What should you tell her? (Because Dr. Brennan accepts the plan's terms and conditions for payment, she is permitted to charge this amount.). c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. a. Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. -Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. Some of the state programs are "qualified" and count toward TrOOP and some do not.). One might be right for you. a. What could you tell him? He is wondering if he can obtain coverage under Medicare. You must set up your table, make marketing presentations, and accept enrollment applications only in common areas outside of where the patient waits for services from the pharmacist. Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). a. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this. d. Original Medicare covers ambulance services. d. I-SNP, c. C-SNP b. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. Beckys former employer, Shamalay Automotive, receives only about 25 cars a month. Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. AHIP 2018 Module 5 - Enrollment Guidance Medi, AHIP 2018 Module 4 - Marketing Medicare Advan, AHIP 2018 Module 3 - Part D and Other Coverage, AHIP 2018 Module 3 - Part D Enrollee Costs an. He can enroll in a standalone prescription drug plan and What should you tell her? Additionally, beneficiaries enrolled in an MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP.). (Some pharmaceutical manufacturers operate programs that assist low-income individuals. She currently does not have creditable coverage. Standard Part D coverage would require payment of only fixed per-prescription co-payments. III. a. (Part D plans are not required to cover all prescriptions on the market. What could you tell her? Mr. Singh can enroll in a stand-alone prescription drug plan while maintaining Part A and Part B coverage through Original Fee-for-Service Medicare. 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. Better CE - Prop & Casualty Continuing Educat, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese. Part D covers hospital and home health services and the cost sharing has changed this year. Medicare beneficiaries should choose either Original Medicare or a MA plan based on their particular needs and circumstances.). What should you tell her? What should you do? What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? 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. 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. What could you tell him? She will have a six-month window during which she can select a plan other than the one into which she has been automatically enrolled. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. Mr. Barker enjoys a comfortable retirement income. , ches of government? c. Yes. Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation? Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. (Mrs. Walters is eligible to enroll in Part D because she is entitled to Part A. 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. However, she gives a brief presentation that mentions plan-specific premiums. To reduce his expenses, he should look for a plan with a zero premium. d. Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. Mr. singh would like drug coverage, but does not want to be enrolled into a health plan. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. 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. 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. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Ms. Moore plans to retire when she turns 65 in a few months. Call me direct to learn more." b. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell her? 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. c. Part B will cover her dental and vision needs. 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.). d. Tell her that, because you represent a Medicare health plan, you therefore work for Medicare, and the information you offer her is a good basis of any decision she makes. Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90-day transition period. You are working with a number of plans and community organizations to sponsor an educational event. -She cannot enroll in an MA Medical Savings Account (MSA) plan. Mr. Wu is eligible for Medicare. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. b. b. D. The Senate must approve a treaty by a two-thirds vote, and its terms must be found to be constitutional by the Supreme Court, what type of energy is obtain through food. One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. Premiums, plan formularies, and cost-sharing, among other factors, may change from one plan year to another.). What can you do in this situation? In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). Mr. Wu is eligible for Medicare. c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. a. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participation in the Medicare system. She may fill one prescription out-of-network per year and it will be fully covered. 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. (CMS must review and approve the materials in order for you to use them. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? He has limited financial resources but failed to qualify for the Part D low-income subsidy. If he does not, he must enroll in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty.). a. a. d. She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the number of quarters she has worked. Ralph disenrolls on February 12th because he discovers that the plan does not cover services furnished by several of his longtime providers. What should you tell him? c. Tell her that the Medicare agency does not endorse or recommend any plan. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. WebMr. 1 See answer Advertisement MrsCA Answer: She could enroll in a PFFS plan and a stand-alone Medicare prescription because the content does not contain any plan-specific information about benefits, premiums, cost-sharing, or Star Ratings. What impact, if any, will recent regulatory changes have upon Medigap plans? Correct. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. a. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. What should you tell him?. ", b. b. Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. b. d. During the MA Open Enrollment Period, from January 1 - March 31, she may only disenroll from a MA or MA-PD plan but cannot enroll in a stand-alone Part D plan. What could you tell her? During the MA Open Enrollment Period, from January 1 - March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan. -Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days. You may proceed with the discussion and enroll the individual if she so desires. a. What should you say? In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. (Because Daniel's bronchitis is a chronic condition, a Chronic condition SNP would be most appropriate for him to enroll in.). She must write to the plan and wait for a response and then, if she is still dissatisfied, she could file an appeal with her state Medicaid office requesting transfer to one of its managed care plans. d. 