2018 Fl Smmc Dual Eligible Quiz

The recipient has mentioned that Children and Families informed them about having Medicaid. However, upon reviewing the case, it is identified that there is an active QMB span on file. The correct response is to inform the recipient that they have a limited type of Medicaid called "Qualified Medicare Beneficiary" (QMB). This type of Medicaid assists in covering some of the recipient's Medicare costs, such as premiums, deductibles, and coinsurance. Since Medicare is their primary insurance, the recipient should be advised to contact Medicare to learn how they can receive services.

The enrollee's plan is ending because they lost their full Medicaid coverage and now only have QMB (Qualified Medicare Beneficiary) coverage. QMB is a limited coverage that assists with paying for Medicare premiums, deductibles, and coinsurance. However, recipients with QMB only cannot enroll in any other plans.

A Medicare beneficiary who qualifies to receive all Medicaid services is called a "Full Benefit Dual Eligible." This term is used to describe individuals who are eligible for both Medicare and Medicaid and have access to the full range of benefits provided by both programs. This includes coverage for medical services, prescription drugs, long-term care, and other necessary healthcare services. Being a Full Benefit Dual Eligible allows individuals to have comprehensive coverage and access to a wide range of healthcare services.

The statement is false because QMB (Qualified Medicare Beneficiary) is a program that provides financial assistance to individuals with low income and limited resources to help pay for Medicare premiums, deductibles, and coinsurance. It is not related to Medicaid coverage.

Medicare Part D covers prescription drugs. This means that it helps pay for the cost of prescription medications that are prescribed by doctors and other healthcare providers. It is a separate part of Medicare that is offered through private insurance companies and can be added to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans. Medicare Part D helps to lower the cost of prescription drugs for individuals who are eligible for Medicare.

Based on the information in HealthTrack that Flora has a QI1 active span, it indicates that Flora has limited Medicaid coverage that picks up the Medicare part B premiums. Therefore, advising Flora that Medicare is her primary insurance and explaining her limited Medicaid coverage is the correct response.

Medicare Part C, also known as a Medicare Advantage Plan, is a comprehensive insurance plan that combines the coverage of both Medicare Part A (hospital insurance) and Part B (medical insurance) benefits. It provides additional benefits beyond what Original Medicare offers, such as prescription drug coverage, dental, vision, and hearing services. This option allows individuals to receive their Medicare benefits through private insurance companies approved by Medicare, providing them with more choices and potentially lower costs.

Barbara should be advised to contact Better Health because her MMA Medicaid plan will help coordinate services between Medicare and Better Health. This means that Better Health will work together with Medicare to ensure that her inpatient stay for her surgery is covered.

The correct answer is that the SLMB Program allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums. This means that individuals who qualify for the SLMB Program can have their Medicare Part B premiums covered by Medicaid, which can help alleviate the financial burden of these premiums. This program is specifically designed to assist individuals who meet certain income and asset requirements and need assistance with their Medicare Part B premiums.

The correct answer explains that the enrollee has Medicare coverage as their primary insurance. However, they are also enrolled with Sunshine Health, which provides coverage for Long-Term Care and medical services that are not covered by Medicare. Additionally, the enrollee is covered under the Qualified Medicare Beneficiary (QMB) program, which helps pay for premiums, deductibles, and coinsurance under Medicare. This answer provides a comprehensive explanation of the enrollee's coverage and the role of both Medicare and Sunshine Health.

The statement "All QMB recipients are excluded for enrollment" is false. This means that QMB recipients are not excluded and can enroll in whatever is being referred to.

If an enrollee has both Medicare and a MMA Plan, the agent should inform the enrollee to contact the MMA plan's case manager. The MMA plan is responsible for coordinating the enrollee's care with Medicare and ensuring that the MMA plan does not authorize or provide duplicative services. This means that the case manager will be able to provide information on which services are covered by each plan and help the enrollee navigate their healthcare coverage effectively.

The QMB Program allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance. This means that individuals who meet the eligibility criteria can receive financial assistance from Medicaid to cover the costs associated with their Medicare coverage, including premiums, deductibles, and coinsurance. This can help alleviate the financial burden on individuals who may struggle to afford these expenses on their own.

The recipient's eligibility category for MMA would be listed as "Excluded" because they have an active QMB span for their Medicaid eligibility and also have both a TPL 11 and 19 on file.

Irene should be advised to contact Medicare to determine how her services will be covered. She has an active SLMB span for her Medicaid eligibility, which means that her Medicaid only covers Medicare Part B premiums and not services. Therefore, it is important for Irene to reach out to Medicare to understand how her doctor's visit will be covered.