2021 United Healthcare Chronic Condition And Dual Special Needs Plans (CSNP-DSNP) Test Questions And Answers

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2021 United Healthcare Chronic Condition And Dual Special Needs Plans (CSNP-DSNP) Test Questions And Answers Dual Special Needs Plans (DSNP) are defined as which of the following: Correct Answers:... Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid Which statement is true about how loss of Medicaid affects a member's enrollment in a DSNP? Correct Answers: Special Election Period (SEP Dual/LIS Change in Status) is available for DSNP members that lose their Medicaid eligibility. Which consumer might benefit the most by enrolling in a DSNP? Correct Answers: Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+) What program is available to support CSNP and DSNP members who may have unique health care needs? Correct Answers: A care management program that varies depending upon the level of the member's health risk level Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of: Correct Answers: Selling DSNPs The consumer states they currently pay a percentage of charges when they receive medical care. This means: Correct Answers: The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in another type of plan. Which of the following consumer characteristics demonstrates a good fit for a CSNP? Correct Answers: A consumer with a qualifying chronic condition who wants a plan that will help them manage their illness and health care costs On July 19, each of the following consumers met with an agent. Based on the information provided, which consumer must wait until the Annual Election Period (AEP) or Open Enrollment Period (OEP) to enroll? Correct Answers: Joy has a cardiovascular disorder, is enrolled in a CSNP that covers the condition, and wants to enroll in another CSNP offered by the plan that covers the same condition. Which service will a CSNP or DSNP member in the high risk care management category receive? Correct Answers: Case Management (telephonic, digital and/or face-to-face) according to individual needs It is very important for consumers enrolling in a CSNP to know the following about accessing providers: Correct Answers: Some CSNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers, generally with higher cost sharing. Which statement is true about the Medicaid program? Correct Answers: It helps pay medical costs for certain groups of people with limited income and resources. You must advise consumers enrolling in a DSNP that: Correct Answers: They are not required to pay copayments for Medicare-covered services received from a DSNP network provider if they are Full Dual-Eligible or determined DSNP eligible by our plan agreement with the state in which they reside. Their provider should bill the state Medicaid program. Ginny just enrolled in a CSNP that uses the post-enrollment verification method. When will the plan send her a termination notification letter if it has not yet been able to verify a qualifying chronic condition? Correct Answers: At the end of her first month of enrollment A DSNP member loses his eligibility due to a change or loss of Medicaid status. What cost sharing is he responsible for while in the grace period? Correct Answers: All, such as premiums, deductibles, copayments, and coinsurance When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members that lose Medicaid eligibility? Correct Answers: Upon notification or effective date of the loss, whichever is earlier Which statement is true about CSNPs, DSNPs, and prescription drug coverage? Correct Answers: CSNPs and DSNPs include Medicare Part D prescription drug coverage When selling DSNPs, agents must: Correct Answers: Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B Which consumer may be a good candidate for a DSNP? Correct Answers: WRONG - Larry, who has a qualifying chronic condition and wants a plan that will help him manage his illness and health care costs Which of the following consumers is best suited for a CSNP? Correct Answers: Mary, who has been seeing a specialist for a qualifying chronic condition John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans that will help him manage his condition. Can John enroll in a Chronic Special Needs Plan (CSNP) that covers his chronic condition? Correct Answers: Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic) Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level? Correct Answers: All of the responses are correct. It is very important for consumers enrolling in a CSNP to know the following about accessing providers: Correct Answers: Some CSNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers, generally with higher cost sharing. Which statement is true about the Medicaid program? Correct Answers: Benefits vary from state to state. CONTINUES... [Show More]

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