Chapter 24: Health Plans and Medicare 1. Which type of MA plan is experiencing a

Question

Chapter 24: Health Plans and Medicare 1. Which type of MA plan is experiencing an increase in availability and enrollment due to broad waivers from CMS? A. Medical savings account plan. B. Health Maintenance Organization plan. C. Private fee-for-service plan. D. Group retiree plan. 2. Dual Eligible Special Needs Plans enroll individuals who are “dual eligible.” Who are the “dual eligible”? A. Individuals who are eligible for Medicare and have Long-Term care insurance B. Individuals who are eligible for Medicare and Medicaid C. Individuals who are eligible for Medicare and are institutionalized D. Individuals who are eligible for Medicare and have a severe or disabling chronic condition 3. Plans can receive bonus payments for high star quality ratings. The bonus payments can be used to: A. Provide additional benefits B. Reduce cost sharing C. Reduce enrollee premiums D. All of the above 4. If a plan’s bid to CMS exceeds the benchmark, the plan must charge enrollees the difference in the form of : A. A monthly premium B. Higher deductibles C. Reduced services D. Higher copayments 5. MA plans must have a quality improvement program that measures performance under the program and includes: A. Chronic Care Improvement Programs (CCIP) B. Quality Improvement Projects (QIPs) C. Health Information Systems D. All of the above 6. Which of the following is most likely to cause the rise of Medicare enrollment in MA plans over the next few decades? A. The Affordable Care Act B. Baby Boomer interest in staying in managed care when becoming eligible for Medicare C. Politicians encouraging Medicare beneficiaries to choose MA over FFS D. Increased marketing by MA plans to raise awareness of MA Chapter 24: Health Plans and Medicare 1. Which type of MA plan is experiencing an increase in availability and enrollment due to broad waivers from CMS? A. Medical savings account plan. B. Health Maintenance Organization plan. C. Private fee-for-service plan. D. Group retiree plan. 2. Dual Eligible Special Needs Plans enroll individuals who are “dual eligible.” Who are the “dual eligible”? A. Individuals who are eligible for Medicare and have Long-Term care insurance B. Individuals who are eligible for Medicare and Medicaid C. Individuals who are eligible for Medicare and are institutionalized D. Individuals who are eligible for Medicare and have a severe or disabling chronic condition 3. Plans can receive bonus payments for high star quality ratings. The bonus payments can be used to: A. Provide additional benefits B. Reduce cost sharing C. Reduce enrollee premiums D. All of the above 4. If a plan’s bid to CMS exceeds the benchmark, the plan must charge enrollees the difference in the form of : A. A monthly premium B. Higher deductibles C. Reduced services D. Higher copayments 5. MA plans must have a quality improvement program that measures performance under the program and includes: A. Chronic Care Improvement Programs (CCIP) B. Quality Improvement Projects (QIPs) C. Health Information Systems D. All of the above 6. Which of the following is most likely to cause the rise of Medicare enrollment in MA plans over the next few decades? A. The Affordable Care Act B. Baby Boomer interest in staying in managed care when becoming eligible for Medicare C. Politicians encouraging Medicare beneficiaries to choose MA over FFS D. Increased marketing by MA plans to raise awareness of MA Chapter 24: Health Plans and Medicare 1. Which type of MA plan is experiencing an increase in availability and enrollment due to broad waivers from CMS? A. Medical savings account plan. B. Health Maintenance Organization plan. C. Private fee-for-service plan. D. Group retiree plan. 2. Dual Eligible Special Needs Plans enroll individuals who are “dual eligible.” Who are the “dual eligible”? A. Individuals who are eligible for Medicare and have Long-Term care insurance B. Individuals who are eligible for Medicare and Medicaid C. Individuals who are eligible for Medicare and are institutionalized D. Individuals who are eligible for Medicare and have a severe or disabling chronic condition 3. Plans can receive bonus payments for high star quality ratings. The bonus payments can be used to: A. Provide additional benefits B. Reduce cost sharing C. Reduce enrollee premiums D. All of the above 4. If a plan’s bid to CMS exceeds the benchmark, the plan must charge enrollees the difference in the form of : A. A monthly premium B. Higher deductibles C. Reduced services D. Higher copayments 5. MA plans must have a quality improvement program that measures performance under the program and includes: A. Chronic Care Improvement Programs (CCIP) B. Quality Improvement Projects (QIPs) C. Health Information Systems D. All of the above 6. Which of the following is most likely to cause the rise of Medicare enrollment in MA plans over the next few decades? A. The Affordable Care Act B. Baby Boomer interest in staying in managed care when becoming eligible for Medicare C. Politicians encouraging Medicare beneficiaries to choose MA over FFS D. Increased marketing by MA plans to raise awareness of MA

Explanation / Answer

1. Which type of MA plan is experiencing an increase in availability and enrollment due to broad waivers from CMS?

Correct Answer:- D. Group retiree plan.

Reason:- Group retiree plan is experiencing an increase in availability and enrollment due to broad waivers from CMS

2. Dual Eligible Special Needs Plans enroll individuals who are “dual eligible.” Who are the “dual eligible”?

Correct Answer:- B. Individuals who are eligible for Medicare and Medicaid

Reason:- Dual eligibility is related to the Medicare and Medicaid

3. Plans can receive bonus payments for high star quality ratings. The bonus payments can be used to:

Correct Answer:- D. All of the above

Reason:- The bonus payments can be used to provide additional benefits, reduce cost sharing, reduce enrollee premiums

4. If a plan’s bid to CMS exceeds the benchmark, the plan must charge enrollees the difference in the form of :

Correct Answer:- A. A monthly premium

Reason:-

A monthly premium will be charged if plan’s bid to CMS exceeds the benchmark

5. MA plans must have a quality improvement program that measures performance under the program and includes:

Correct Answer:- D. All of the above

Reason:- MA plan must measure the performance under the program which includes Chronic Care Improvement programs (CCIP), Quality Improvement Projects (QIPs), Health Information Systems

6. Which of the following is most likely to cause the rise of Medicare enrollment in MA plans over the next few decades?

Correct Answer:- B. Baby Boomer interest in staying in managed care when becoming eligible for Medicare

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