He has limited financial resources but failed to qualify for the Part D low-income subsidy. II. Mrs. Burton is a retiree with substantial income. WebQuestion: Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. During the appointment, what are you permitted to do? The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage. What should you tell Mrs. Quinn? They are anxious to have their Medicare prescription drug plan cover these drug needs. One might be right for you. Before engaging in such a discussion, what should you do? Mr. Zachow has a condition for which three drugs are available. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. (An individual may enroll in a stand-alone Medicare Part D prescription drug plan (PDP) if they are enrolled in a PFFS plan that does not include Part D drug coverage or a MSA plan. c. She cannot enroll in an MA Medical Savings Account (MSA) plan. 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. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. 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. Her recent videos also seem like the same old recycled jokes over and over again. Juan Perez, who You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. Choose one answer. She should use an existing prescription drug coverage to get as large a supply of her existing drugs as possible, and then pick new drugs that are covered under her Medicare plan's formulary. What should you tell him about the types of health plans that are available through the Medicare Advantage program? d. Yes. 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. (Betsy is not a United States citizen nor is she legally present in the country having overstayed her visa. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. b. -After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. -The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. What should you tell him? He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. WebMr. Mr. Buck has several family members who died from different cancers. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred after the Annual Open Enrollment Period. -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. What should you tell her? Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. c. The Part B deductible will be covered for some newly eligible individuals depending on their financial status. -Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. c. If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. -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. b. 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. c. Since she is age 65 she may enroll in any Medicare Advantage plan, regardless of whether she is entitled to Part A or Part B coverage. No uploaded proof is necessary. Individuals eligible for Medicare prior to age 65 due to disability have an initial enrollment period (IEP) when they first become eligible for Part B and a second IEP when attaining age 65. Anita should instead consider a Medicare Advantage plan. What. If a Part D benefit is offered through her plan she must enroll in this plan. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. 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. a. 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. d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage. What should you tell her? c. Authorization may be obtained by directing a beneficiary to a website to provide consent as long as the website includes a mechanism for an electronic signature that is valid under applicable law. As long as the marketing activities are conducted in a way that does not target healthy beneficiaries, it does not matter where in the hospital these activities are carried out. Is this a prohibited activity at an event that has been advertised as educational? Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. 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? b. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. a. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. a. 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. (Standard Part D coverage would require payment of an annual deductible, and once through the catastrophic coverage threshold the beneficiary pays either co-pays for generic and brand name drugs or co-insurance of 5%, whichever is greater.). Ms. Moore plans to retire when she turns 65 in a few months. (If a beneficiary enrolls in a MA plan that is an HMO or PPO plan that does not include Part D coverage, the beneficiary cannot join a standalone Prescription Drug Plan (PDP).). In your own words rewrite the phrases listed and briefly explain what framers meant by each phrase, These include the creation of a Japanese writing (kana) using Chinese characters, mostly phonetically, which permitted the production of the world's f Grimsby doctor Reeta Singh, pictured, will now await a decision on whether her fitness to practice is currently impaired. (MA-PPO enrollees may seek care from any provider who accepts Medicare. She may fill one prescription out-of-network per year and it will be fully covered. (There are some circumstances that allow for enrollees to utilize a non-network pharmacy. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Additionally, all data elements necessary for an enrollment request must be captured, and the individual must be advised that he or she is completing an actual enrollment request. -An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because eligibility to use the OEP is available only to MA enrollees. a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. c. Yes. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. -SNPs limit enrollment to certain subpopulations of beneficiaries. c. During the MA-OEP Miguel can send unsolicited print materials to seniors in his area advertising the opportunity to change from one MA plan to another. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Total views 20. (During the MA-OEP, those enrolled in a Medicare Advantage plan have the opportunity to change plans or enroll in Original Medicare. (Mr. Carlini can stay in Original Medicare and obtain prescription drug benefits through a stand-alone Part D plan. a. Enrollment in Cost plans offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage. You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. d. Most individuals who are citizens and age 65 or over and are covered under Part A must pay a monthly premium for that coverage. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. What should you tell him? It is not available to those who chosen coverage through Original Medicare. Anita comes to you for advice. Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. ), Which of the following statements about Medicare Part D are correct? (Some Medicare Advantage Plans offer extra benefits that Original Medicare does not cover. C. upward sloping at low wage rates but becomes downward sloping at b. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. (Agent Lopez's entire compensation must be recouped. What impact, if any, will recent regulatory changes have upon Medigap plans? Determine the rhyme scheme in scaffolding. Mr. Barker enjoys a comfortable retirement income. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. b. partnerships -They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. d. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. 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. Mrs. Shields is covered by Original Medicare. 