Medicare D-SNP Quiz & Flashcards for Consumers

Questions and Answers

Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of?

Selling DSNPs

The consumer states they currently pay a percentage of charges when they receive medical care. This means they are enrolled in a Medicare Supplement Insurance Plan.

False

Which of the following consumers is best suited for a CSNP?

John, who is healthy

Kyle, who rarely sees a doctor

Laura, who does not have any chronic conditions

Mary, who has a specialist for a qualifying chronic condition (correct)

When can Michael enroll in a different CSNP that also covers diabetes, assuming he has not moved out of his current plan's service area?

During open or annual Signup and view all the answers

Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level?

All of the responses Signup and view all the answers

What is very important for consumers enrolling in a CSNP to know about accessing providers?

Some CSNPs are PPO or POS plans that allow members to see out-of-network providers. Signup and view all the answers

The Medicaid program helps pay medical costs for certain groups of people with limited income and resources.

True Signup and view all the answers

Members who are QMB+ or are Full Dual-Eligible are required to pay copayments for Medicare-covered services obtained from a DSNP in-network provider.

False Signup and view all the answers

Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified?

30 days after the last attempt to contact the provider Signup and view all the answers

What cost sharing are members responsible for if they lose their eligibility for the DSNP due to a change or loss of Medicaid status?

All, such as premiums, deductibles, copayments, and coinsurance Signup and view all the answers

What are Dual Special Needs Plans (DSNP)?

Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid Signup and view all the answers

The Special Election Period for Dual/LIS Change in Status begins after the grace period ends for DSNP members that lose Medicaid eligibility.

False Signup and view all the answers

Which consumer might benefit the most by enrolling in a DSNP?

Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+) Signup and view all the answers

Which program is available to support the unique health care needs of CSNP and DSNP members?

A care management program that varies depending upon the level of the member's health risk level Signup and view all the answers

What statement best describes a DSNP?

The monthly premium is at or below the Low Income Subsidy benchmark to cover drug costs Signup and view all the answers

What must Melanie's agent confirm for her to enroll in a DSNP?

All of the above Signup and view all the answers

Larry, who has a qualifying chronic condition, wants a plan that will help him manage his illness and health care costs, may be a good candidate for a DSNP.

False Signup and view all the answers

What is a characteristic of consumers for whom a CSNP may be most appropriate?

Consumers who have a qualifying chronic condition and may have concerns about managing their illness. Signup and view all the answers

What service will a CSNP or DSNP member in the high risk care management category receive?

Case Management (telephonic, digital and/or face-to-face) according to individual needs Signup and view all the answers

What is the purpose of the Chronic Condition Verification form?

It authorizes the plan to contact the provider to verify that the consumer has at least one qualifying chronic condition. Signup and view all the answers

Consumers enrolling in a DSNP are required to pay copayments for Medicare-covered services from a DSNP network provider if they are Full Dual-Eligible.

False Signup and view all the answers

Lucille's responsibility for cost sharing changes during the grace period after she loses her DSNP eligibility.

False Signup and view all the answers

What are the three types of Special Needs Plans?

All of the above Signup and view all the answers

A Special Election Period (SEP Dual/LIS Change in Status) is available for DSNP members that lose their Medicaid eligibility.

True Signup and view all the answers

A DSNP might be in the best interest of which of these consumers?

Joe, whose low income qualifies him for full Medicaid coverage Signup and view all the answers

CSNPs and DSNPs include Medicare Part D prescription drug coverage.

True Signup and view all the answers

Which consumers may not be good candidates for a DSNP?

Those who do not meet the eligibility requirements. Signup and view all the answers

Which consumer characteristics demonstrate a good fit for a CSNP?

A consumer with a qualifying chronic condition who wants a plan that helps manage their health. Signup and view all the answers

How is a CSNP or DSNP member's care management health risk levels determined initially?

The member completes a Health Assessment. Signup and view all the answers

Study Notes

Medicare Special Needs Plans (SNPs)

Confirming Medicaid level and entitlement to Medicare Parts A and B is required for selling Dual Special Needs Plans (DSNPs).
Chronic Special Needs Plans (CSNPs) cater to consumers with qualifying chronic conditions, such as diabetes.
Enrollment in CSNP can only occur during Open Enrollment if previously enrolled in another carrier's CSNP.

