UCare for Seniors Flashcards

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Questions and Answers

What does UCare for Seniors provide?

Coordinated Care

Medicare Advantage Plan

Both A and B (correct)

None of the above

How does UCare for Seniors work as a Coordinated Care Plan?

UCare contracts with the federal government to administer Medicare benefits for members.

Who does UCare contract with to administer Part A and Part B for UCare for Seniors members?

The Federal Government

Who is UCare for Seniors available to?

All eligible Medicare beneficiaries regardless of income or assets Signup and view all the answers

Is there health screening for pre-existing conditions for UCare for Seniors?

False Signup and view all the answers

How many counties in MN and WI is UCare for Seniors Value Plan and Essentials Rx plans available?

All 87 counties in MN and 26 counties in WI Signup and view all the answers

In how many counties is UCare for Seniors Value Plus and Classic available?

44 counties in MN only Signup and view all the answers

Do UCare for Seniors products provide all the benefits as Original Medicare?

True Signup and view all the answers

Does UCare for Seniors only cover individuals?

False Signup and view all the answers

What type of plan is UCare for Seniors?

A Health Maintenance Organization with a Point-of-Service contract. Signup and view all the answers

What does the Point of Service feature allow UCare for Seniors members to do?

Seek certain non-emergent, non-urgent care from non-contracted Medicare providers at higher cost share levels. Signup and view all the answers

Are emergency services included in UCare for Seniors?

True Signup and view all the answers

Name all four of the UCare for Seniors products.

Value, Essentials Rx, Value Plus, Classic Signup and view all the answers

Do UCare for Seniors members pay a premium for coverage?

Yes, premiums vary by product. Signup and view all the answers

What is extra help for Part D?

A program through Social Security that reduces the UCare for Seniors premium and cost-share for drugs. Signup and view all the answers

When was UCare for Seniors first offered?

1998 Signup and view all the answers

How many members are enrolled in UCare for Seniors?

Over 100,000 members Signup and view all the answers

What are the target populations for UCare for Seniors?

Baby boomers, current Medicare beneficiaries, and disability organizations. Signup and view all the answers

What does Medicaid provide?

Hospital and medical coverage for people with very limited resources. Signup and view all the answers

What does the acronym CMS stand for?

The Centers for Medicare & Medicaid Services Signup and view all the answers

What is HEDIS?

The Healthcare Effectiveness Data and Information Set Signup and view all the answers

What does MA-PD stand for?

Medicare Advantage plan that includes Medicare Part D outpatient prescription drug coverage. Signup and view all the answers

What is the Medical Loss Ratio?

The proportion of premium revenues spent on medical claims and quality improvement activities. Signup and view all the answers

What is a Copay?

A set amount the member pays for each medical service. Signup and view all the answers

What is PBM?

Pharmacy Benefits Manager Signup and view all the answers

What are Election Periods?

Timeframes during which one can enroll or disenroll from a Medicare Advantage plan. Signup and view all the answers

Study Notes

UCare for Seniors Overview

A Coordinated Care Medicare Advantage Plan that provides Medicare Part A and Part B benefits.
Enrolled members receive Medicare benefits through UCare instead of Original Medicare.

Enrollment and Eligibility

Available to all eligible Medicare beneficiaries, with no income or asset restrictions.
No health screenings for pre-existing conditions, except for end-stage renal disease.
Coverage is offered in all 87 counties in Minnesota and 26 counties in Wisconsin.

UCare for Seniors Plans

Offers four products: Value, Essentials Rx, Value Plus, and Classic.
Not all products provide the same benefits; for example, Value does not include Medicare Part D.
Essentials Rx includes limited dental benefits and prescription drug coverage.
Value Plus and Classic provide comprehensive medical coverage and Part D benefits.

Coverage and Benefits

UCare for Seniors products match Original Medicare benefits and add supplemental benefits like emergency coverage and preventive services without copays.
Plans are available to both individuals and employer group retirees, excluding active employees.

Network and Care Features

Functions as a Health Maintenance Organization with a Point-of-Service contract, providing access to a network of doctors.
Emergency and urgent care services covered worldwide at in-network cost share levels.
The Point-of-Service feature permits members to seek care from non-contracted providers at higher costs.

Cost and Financial Assistance

Members pay premiums that vary by product, with potential reductions for those who qualify for Extra Help for Part D.
Extra Help assists low-income individuals with Part D premium and cost share.

Historical Context and Membership

UCare for Seniors was established in 1998 and now serves over 100,000 members, generating approximately 42% of company revenue.
Target populations include baby boomers and current Medicare beneficiaries, as well as those eligible due to disability.

Regulatory and Administrative Details

Contracts with the federal government and CMS to administer Medicare Advantage and Part D coverage.
UCare adheres to requirements set by regulatory bodies, including annual bid proposals for plan benefits.

Performance and Quality Metrics

Participates in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) to assess member experiences.
HEDIS metrics evaluate care effectiveness across various dimensions, including access, utilization, and health plan stability.

Medicare Framework

Medicare consists of Parts A (hospital insurance), B (medical insurance), C (Medicare Advantage), and D (prescription drug coverage).
Medicare Advantage Organizations (MAOs) provide enhanced benefits compared to Original Medicare, often covering additional services.

Key Terminology

Coinsurance: Percentage paid for services after deductibles.
Copay: Fixed amount paid for specific services.
Cost share: Total member's financial responsibility (copay, coinsurance, deductible).
Dual eligible: Individuals qualifying for both Medicare and Medicaid.
Stand Alone PDP: Specific drug plans covering only outpatient prescription medications.

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Description

Test your knowledge about UCare for Seniors with these flashcards. Learn how this coordinated care plan works, including its relationship with Medicare. Perfect for those looking to understand senior healthcare options better.