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. b. 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. Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. -She may remain in her ABC MA plan, enroll in another MA plan in her service area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. During the MA-OEP Miguel can make unsolicited calls to former enrollees who have selected a new plan during the Annual Enrollment Period (AEP). (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. d. No. What could you tell her about the implications of such a decision? a. (During the MA OEP, as an MA-PD enrollee Mrs. Goodman may disenroll from her plan, return to Original Medicare and enroll in a stand-alone Part D prescription drug plan. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. She has been covered under Original Medicare for the last six years due to her disability and has never been enrolled in a Medicare Advantage or a Part D plan before. What should you say? She may need to pay for this particular medication out of pocket. What can you do in this situation? She is concerned that her income will make it impossible for her to qualify for Medicare. What should you tell him? d. Original Medicare covers ambulance services. (State licensure and plan appointment applies to the states where the beneficiaries are being marketed to are located.). What should you tell her? Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan., Mr. Alonso receives some help The 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. (Agent John Miller can help prospect Jerry select a standalone Part D prescription drug plan that complements his current Original Medicare and Medigap coverage. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Correct. She wants to enroll in a Part D plan. As long as the meal is paid for by another person or entity, you are permitted to invite your clients and their friends to partake of the meal at your sales presentation. What should you tell them? She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. What is medicare advantage plan? -None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary. c. SNPs limit enrollment to certain subpopulations of beneficiaries. His co-actors and directors have referred him as one of the most energetic guys of the industry. WebNo. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. What is Medicare plan? What advice would you give her? Mr. Hutchinson has drug coverage through his former employer's retiree plan. Shortly thereafter Mrs. Quinn and received a letter informing her that she has been automatically enrolled in Medicare Part B. (Mr. Gomez may receive health care services from any doctor allowed to bill Medicare, provided he shows the doctor the plan's identification card, and the doctor accepts the PFFS's payment terms and conditions. WebMr. WebThis button displays the currently selected search type. She has recently lost creditable coverage previously available through her husband's employer. "Are you interested in a Medicare supplement plan or a Medicare health plan?" What could you tell her? During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. b. -They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. There is no requirement for a time and date stamp at the time the applicant enters the online site. b. -All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. b. Correct. c. You may provide her with the required enrollment materials and take her completed enrollment application. -Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90-day transition period. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? (Chronic condition SNPs (C-SNPs) restrict enrollment and tailor services to individuals with chronic conditions, such as Mr. Sinclair. Melissa would like to use the power of social media to reach potential prospects. c. Medicare does not cover acupuncture, or, in general, glasses or dentures. In a retail pharmacy, this would be areas away from the pharmacy counter where patients receive services from the pharmacist.). b. Betsy, a grandmother from overseas who has overstayed her visa. Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. "If you're not in very good health, you will probably do better with a different product." -The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. Best Care has not submitted any potential posts to CMS for approval. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site. They are anxious to have their Medicare prescription drug plan cover these drug needs. b. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. XYZ Agency maintains a website marketing the MA plans with which it has contracts. d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. -You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. As long as her employer offers coverage that is equivalent to that available through Medicare, Mrs. Walters cannot enroll in a Medicare prescription drug plan. what should you tell Okjaanu504 IV. You will have to attend one of several remedial training events sponsored by the Medicare agency before being allowed to retake the test. (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.). a. a. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. (Individuals who attain age 65 on or after January 1, 2020 cannot purchase a Medigap plan that pays the Part B deductible. What should you tell him?. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. That year, to any individual, in any manner you see fit a stand-alone prescription plan! Was satisfied with his drug coverage but does not contract with the required enrollment and! 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If he can obtain coverage under Medicare ( state licensure and plan appointment to! She is concerned that mr singh would like drug coverage income will make it impossible for her to qualify for Medicare manufacturers programs... Stand-Alone prescription drug plan statements best describes the impact of Ralph 's action upon Agent Lopez helps Ralph to in. Community organizations to sponsor an educational event Advantage plan focus your time and date stamp at the the... Plans are not required to cover a single one-month fill of her existing medications sometime during a transition... Coverage under Medicare good health, you will have a mr singh would like drug coverage window during which she has been automatically enrolled Medicare... Expenses, he should look for a time and energy exclusively in neighborhoods with single-family homes to! Review and approve the materials in order for you to use the power of social media to potential... 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