand for?

A.

Premium Cost Plan
B.

Primary Care Physician
C.

Prior Cost Plan
D.

Prescription Cost Plan

Correct Answer
B. Primary Care pHysician

Explanation
PCP stands for Primary Care Physician. A primary care physician is a healthcare professional who serves as the first point of contact for patients seeking medical care. They provide comprehensive and continuous care, manage common medical conditions, and coordinate referrals to specialists when necessary. This term is commonly used in healthcare settings to refer to the main doctor or healthcare provider who oversees a patient's overall healthcare needs.

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5.

A Medicare Part D plan...

A.

Must meet the minimum standard set by Medicare
B.

Can provide lower coverage than Medicare
C.

Includes a deductible, initial coverage limit, donut hole and catastrophic coverage
D.

Both A & C
E.

All of the above

Correct Answer
D. Both A & C

Explanation
The correct answer is "Both A & C". This means that a Medicare Part D plan must meet the minimum standard set by Medicare, and it also includes a deductible, initial coverage limit, donut hole, and catastrophic coverage. This implies that the plan cannot provide lower coverage than Medicare, as it must meet the minimum standard.

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6.

What does a tier correspond to?

A.

The copayment or coinsurance amount
B.

The deductible
C.

The monthly premiums
D.

The Coverage Gap timeframes

Correct Answer
A. The copayment or coinsurance amount

Explanation
A tier corresponds to the copayment or coinsurance amount. This means that when a person receives medical services or fills a prescription, they will be responsible for paying a certain percentage or fixed amount, depending on the tier of their insurance plan. The tier system is used to categorize different types of medications or services based on their cost or level of coverage.

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7.

The TROOP or True Out-of-Pocket refers to...

A.

The total amount the customer has paid towards drug costs, including premiums
B.

The total amount the drug manufacturer has paid towards the customer's drug costs
C.

The total amount the customer has paid towards drug costs, including copays but excluding premiums
D.

Both B & C

Correct Answer
D. Both B & C

Explanation
The correct answer is Both B & C. The TROOP or True Out-of-Pocket refers to the total amount the customer has paid towards drug costs, including copays but excluding premiums. It also includes the total amount the drug manufacturer has paid towards the customer's drug costs.

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8.

In order for a drug to be covered by a Medicare Part D plan, it has to be included in the carrier’s formulary list.

A.

True
B.

False

Correct Answer
A. True

Explanation
The explanation for the given correct answer is that for a drug to be covered by a Medicare Part D plan, it must be included in the carrier's formulary list. The formulary list is a list of prescription drugs that the plan covers. If a drug is not included in the formulary list, it will not be covered by the Medicare Part D plan. Therefore, the statement "True" is correct.

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9.

Which of the following drugs is not covered by Part D?

A.

Symptom relief of cough or cold
B.

Weight loss or weight gain
C.

Erectile dysfunction
D.

Both A and C
E.

All of the above

Correct Answer
E. All of the above

Explanation
The correct answer is "All of the above". This means that all of the drugs mentioned in the options - symptom relief of cough or cold, weight loss or weight gain, and erectile dysfunction - are not covered by Part D. Part D is a prescription drug benefit program offered by Medicare, and it covers a wide range of prescription drugs. However, drugs for symptom relief of cough or cold, weight loss or weight gain, and erectile dysfunction are not included in this coverage.

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10.

VA and TRICARE are Creditable Coverage.

A.

True
B.

False

Correct Answer
A. True

Explanation
VA and TRICARE are both government-sponsored healthcare programs in the United States. VA (Veterans Affairs) provides healthcare services to eligible veterans, while TRICARE provides healthcare coverage for active duty service members, retirees, and their families. Both VA and TRICARE are considered creditable coverage, meaning they meet the minimum standards set by the Affordable Care Act (ACA) and can be used to avoid penalties for not having health insurance. Therefore, the statement "VA and TRICARE are Creditable Coverage" is true.

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