Questions and Answers
What does Medicare Part B cover? Select one:
What is a plan characteristic for patients with an HMO? Select one:
What does Medicare Part D cover? Select one:
What is adjudication known as? Select one:
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What is a plan characteristic for patients with a PPO? Select one:
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Who typically reimburses healthcare providers for their services? Select one:
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Hospital visits, hospice, and skilled nursing facilities are covered by which Medicare part? Select one:
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What is a list of medications that insurance will cover called? Select one:
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What is the set amount of money paid by the patient until the insurance pays for health coverage? Select one:
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What is it called when a patient pays a set amount of money for their medication? Select one:
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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:
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Once a patient has enrolled or made changes to Medicare Part D, when does it take effect? Select one:
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PBMs are: Select one:
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What is an ongoing amount paid by an individual to maintain insurance coverage? Select one:
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Which Medicare plan combines original Medicare with a prescription plan? Select one:
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A joint government program that helps with medical costs for those who fall under the national poverty level is called what? Select one:
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What is it called when a percentage of the drug cost is to be paid, for each prescription? Select one:
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Which Medicare plan covers most outpatient prescriptions? Select one:
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When a patient is able to see the physician of their choice, it's likely they have which type of insurance? Select one:
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Based on age, when can a patient first enroll in Medicare Part D? Select one:
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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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Description
Test your knowledge on Medicare coverage and insurance plan characteristics. This quiz covers essential details about different parts of Medicare, the complexities of insurance plans, and how adjudication and reimbursements work. Perfect for anyone interested in healthcare systems and insurance.
