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Final Q#11

  1. What is the full name of LA Care's MediCare plan?
    LA Care Health Plan Medicare Advantage HMO SNP.
  2. What are the membership requirements for LA Care's MediCare plan?
    • Live in LA county
    • 65 and older
    • Under age 65 with certain disabilities
    • Dually eligible or MEDI/MEDI
    • Must have MediCare both Part A and Part B
    • Must have Fully Scope Medi-Cal
    • Cannot have Medi-Cal Share of Cost
    • Cannot have ESRD at time of enrollment
    • Cannot be in Long Term Care at time of enrollment
  3. What is the premium in MedCare Part A for someone who worked 40 quarters or 10 years?
    Zero
  4. What is the premium for MediCare Part B?
    Extra Help of LIS (Low Income Subsidy)
  5. What should LA Care SNP members' co pay level be?
    2 or 3
  6. What is the name of LA Care's Dental plan?
    Liberty Dental
  7. How many non transportation trips can a MediCare member have in one benefit year 2013 ____ one way
    28
  8. What is the premium for medicare Part B?
    $104.90
  9. What is the medicatino therapy management program called?
    Medication Therapy Management Program "Outcomes Pharmacist"
  10. What is it called when the plan gives their initial decision on whether they will cover a Part A or Part B benefit?
    Organization Determination
  11. How many days does the plan have to resolve a Part C grievance?
    30 days
  12. A standard Coverage Determination should be resolved within ____.
    72 hours or 3 days.
  13. "Transition" is a part of what part of medicare?
    Part D
  14. What is transition?
    A time when the plan provides non-formulary drugs to new members until the doctor can change the prescription or submit supporting documentation on why the member must stay on the medication.
  15. What is the name of LA Care's pharmacy vendor?
    MedImpact
  16. What is the dollar amount for eye glasses in LA Care MA-PD plan?
    $200
  17. How many routine podiatry visits can a medicare member have during one benefit year?
    Unlimited if medically necessary
  18. Name one BAE document a medicare member may show to confirm their co-pay level.
    • medi-cal card
    • BIC card
  19. What must our SNP member do when they want to disenroll out of the plan?
    • Enroll into another plan
    • Give the plan a written notice
    • submit a request via the internet
    • call 1-800-MEDICARE
Author
ismael_b30
ID
242233
Card Set
Final Q#11
Description
Final review
Updated

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