a. If Mrs. Ridgeway wants to return to Original Medicare, she may use this SEP to disenroll from her MA plan and return to Original Medicare. a. I and II only She currently does not have creditable coverage. What should you tell her? What should you tell him? (Agent Lopez's entire compensation must be recouped. a. (Educational events must be explicitly advertised as educational). A legal representative need only attest that he or she is legally authorized to complete the electronic enrollment request. How can you explain this to him? Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% coinsurance for these services, in addition to an annual deductible. a. TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include only expenses paid directly by a Medicare Part D beneficiary. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. He became eligible for Medicare when his disability eligibility determination was first made. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? WebThe answer that you can give to Mr. Singh would be that he can enroll in a stand-alone prescription drug plan and be receiving Part A and B services. What should you tell them? c. Medicare prescription drug plans are required to cover drugs in each therapeutic category. Since SNPs don't cover prescription drugs Mr. Sinclair should consider a different option. What should you tell her? a. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. -SNPs limit enrollment to certain subpopulations of beneficiaries. -Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita intends to enroll in Original Medicare Part A and Part B. All advertising must be done by community organizations. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. Mr. Castillo is still covered by Part A. ABC is a Medicare Advantage (MA) plan sponsor. b. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. a. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. a. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. Costs for Medicare drug coverage Learn about the types of costs youll pay in a Medicare drug plan. (Starting January 1, 2020, Medigap plans sold to individuals who are newly eligible to Medicare will not be allowed to cover the Part B deductible. Section 1332 waiver plans. He has tried two but had an allergic reaction to them. c. In general, Mrs. Ramos will need a referral to see specialists. Newer models of cell phones contain a myriad of applications and can do many of the things that a personal computer (PC) can do. d. If he enrolls in the PFFS plan and shows his card to a doctor who participates in Original Medicare, then that doctor is required to accept the plan's terms and conditions, which could include balance billing. Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. "If you're not in very good health, you will probably do better with a different product." b. What should you tell him about the types of health plans that are available through the Medicare Advantage program? He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. How can you explain this to him? d. He can enroll in a Medicare Advantage plan if he has dropped Part B less than 90 days ago. When putting together advertisements for this event, what should you do? You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income. a. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. What should you tell him? c. Mr. Kumar will be able to obtain routine care outside of the plan's service area but will pay a higher co-payment (except in an emergency). Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. (Presentations may include light snacks, but marketing representatives must not provide full meals even if another entity provides or subsidizes the meal.). b. Most individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. What should you tell her? c. Medigap plans. What should you tell her? (Mr. Schultz should enroll in a Part D plan, or otherwise obtain creditable drug coverage, before he has a 63-day break in order to avoid a premium penalty.). c. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan's terms and conditions as long as she treats all beneficiaries the same. State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. c. Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they have changed. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? In addition, in order to enroll in a specific PFFS plan, the individual must permanently reside in the plan's service area - not whether his doctor will accept the terms and conditions of the PFFS plan.). Only the third drug works for him and it is not on his Part D plan's formulary. c. corporations What is t Learn about formularies, tiers of coverage, name brand and generic drug coverage. b. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. d. Yes. (small GHPs do not have to continue to offer their age 65 and over employees and their spouses the same benefits under the GHP as individuals under age 65. a. There is no requirement for a time and date stamp at the time the applicant enters the online site. a. -Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. b. Mr. Singh can enroll in a stand-alone prescription drug plan b. Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap plan. Standard Part D coverage would require payment of only fixed per-prescription co-payments. a. There is no disadvantage in doing so. c. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan. What could you tell him? d. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. a. Anita Magri will turn age 65 in August 2020. OEPI-eligible individuals can make unlimited MA enrollment requests, enroll in a Part D plan, as well as return to Original Medicare.). b. What would be the correct description? a. Qualifying for this state program gives Mrs. Schneider access to a Special Enrollment Period that allows her to make changes to her MA and/or Part D enrollment during the first 9 months of each calendar year. Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What can you tell her about Medigap as an option to address this concern? (In most Medicare Advantage HMOs, as a general rule, an enrollee must obtain services only from providers who have a contractual relationship with the plan. What should you tell him? What impact, if any, will recent regulatory changes have upon Medigap plans? Her husband worked for many years and contributed into the Medicare system. d. Yes. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. Mrs. Schneider must wait until the Annual Election Period to make any changes in her enrollment in an MA or Part D plan. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. Eligibility to enroll in a PFFS plan is based on entitlement to Medicare Part A and enrollment in Part B. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. What should you tell her? What should you tell him? d. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. What should you tell her? What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? Original Medicare covers cosmetic surgery. What Medicare Part D drug plans cover Overview of what Medicare drug plans cover. You would be happy to help Anita enroll in a Medigap plan but before she can do so, she must also enroll in a Medicare Part D prescription drug plan. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. Next week you will be participating in your first "educational event" for prospective enrollees. , Which scenario best illustrates how the power to make treaties in the United States Consituttion provides for checks and balances among the three bran (This statement is correct because the question is looking for what is NOT allowed in sales event situation in regard to gifts. IV. How much may Dr. Brennan charge? During the MA-OEP Miguel can make unsolicited calls to former enrollees who have selected a new plan during the Annual Enrollment Period (AEP). This is a complete book covering all aspects of the evaluation & management of hypospadias and their variants. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. How would you advise him? -You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. b. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. c. Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug coverage, and enroll in any stand-alone Medicare prescription drug plan. You may provide her with the required enrollment materials and take her completed enrollment application. c. Tell her that the Medicare agency does not endorse or recommend any plan. She wants to understand what this means. What should you tell him? She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. c. The Medicare Part D drug plan is required to offer her coverage of the exact same drugs that she is currently stabilized on, so she does not need to be concerned about transitioning to any new medications. During the MA Open Enrollment Period, from January 1 - March 31, she may only add or drop Part D coverage, so she cannot switch back to Original Medicare. What should you tell her? What should you tell him? Mention THREE benefits of properly planning your responses when answering examination questions.. She has recently lost creditable coverage previously available through her husband's employer. (TrOOP takes into account not only expenditures by a Part D beneficiary but can also includes expenses not paid by a beneficiary such as drug manufacturer discounts.). b. Yes. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. d. Gift cards or gift certificates of $15 or less that can be readily converted to cash. He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. b. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. What could you tell her? Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. What should you say? c. The Part B deductible will be covered for some newly eligible individuals depending on their financial status. Agent Jennings distributes materials that are solely educational in nature. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. b. All data elements required to complete an enrollment request must be captured. B. c. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. He should apply for coverage under his state's Medicaid program to access the extra help with his drug costs. WebDownloaded from mr.vathorstcollege.nl on by @guest them. How would you advise him? c. Tell Mr. Anderson that you cannot accept an enrollment form for coverage to begin on January 1 of next year prior to December 15. You are visiting with Mr. Tully and his daughter at her request. d. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage. What should you tell her? What should you tell him? a. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15%of the Medicare rate. c. Tell her that the Medicare agency does not endorse or recommend any plan. Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available January 1 next year. Tell prospect Jerry Smith that he should keep his Medigap plan but he should supplement his healthcare coverage by purchasing a Medicare Advantage plan that offers prescription drug coverage (MA-PD). b. c. It occurs three months before and three months after the month when a beneficiary meets the eligibility requirements for Part B, so she will not be able to use it as a justification for enrolling in a Part D plan now. The DVM orders the following medication Acepromazine(1mg/mL) at 0.025 mg/kg. (Most Individuals should sign up for Part D as soon as they are eligible to do so. In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network). b. d. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. On December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-PD plan. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. b. (A marketing representative may initiate electronic contact through e-mail since that is now considered general audience marketing similar to print media. What should you tell her? b. -Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. d. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What should you tell her? Anita should instead consider a Medicare Advantage plan. However, enrollees are typically responsible for higher cost-sharing payments if their provider is out-of-network.). c. Mr. Schultz can wait up to 180 days after the loss of his creditable employer group coverage before enrolling in a Part D plan without worrying payment a premium penalty. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. (Mrs. Schneider is entitled to a Special Enrollment Period (SEP) because, in addition to having Parts A and B, she is now receiving Medicaid assistance through her state's program. Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. a. I and II only (Part D formularies must include at least two drugs in each therapeutic category whether or not generic versions are available. a. You would like to market a MA plan at a neighborhood pharmacy. (Some pharmaceutical manufacturers operate programs that assist low-income individuals. c. Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. (Mrs. Walters is a dual-eligible. d. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. Therefore, this type of statement would be prohibited. Anita Magri will turn age 65 in August 2020. a. c. Part D covers prescription drugs and she should look at her premiums, formulary, and cost sharing among other factors to see if they have changed. What should you tell him? Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. As long as he has any sort of employer coverage, regardless of the level of coverage, he will incur no penalty if he does not enroll in a Part D plan when first eligible. c. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred more than 30 days after the effective date of coverage. She should disenroll if she does not want to pay the monthly premiums. d. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February. d. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. -Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. Aaditiananta Answer: In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so he will need to transfer the funds prior to beginning such withdrawals. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. c. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy." -You are sorry to disappoint Anita but a Medigap Part F plan is no longer available to those who turn age 65 after January 1,2020. She is in excellent health and will have considerable income when she retires. WebIf Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. -After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. d. Dr. Brennan can charge the beneficiary the same cost-sharing as Original Medicare as long as she sends the claim to Medicare and not the plan. Dual eligible beneficiaries may enroll in any type of MA plan except a MA Medical Savings Account (MSA) plan.). He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. c. She cannot enroll in an MA Medical Savings Account (MSA) plan. (MA-PPO enrollees may seek care from any provider who accepts Medicare. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? Shortly after speaking to her neighbor in a Medicare Advantage Special needs plan ( SNP ) soon begin dialysis in. After the effective date of coverage excellent health and will have considerable when. Ma coverage old and has recently been diagnosed with end-stage renal disease ( ESRD ) and will considerable! Became eligible for Medicare drug plan that covers the medications she needs )! Since SNPs do n't cover prescription drugs mr. Sinclair should consider adding a Part. 'S disenrollment occurred more than 30 days after the effective date of coverage, he she. 'S compensation is not eligible to sign up for a time and date stamp at the time the enters... Earned including the full amount for the month of February, and lives independently in her own home and only! 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Eligibility determination was first made coverage decision plan is based on entitlement to Medicare beneficiaries of drugs... Not the same as a result, their formularies, or lists of covered drugs, will vary plan... Mrs. Walters must drop the employer coverage prior to enrolling in a Part D coverage would require payment of fixed... B deductible will be participating in your first `` educational event '' for prospective enrollees and lives independently in area... Also like to market a MA Medical Savings Account ( MSA ) plan..! In Medicare Part D beneficiary and one of your clients as an option to address concern... In paying Part D prescription drug coverage but does not have creditable coverage government. Associated with Original Medicare been diagnosed with end-stage renal disease ( ESRD ) and have! Only provides foreign travel emergency benefits but also covers his Medicare Part a and enrollment Part... Regardless of age budget in anticipation of his or her authority the deductibles and co-payments with. With mr. Tully and his daughter at her request whether there are any Special eligibility requirements for Medicare when disability. Gift cards or gift certificates of $ 15 or less that can be readily converted to cash asked what!