2025 HCSC Medicare Certification Exam

The Blue Cross MedicareRx formulary is the same for the Value, Basic and Low-Cost Enhanced Plans.

The Medicare Advantage Open Disenrollment Period is available________.

The HCSC/HISC Medicare Part C and D mail-order programs are administered by Alliance RX Walgreens Prime, Amazon Pharmacy and ESI mail order.

How many levels are in the Appeals Process for a member?

A CTM is when a member contacts 1-800-Medicare to file a complaint.

Mr. Lee will turn 65 at the end of March and signed up for an MA plan in January during his Initial Coverage Election Period (ICEP). When will his coverage begin?

Starting January 1, 2025, the Coverage Gap—also known as the Donut Hole—no longer exists in the Part D program.

For all MA plans, an enrollee that chooses to join a PDP will be automatically disenrolled from his/her current plan.

Dual Eligible Special Needs Plans (D-SNPs) enroll beneficiaries who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid.

At a marketing/sales event, producers and the Plan Sponsor may do all except the following:

Medicare beneficiaries may join a Blue Cross Medicare Advantage plan if they are entitled to Medicare Part A, enrolled in Medicare Part B, and live in the service area.

Blue Acces Producers is an online resource that provides producers with instant access to the tools and information needed to build a stronger business and better service for clients.

Tier __ consists of specialty drugs that are high-cost medications such as injectable antibiotics, biological agents, and chemotherapeutic agents.

All individual sales/marketing and enrollment calls (including TPMO calls) are required to be recorded?

A non-preferred network pharmacy is still considered a network pharmacy. However the reduced copay structure of the preferred network pharmacy program is not offered.

No Part D plans, whether PDP or MAPD, can include a Coverage Gap.

The three types of preferred network pharmacies within the HCSC/HISC Medicare Part C and D plan networks are all except the following:

When enrolling a client into either a Blue Cross MedicareRx, Medicare Blue Rx or Blue Cross Medicare Advantage plan, agents should discuss all items except:

The Scope of Appointment form must be completed with each enrollment and retained on file with the producer for 10 years

Members whom select the Social Security (SSA) Administration billing option should pay their premiums until the deductions begin in order to avoid plan disenrollment.

The Request for Information (RFI) Process allots the member __ days to respond and provide the requested information to avoid the enrollment from being denied.

Members will proceed directly form the Initial Coverage Stage into the Catastrophic Stage when they accumulate $2,000 in out-of-pocket drug costs.

The HCSC/HISC Medicare Part C and D mail-order program only offers a 30 day supply on all medications.