Our plans test yourself transcript

What's the difference between an HMO-POS plan and a PPO plan?

Choose the best answer:

  1. With a PPO plan I have more freedom to manage my own health care
  2. They work just the same, they're just names insurers use to confuse people
  3. With an HMO-POS plan I can only see doctors my health plan approves

Answers:

  1. With a PPO plan I have more freedom to manage my own health care: True. You won't need to ask permission before you get services to have them covered and you won't have to choose a primary care physician (PCP) to coordinate all of your care. But with freedom comes more responsibility. You may have to make your own appointments with specialists and other health care providers.
  2. They work just the same, they're just names insurers use to confuse people: Not exactly. They both allow you to see doctors and hospitals outside of your health plan's approved network, but you have more control over your own health care with a PPO. If you choose an HMO-POS plan, you'll choose a primary care physician (PCP) to coordinate all of your care and you'll need to work with that doctor to get prior authorization before you get some services (otherwise they won't be covered). If you choose a PPO you won't have to rely on one doctor for all of your care and you won't need prior authorization to get your services covered outside of your health plan's approved network.
  3. With an HMO-POS plan I can only see doctors my health plan approves: No. A lot of people think this is the case, but it's not. Whether you have an HMO-POS or a PPO plan, you can see doctors and hospitals outside of your health plan's approved network. Doing so may cost you more.

What's a Medicare "star rating"?

Choose the best answer:

  1. A reason to choose a different Medicare plan
  2. A way to show which Medicare plans are the most popular
  3. An indicator of how a Medicare plan performs

Answers:

  1. A reason to choose a different Medicare plan: It could be. The star ratings show how well Medicare Advantage and Part D prescription drug plans perform each year. Excellent plans earn 5 stars while poorly performing plans earn 1 star. If a 5-star plan is offered in your area, you may want to choose it for your coverage. Once each year you can switch to a plan that has an overall 5-star rating. You can do this at any time.
  2. A way to show which Medicare plans are the most popular: Not necessarily. The star ratings show how well Medicare Advantage and Part D prescription drug plans perform each year. The Centers for Medicare and Medicaid Services (CMS) sets guidelines for plans to meet so that all plans are rated equally. Excellent plans earn 5 stars while poorly performing plans earn 1 star. Plans with higher star ratings may be more popular because they generally offer better care and value.
  3. An indicator of how a Medicare plan performs: Yes. The Centers for Medicare and Medicaid Services (CMS) rates how well Medicare Advantage and Part D prescription drug plans perform each year. Excellent plans earn 5 stars while poorly performing plans earn 1 star. In general, the better the star rating, the better the care and value you'll receive.

When can I enroll in a Priority Health plan?

Choose the best answer:

  1. When I stop working
  2. Anytime after I turn 65
  3. Only the 6 months around when I turn 65

Answers:

  1. When I stop working: No. If you're within 3 months of turning 65 and still working, don't wait. You should sign up for Part A (hospitalization) even if you don't plan to retire anytime soon. Depending on your situation, you may be able to delay enrolling in Part B (medical) and/or Part D (prescription drugs).
  2. Anytime after I turn 65: Almost. You have an initial enrollment period to sign up, which includes the 3 months before your 65th birthday, your birthday month and the 3 months after your 65th birthday. You should sign up for Part A (hospitalization) right away even if you don't plan to retire anytime soon. Depending on your situation, you may be able to delay enrolling in Part B (medical) and/or Part D (prescription drugs).
  3. Only the 6 months around when I turn 65: Not exactly. When your first become eligible for Medicare, you should sign up for Part A (hospitalization) during your initial enrollment period, which includes the 3 months before your 65th birthday, your birthday month and the 3 months after your 65th birthday. Depending on your situation, you may be able to delay enrolling in Part B (medical) and/or Part D (prescription drugs).