2025 Elevance HMO Plans

The beneficiary must continue to pay the Medicare Part B premium in order to be eligible for the HMO plan.

Which of the following statements regarding eligibility criteria for Medicare Advantage HMO plans is true?

If the member obtains preventive care and screening tests from out-of-network providers, neither Medicare nor the HMO plan will be responsible for the costs. The member will be responsible for the costs in this case.

Some plans may have narrow or select networks. With these plans, if the enrollee chooses a PCP that is part of an IPA or medical group, the specialists, ancillary providers, and hospitals available to them may be limited to only those contracted with the PCP’s IPA or medical group.

Prescription drug costs under Part D apply toward the medical out-of-pocket maximum.

Coinsurance is defined as:

Once a member reaches their annual maximum out of pocket, they are still subject to pay their medical care copayments for the remainder of the calendar year.

Which statement about rules on rates is NOT true?

A medical ­­­­­­­­­­­__________ is defined as "when you believe that your health is in serious danger."

The Medicare Advantage (MA) Program, sometimes called "Part C", combines coverage for Parts A & B benefits and is administered by private health plans.