Day 2 Medicare Advantage (Part C). Review. Medicare. For people 65+ and under 65 with a disability 4 parts of Medicare Part A: Hospital Insurance Part B: Medical Insurance Part C: Medicare Advantage Plans Part D: Prescription Drug Coverage Part A & B called Original Medicare.
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Q. What does HMO stand for?
This is actually a variation of the phrase, “HEY MOE” Its roots go back to a concept by Moe of the Three Stooges, who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes.
Q. Do all diagnostic procedures require pre-certification?
No — only those you need.
Q. Can I get coverage for my pre-existing conditions?
Certainly, as long as they don’t require any treatment.
Q. What happens if I want to try alternative forms of medicine?
A. You’ll need to find alternative forms of payment.
Q. I just joined a HMO. How difficult will it be to choose the doctor I want?
A. Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors in the plan. These doctors fall into 2 categories - those who are no longer accepting new patients and those who will see you, but are no longer participating in the plan. But don’t worry; the remaining doctor who is still in the plan, and accepting new patients, has an office just a half-day’s drive away.
Q. My pharmacy plan only covers generic drugs, but I need the name brand. I tried the generic drugs, but it gave me a stomach ache. What should I do?
A. Poke yourself in the eye.
Q. What if I’m away from home and I get sick?
A. You really shouldn’t do that.
Amanda is a 67 year old beneficiary enrolled in a Medicare Advantage Plan. As a member of this plan Amanda has all the rights and protections guaranteed under Medicare. Is this True or False?
When can a Medicare beneficiary join a Medicare Advantage Plan?
Ms. King joined a Medicare Advantage Plan 6 months ago when she first became eligible for Medicare. She wants to change to a new PCP (primary care physician) but learned he is not affiliated with her MA plan. Ms. King wants to change to original Medicare, but was told that she would have to wait until the Open Enrollment Period to make a change. How would you assist her?
Gordon has ESRD (End Stage Renal Disease) and belongs to an HMO through his employer. He will be 65 next month and will retire from his employment. He has been on Medicare for the past 7 months and wants to purchase a MA plan once he retires. He has Part A now and will enroll in Part B when he retires. Check all that apply.
____ He can purchase a MA plan if the employer HMO offers a MA plan.
____ He cannot purchase a MA plan under any circumstances because he has ESRD.
____He can purchase any MA plan and all plans have to accept him
List the eligibility criteria to enroll in a Medicare Advantage Plan.