2025 Kaiser Medicare Certification ExamBy Brian Platte / August 13, 2024 Kaiser Permanente offers a Medicare Senior Advantage and Medicare Advantage plan. Both plans provide members with a comprehensive set of benefits. These plan offerings are based on the Kaiser Permanente Market service area. True False Kaiser Permanente Senior Advantage (KPSA) is a ____________ plan. Medicare Advantage (MA), without Prescription 1876 Cost Medicare Advantage Prescription Drug (MA-PD) Kaiser Permanente Washington and Mid-Atlantic States offer which Medicare Advantage plan(s)? Medicare Advantage without Prescription Drugs Medicare Advantage both with and without Prescription Drug coverage Medicare Advantage Prescription Drug (MA-PD) Senior Advantage (KPSA) and Medicare Advantage members are expected to obtain their health care: At Kaiser Permanente facilities, but they can also obtain care at non-KP facilities at a higher out-of-pocket cost At any health care facility, as long as it is in a CMA-approved service area Only at Kaiser Permanente or contracted health care facilities or pharmacies (except for certain urgent care and emergency-related services At any facility of their choice To be eligible for Senior Advantage (KPSA) and Medicare Advantage, an individual must: Be age 65 or older with no disabilities Be entitled to Medicare Part A and enrolled in Medicare Part B Qualify as low-income, based on state guidelines To be eligible for Senior Advantage (KPSA) and Medicare Advantage, an individual must: Permanently reside within the KP Medicare service area Permanently reside within 20 miles of the KP service area Reside at least 8 months out of the year in the KP service area Reside within 30 miles of his or her primary physician Advantage Plus is an optional supplemental plan that ___________ at an additional monthly premium. Adds family members to the plan Reduces eligibility requirements Expands geographic coverage Provides extra benefits (such as vision, dental, and/or hearing coverage) An HMO-POS plan allows members to use providers outside the plan's network for an additional cost. True False To be eligible for the Senior Advantage Special Needs plan, an individual must already have ______________. Medicare A and B only Medicaid/Medi-Calonly Both Medicare Part A, Part B and Medicaid/Medi-Cal Individuals with Medicare and Medicaid or Medi-Cal qualify for a Special Election Period and can enroll or disenroll ______________. Only between January 1 and February 14 Only between October 15 and December 7 Once per quarter during the first 3 quarters of the year At Kaiser Permanente, __________ apply to the Maximum Out-of-Pocket (MOOP). only preventive services all Medicare-covered services (Parts A & B) some covered services (see Summary of Benefits) only diagnostic services What is the correct prescription drug coverage tier for non-preferred drugs? Tier 1 Tier 2 Tier 3 Tier 4 What is the correct prescription drug coverage tier for non-preferred generic drugs? Tier 1 Tier 2 Tier 3 Tier 4 What is the correct prescription drug coverage tier for injectable Part D vaccines? Tier 1 Tier 5 Tier 3 Tier 6 What is the correct prescription drug coverage tier for preferred generic drugs? Tier 1 Tier 5 Tier 3 Tier 6 What is the correct prescription drug coverage tier for specialty tier? Tier 1 Tier 5 Tier 3 Tier 4 What is the correct prescription drug coverage tier for preferred brand-name drugs? Tier 1 Tier 5 Tier 3 Tier 6 Under KP's Medicare prescription drug benefit, when are injectable Part D vaccines covered at no charge? Only at the initial coverage stage Only as part of the deductible Only at the catastrophic coverage stage At any coverage stage (in most plans) You are looking up the cost sharing for a member's prescription. After finding the drug tier level in the formulary, where will you look up the tier cost-share? Medicare Coverage Policy Manual Summary of Benefits Monthly utilization report Brand discount summary Lower copays for selected chronic condition drugs are in ______________ (in most plans). Tier 1, preferred generic Tier 5, specialty Tier 3, preferred brand-name Tier 4, non-preferred drugs ResultsVote
