2025 Elderplan Medicare Certification Exam

In 2025, Elderplan will have (7) Medicare Advantage Plan options.

In some cases, members will be responsible for paying for out-of-network services not covered by Elderplan

A beneficiary will qualify for EPIC (SPAP) if they are under 65 years of age with certain disabilities.

Elderplan is not:

In 2025, Elderplan's Extra Help (009) and Flex (016) plans will be available in Nassau county.

Members may ask Elderplan to cover a prescription that is not on the formulary, with no guarantee that it will be approved.

Quantity Limits is when the plan limits the amount of the drug the plan will cover, or for a defined period of time (i.e.: 30 tablets per prescription of Zetia).

It is critical that Sales Agents complete the following fields on the Enrollment Form:

If Elderplan denies an exception request, the member does not have the right to appeal the decision.

Certain drugs require a beneficiary or their physician to get prior authorization from Elderplan before the pharmacy will fill their prescription. This is known as Limited Access drugs.

In a case where the beneficiary has agreed to an appointment to discuss a specific product (i.e.: PDP), an agent cannot discuss a MA product during that same meeting unless the beneficiary requests it.

Members may self-refer to a plan provider without a referral or approval in advance from their PCP for the following services:

If a particular service is not included in the plan's Summary of Benefits, it is safe to assume the service is covered under basic covered services.

If a member in our Extra Help plan has the Epic Deductible plan, they must meet their Elderplan Part D deductible and their Epic deductible before Epic assists with lowering their copayments between $3-$20:

The name on the enrollment form should be written exactly as it appears on the Medicare card, even if the spelling is incorrect.

Which statement(s) are TRUE regarding a Scope of Appointment:

Step Therapy and Limited Access are examples of prescription utilization management tools that may be administered by the plan:

If a member in our Extra Help plan has the Epic Fee plan, they will be required to meet their Elderplan Part D deductible, if they have one:

The following drugs are not covered (or "Excluded Drugs"). Select all that apply:

A standard appeal time for prescription drug appeal is:

A standard appeal time for health services is:

Elderplan offers an Over-the-Counter (OTC) card for all plans.

In the Flex plan (016), members will receive both an OTC card and transportation benefit:

Members should contact member services for the following reasons:

The amount a member pays for a prescription depends on: Select all that apply:

Medicare beneficiaries with limited income may qualify for the Medicare Savings Program (MSP) which will help lower their prescription drug costs:

In most cases, the member's effective date of coverage will be:

Elderplan will generally cover the drugs listed in the formulary as long as:

Members in the EPIC Fee Plan will always receive assistance with their Part D Plan premium

It is unacceptable for a spouse to sign and date an enrollment form for their husband or wife unless the spouse is the Durable Power of Attorney for Healthcare.