Competency 14 Section 6

Question 1

1. If a client is enrolled in an employer-sponsored plan and becomes eligible for Medicare, it will be key for them to clarify which plan is the secondary payer before enrolling in Medicare.

Answer 1

True. (LO 14-6-1)

Question 2

2. If a client is enrolled in an employer-sponsored plan, becomes eligible for Medicare, but chooses not to enroll at that point, they will face late enrollment penalties when they do enroll.

Answer 2

False. They will be eligible to enroll in Medicare penalty free due to the special enrollment periods. (LO 14-6-1)

Question 3

3. Exchanges, created by the Affordable Care Act, will be operational in 2012.

Answer 3

False. They will be operational in 2014. (LO 14-6-2)

Question 4

4. Exchanges are an option for early retirees that are not yet eligible for Medicare

Answer 4

True. (LO 14-6-2)

Question 5

5. Exchanges will offer uniform sets of benefits that cover a varying level of plan costs

Answer 5

True. (LO 14-6-2)

Question 6

6. Exchanges will offer cost-sharing subsidies to individuals whose household incomes are below 400% of the federal poverty level.

Answer 6

True. (LO 14-6-2)

Question 7

7. Accountable Care Organizations are created by the Affordable Care Act and are a new delivery system for Medicare services

Answer 7

True. (LO 14-6-3)

Question 8

78. Early retirees may be able to purchase coverage through a health benefit exchange beginning in 2014. All of the following are characteristics of the qualified health plans that will be offered through the exchanges EXCEPT (LO 14-6-2)

A. They will cover “essential health benefits.”

B. They will have out-of-pocket maximum limits.

C. They will have federally set premiums.

D. They will be offered at one of four different tiers of coverage.

Answer 8

78. The answer is C. False There are no Federal specifications on the premiums for a health benefit exchange.

True

They will cover “essential health benefits.

True

They will have out-of-pocket maximum limits.

True

They will be offered at one of four different tiers of coverage.

Question 9

79. All of the following statements concerning Accountable Care Organizations are correct EXCEPT (LO 14-6-3)

A. They were established as part of the Shared Savings Program for Medicare Reimbursement of Healthcare Reform. B. They must demonstrate accountability for quality, cost, and care of a population of Medicare beneficiaries. C. They must be established to align care, reduce costs, and increase quality of care. D. They must be established to provide services to fewer than 1,000 Medicare beneficiaries.

Answer 9

79. The answer is D. The Medicare population that must be covered is a minimum of 5,000 Medicare beneficiaries.

Question 10

Accountable Care Organizations They were established as part of the Shared Savings Program for ____ ____ of Healthcare Reform.

Answer 10

Medicare Reimbursement

Question 11

Accountable Care Organizations must demonstrate accountability for quality, cost, and care of a population of _____ beneficiaries.

Answer 11

Medicare

Question 12

Accountable Care They must be established to align care, reduce costs, and increase _____ -

Answer 12

quality of care.

Question 13

Accountable Care Organizations…the Medicare population that must be covered is a minimum of _____ Medicare beneficiaries.

Answer 13

5000