Medicaid helps cover medical costs for individuals with limited income and resources.
DSNP members who are Full Dual-Eligible do not pay copayments for Medicare services when using in-network providers; costs should be billed to the Medicaid program.

Care Management and Risk Levels

Members in low to moderate care management risk levels receive a variety of health services based on risk.
High-risk CSNP or DSNP members receive tailored case management support to meet their individual health needs.

Eligibility and Enrollment

Individuals losing Medicaid eligibility after being enrolled in DSNP are subject to all cost-sharing responsibilities, including premiums and deductibles.
DSNPs are specifically designed for those enrolled in both Medicare and Medicaid, often benefiting those with Qualified Medicaid Beneficiary (QMB+) status.

Special Election Periods (SEPs)

A Special Election Period is triggered for DSNP members when they lose Medicaid eligibility, allowing them to enroll in alternate plans.
Verification of chronic conditions for CSNP enrollment requires authorization for the plan to contact the consumer's healthcare provider.

Characteristics of SNP Members

Ideal candidates for DSNPs include consumers with low incomes qualifying them for full Medicaid or those focused on managing chronic conditions through healthcare plans.
Members are initially assessed for health risk levels using a Health Assessment aimed at identifying their needs for daily living support.

Prescription Drug Coverage

Both CSNPs and DSNPs include Medicare Part D prescription drug coverage, ensuring that members have access to necessary medications.

Consumer Guidance

Agents must ensure that enrolled consumers meet Medicare eligibility criteria and confirm Medicaid levels.
It’s crucial for consumers to understand the implications of losing Medicaid on their plan coverage and associated costs.

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Description

Test your knowledge and understanding of Medicare and Medicaid with these comprehensive flashcards. Each card presents key concepts and definitions relevant to selling Dual Special Needs Plans (DSNPs). Perfect for those preparing for certification or seeking to reinforce their knowledge in this area.

Medicare CE Flashcards

Questions and Answers

Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of?

The consumer states they currently pay a percentage of charges when they receive medical care. This means they are enrolled in a Medicare Supplement Insurance Plan.

Which of the following consumers is best suited for a CSNP?

When can Michael enroll in a different CSNP that also covers diabetes, assuming he has not moved out of his current plan's service area?

Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level?

What is very important for consumers enrolling in a CSNP to know about accessing providers?

The Medicaid program helps pay medical costs for certain groups of people with limited income and resources.

Members who are QMB+ or are Full Dual-Eligible are required to pay copayments for Medicare-covered services obtained from a DSNP in-network provider.

Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified?

What cost sharing are members responsible for if they lose their eligibility for the DSNP due to a change or loss of Medicaid status?

What are Dual Special Needs Plans (DSNP)?

The Special Election Period for Dual/LIS Change in Status begins after the grace period ends for DSNP members that lose Medicaid eligibility.

Which consumer might benefit the most by enrolling in a DSNP?

Which program is available to support the unique health care needs of CSNP and DSNP members?

What statement best describes a DSNP?

What must Melanie's agent confirm for her to enroll in a DSNP?

Larry, who has a qualifying chronic condition, wants a plan that will help him manage his illness and health care costs, may be a good candidate for a DSNP.

What is a characteristic of consumers for whom a CSNP may be most appropriate?

What service will a CSNP or DSNP member in the high risk care management category receive?

What is the purpose of the Chronic Condition Verification form?

Consumers enrolling in a DSNP are required to pay copayments for Medicare-covered services from a DSNP network provider if they are Full Dual-Eligible.

Lucille's responsibility for cost sharing changes during the grace period after she loses her DSNP eligibility.

What are the three types of Special Needs Plans?

A Special Election Period (SEP Dual/LIS Change in Status) is available for DSNP members that lose their Medicaid eligibility.

A DSNP might be in the best interest of which of these consumers?

CSNPs and DSNPs include Medicare Part D prescription drug coverage.

Which consumers may not be good candidates for a DSNP?

Which consumer characteristics demonstrate a good fit for a CSNP?

How is a CSNP or DSNP member's care management health risk levels determined initially?

Study Notes

Medicare Special Needs Plans (SNPs)

Medicaid and Cost Sharing

Care Management and Risk Levels

Eligibility and Enrollment

Special Election Periods (SEPs)

Characteristics of SNP Members

Prescription Drug Coverage

Consumer Guidance

Studying That Suits You

Description

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