An older adult asks a nurse, "I saw an advertisement and went to a free breakfast to hear about Medicare Advantage Plans. They sound really good, but I am not sure. Are there benefits to joining one?"
The nurse relies on which of the following information when formulating a response? (Select all that apply.)
a. All Medicare advantage plans have pre-scription drug coverage.
b. Medicare advantage plans must cover all services traditionally covered by Medicare Parts A and B.
c. There are no deductibles in Medicare Ad-vantage plans.
d. Medicare advantage plans may provide a cost savings to the member.
e. Members must obtain a referral to see a specialist from an assigned primary care provider.
ANS: B, D, E
Medicare Advantage Plans (MAPs), or Medicare Part C, use a prospective payment system and includes traditional health maintenance organizations (HMOs) and other managed care plans. All traditional services covered by Medicare Parts A and B must be provided, and additional ser-vices, co-pays, and deductibles are predetermined. Medicare Advantage Plans may or may not provide prescription drug benefits. MAPs may provide a cost savings to the member as well as extra benefits. However, special rules must be followed, including the requirement that no care is obtained without a referral from an assigned primary care provider.
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