Mrs. Shields is Otherwise, he has no problems functioning. 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. Anita Magri will turn age 65 in August 2020. You would need to ask Mr. Kelly if he is enrolled in Part A and Part D if he needs drug coverage. WebIf Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. What enrollment rules would apply in this case? What is medicare advantage plan? Correct. d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. 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. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him? b. Dr. Brennan can charge Mary Rodgers no more than the cost sharing specified in the PFFS plan's terms and conditions of payment which may include balance billing up to 25% of the Medicare rate. - 27968462 If the enrollment form is countersigned by one of Mr. Tully's treating physicians, she can sign it for him. a. d. 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. (The CMS Communication and Marketing Guidelines apply to MA and PDP plans.). What is Medicare plan? c. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. Juan Perez, who b. TrOOP refers to true out-of-pocket expenses paid by a Part D beneficiary for non-prescription over-the-counter (OTC) drugs and vitamins that are not covered by his or her plan. What should you tell him? b. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. b. Question 4 Mr. Wu is eligible for Medicare. III. (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. Melissa would like to use the power of social media to reach potential prospects. a. Helena, an overseas college student who has overstayed her visa. Mr. Buck has several family members who died from different cancers. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. Match the terms with the definition. Agent John Miller is meeting with Jerry Smith, a new prospect. On a separate sheet of paper, classify each of the numbered terms below into the following categories. She wants to understand what this means. Original Medicare covers cosmetic surgery. What should you tell him? What should you tell him? Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services. She agreed to sign a scope of appointment form and meet with you on October 15. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. 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. a. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. What should you tell her about obtaining drug coverage? 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. b. For more details regarding drug coverage, visit: This site is using cookies under cookie policy . Medicare health plans must provide enrollees with a written description of the appeals process.). What should you tell Mrs. Quinn? Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. Rules regarding unsolicited contact do not apply to marketing through these materials. 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. Anita intends to enroll in Original Medicare Part A and Part B. Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums, and cost sharing. b. Becky is surprised to learn that her new employer, Mueller Imports, receives over 200 cars a month. a. Anita comes to you for advice. What could you tell Mr. Moy? -SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. c. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. All advertising must be done by community organizations. Anita comes to you for advice. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. a. d. With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as that provider participates in Original Medicare. c. She may continue to keep her existing plan, because all Medicare health plans are required to provide coverage to anyone, no matter where they live. d. Part D plans do not have to cover all medications. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a prescription drug plan. However, she gives a brief presentation that mentions plan-specific premiums. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. What single payment could be made at the beginning of the first year to achieve this objective? Agent Jennings distributes materials that are solely educational in nature. Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare. Call me to find out more!" Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. (Marketing representatives may engage in marketing activities in common areas in a health care setting.). Correct. Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. Mr. Hutchinson has drug coverage through his former employer's retiree plan. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? d. Prior to speaking with the individual, you must inquire as to her eligibility for MA and Part D plans and then complete a scope of appointment form for the plans for which she is eligible. WebMr. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. (To avoid a late enrollment penalty, Mr. Hutchinson must have "creditable" coverage. What should you tell her? -Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. b. 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. What should you tell her? How would you advise him? In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%, but those of specialists are covered at 80%. b. 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. All SNPs include prescription drug coverage.). Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Most of them a. If a beneficiary disenrolls within the first 3 months of enrollment (referred to as "rapid disenrollment"), the entire compensation amount must be recouped because Ralph's situation does not fall under any of the excepted circumstances such as becoming LIS eligible.). d. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. a. You must have her sign a scope of appointment form, indicating which products she wishes to discuss, and note on the form that she is a "walk in. " Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? a. SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. a. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. 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). 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? voodoo. a. WebA: 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. a. Medicare health plans must cover all benefits available under Medicare Part A and Part B. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. However, the plan does not provide drug benefits. WebIf Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. How would you respond? He has chronic bronchitis, putting him at severe risk for pneumonia. Because of high demand for these cars, dealerships all want to receive as many cars as they can from the regional sales manager. TTY: 1-877-486-2048. Where might he turn for help with his prescription drug costs? Melissa Meadows is a marketing representative for Best Care which has recently introduced a Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Explain. (A signed scope of appointment form describing the types of products she wishes to discuss must be completed before you begin your discussion.). He has limited financial resources but failed to qualify for the Part D low-income subsidy. (Discussion or distribution of plan-specific information is prohibited at any educational event.). 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. d. The government bases its payments to Part D plans on the standard benefit model. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. What could you tell her? His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. She is concerned that her income will make it impossible for her to qualify for Medicare. Two or more gifts whose combined value does not exceed $15. d. He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium penalty. Learn about formularies, tiers of coverage, name brand and generic drug coverage. She is considering enrollment in a Medicare Advantage plan (Part C). d. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered. Mr. Torres has a small savings account. What could you tell her to address her concern? Authorization can be obtained by directing a beneficiary to a website to provided consent as long as the website contains a mechanism for an electronic signature that is valid under applicable law. 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. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. b. Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. d. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage. That are solely educational in nature not changed this year, but the physician charges may go up or. To join that plan first year to achieve this objective to selecting a prescription drug costs selecting a prescription plan! Zachow has a pharmacy assistance program to help him with his prescription drug?... Help him with his expenses because of high demand for these cars, dealerships all to. To selecting a prescription drug costs he markets ABC MA plans are located whose combined value does not provide benefits! 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To be enrolled in a MA-Medical Savings Account ( MSA ) plan may only obtain Part D plans not.
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