Podcast
Questions and Answers
What does Medicare Part B cover? Select one:
What does Medicare Part B cover? Select one:
- Hospice
- Prescriber visits (correct)
- Hospital visits
- Most outpatient prescriptions
What is a plan characteristic for patients with an HMO? Select one:
What is a plan characteristic for patients with an HMO? Select one:
- Unable to have their prescriptions covered by out-of-network prescribers
- Able to see the prescriber of their choice
- Restricted from seeing out-of-network prescribers (correct)
- Have smaller co-pays when they visit with out-of-network prescribers
What does Medicare Part D cover? Select one:
What does Medicare Part D cover? Select one:
- Hospital visits
- Nebulizer medications
- Outpatient prescriptions (correct)
- Prescriber visits
What is adjudication known as? Select one:
What is adjudication known as? Select one:
What is a plan characteristic for patients with a PPO? Select one:
What is a plan characteristic for patients with a PPO? Select one:
Who typically reimburses healthcare providers for their services? Select one:
Who typically reimburses healthcare providers for their services? Select one:
Hospital visits, hospice, and skilled nursing facilities are covered by which Medicare part? Select one:
Hospital visits, hospice, and skilled nursing facilities are covered by which Medicare part? Select one:
What is a list of medications that insurance will cover called? Select one:
What is a list of medications that insurance will cover called? Select one:
What is the set amount of money paid by the patient until the insurance pays for health coverage? Select one:
What is the set amount of money paid by the patient until the insurance pays for health coverage? Select one:
What is it called when a patient pays a set amount of money for their medication? Select one:
What is it called when a patient pays a set amount of money for their medication? Select one:
Mrs. Huang just turned 65 and comes to your pharmacy wanting more information about Medicare. She asks when open enrollment of Medicare Part D is. Which date range do you tell her? Select one:
Mrs. Huang just turned 65 and comes to your pharmacy wanting more information about Medicare. She asks when open enrollment of Medicare Part D is. Which date range do you tell her? Select one:
Once a patient has enrolled or made changes to Medicare Part D, when does it take effect? Select one:
Once a patient has enrolled or made changes to Medicare Part D, when does it take effect? Select one:
PBMs are: Select one:
PBMs are: Select one:
What is an ongoing amount paid by an individual to maintain insurance coverage? Select one:
What is an ongoing amount paid by an individual to maintain insurance coverage? Select one:
Which Medicare plan combines original Medicare with a prescription plan? Select one:
Which Medicare plan combines original Medicare with a prescription plan? Select one:
A joint government program that helps with medical costs for those who fall under the national poverty level is called what? Select one:
A joint government program that helps with medical costs for those who fall under the national poverty level is called what? Select one:
What is it called when a percentage of the drug cost is to be paid, for each prescription? Select one:
What is it called when a percentage of the drug cost is to be paid, for each prescription? Select one:
Which Medicare plan covers most outpatient prescriptions? Select one:
Which Medicare plan covers most outpatient prescriptions? Select one:
When a patient is able to see the physician of their choice, it's likely they have which type of insurance? Select one:
When a patient is able to see the physician of their choice, it's likely they have which type of insurance? Select one:
Based on age, when can a patient first enroll in Medicare Part D? Select one:
Based on age, when can a patient first enroll in Medicare Part D? Select one:
Medicaid is run by: Select one:
Medicaid is run by: Select one:
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Study Notes
Medicare Coverage
- Medicare Part B covers prescriber visits, primarily for outpatient services.
- Medicare Part D focuses on outpatient prescriptions, helping patients manage medication costs.
- Medicare Part A covers hospital visits, hospice, and skilled nursing facilities.
Insurance Plan Characteristics
- Patients with HMO plans are restricted from seeing out-of-network prescribers, which may limit choices but often results in lower costs.
- PPO plans allow patients to see any prescriber, including out-of-network ones, offering more flexibility.
Adjudication and Reimbursements
- Adjudication refers to the process of submitting a claim to the insurance company for reimbursement.
- Third-party payers, typically insurance companies, reimburse healthcare providers for their services.
Medication and Costs
- A formulary is a list of medications covered by an insurance plan, indicating what is accessible for patients.
- A deductible is the fixed amount patients must pay before insurance covers health expenses.
- A co-pay is the set fee that patients pay for each medication or service, typically at the time of service.
- Coinsurance is when patients pay a percentage of the drug cost per prescription filled.
Enrollment and Plan Details
- Open enrollment for Medicare Part D runs from October 15 to December 7, allowing beneficiaries to enroll or change plans.
- Changes made during open enrollment take effect on January 1 of the following year.
Premiums and Joint Programs
- A premium is an ongoing fee paid by individuals to maintain insurance coverage.
- Medicaid is a government program that assists with medical costs for low-income individuals and is administered by federal and state governments.
Additional Medicare Information
- Part C combines original Medicare with a prescription plan, offering a more comprehensive coverage option.
- Individuals can enroll in Medicare Part D three months before or after turning 65, ensuring access to necessary prescription coverage.
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