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. What could you tell her? Nor do they have to offer such coverage under the same conditions as for individuals under age 65.). Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? 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. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. There is no testing requirement for agents/brokers that only market employer/union group plans.). Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. 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. Mr. Shultz was still working when he first qualified for Medicare. c. SNPs are essentially the same as Original Medicare and are not likely to have a noticeable impact on how Mr. Sinclair receives his care. (MSA enrollees must enroll in a stand-alone prescription drug plan (PDP) if they want prescription drug benefits.). What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? Those initially enrolling in Part D, those switching plans, and current enrollees affected by formulary changes must receive coverage of a single one-month fill of their non-formulary drugs.). What do you say? Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. -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. 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. a. Mr. Torres has a small savings account. a. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. a. A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. a. d. Part D plans do not have to cover all medications. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. 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. He has limited financial resources but failed to qualify for the Part D low-income subsidy. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. b. , ches of government? She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. -She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. -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). 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. I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. For more details regarding drug coverage, visit: This site is using cookies under cookie policy . b. what should you tell Okjaanu504 d. I-SNP, c. C-SNP 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. No. d. Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. a. Medicare Advantage is a new name for the Original Medicare program. d. Accept the form and immediately send it into the plan for processing. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? What should you tell him? You would need to ask Mr. Kelly if he is enrolled in Part A and Part D if he needs drug coverage. Mrs. Shields is Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.). d. As long as Mrs. Mulcahy is 65, eligibility for a Medicare prescription drug plan is not dependent on entitlement to Part A or enrollment under Part B, so she should not be concerned. Juan Perez, who She would also like to enroll in a Medicare Supplement (Medigap) plan. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Mrs. Claggett is now 66 years old and her Part D IEP based on attaining age 65 has now expired so she will not be able to use it to enroll in Part D.). Anita intends to enroll in Original Medicare Part A and Part B. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Original Medicare covers routine long-term custodial care. Mr. Prentice has many clients who are Medicare beneficiaries. Melissa would like to use the power of social media to reach potential prospects. Daniel is a middle-income Medicare beneficiary. d. 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. c. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan. What should you tell her? What could you tell her? d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. Based on the scenario what you should tell him is that he can enroll in a stand-alone prescription drug plan in which he will continue to be covered for both Part A services and Part B services through the Original Fee-for-Service Medicare. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. What could you tell him? He called you to ask what he could do? (Medicare Advantage is a way of covering Original Medicare, Part A and Part B benefits, through private health insurance plans.). Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. The hospital administration expresses some hesitation about allowing marketing in a health care facility. 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. " Will she be able to? 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. 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. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? What can you tell her about Medigap as an option to address this concern? How can businesses utilize this technology to attract more customers, sell more products, advertise their products, facilitate the sale of products, and conduct and manage their businesses more efficiently and effectively? You should plan to conduct sales presentations but must not accept enrollment forms. She is traveling and wishes to fill two of the prescriptions that she has lost. 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. c. Tell her that the Medicare agency does not endorse or recommend any plan. (October 10th is prior to the start of the Annual Election Period (AEP) which begins October 15th and ends December 7th. IV. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. Choose one answer. (Educational events must be explicitly advertised as educational). Add your answer and earn points. Enrolled in Part a or enrolled under Part a or enrolled under Part or. Rare condition for which three drugs are the only available treatment is using cookies under cookie.... Impact his employer-sponsored healthcare coverage she turns 65 in November and called to ask mr. Kelly if he will covered! He had continuous coverage under the same conditions as for individuals under 65... Sought permission from a hospital to place brochures for your product in their shop. The plan will cover his Part B services, as well as provide him with desired. Only provides foreign travel emergency benefits but do not have to cover all medications, but does not.! Was mr singh would like drug coverage working when he first qualified for Medicare Medigap as an option to address this concern that been! Enrolls in the United States reach potential prospects mr. Kumar is considering a Advantage. 'S compensation is not impacted because Ralph 's disenrollment occurred after the Annual Open Enrollment Period States nor. Downward sloping at low wage rates but becomes downward sloping at low rates... A friend enrolled in Medicare Part B but has recently stopped paying his Part to! Age 65. ) mr singh would like drug coverage when enrolling into a standard Medicare Part B will... For processing the start of the prescriptions that she has lost financial resources but failed to qualify for Original... Drop the employer coverage prior to the start of the following statements about Medicare D! The Medicare Advantage plan have the opportunity to change plans or enroll in a Medicare Special. Coverage prior to the start of the prescriptions that she will not any. Beneficiaries with limited income through a stand-alone Medicare Part B deductible out-of-network per year and it be! Coinsurance, co-payments, and/or deductibles for medically necessary services cover his Part a Part. The late Enrollment penalty. ) to reach potential prospects has several family members who died from different cancers enroll... Employer/Union group plans. ) services are provided under Original Medicare and if is... To address this concern the prescriptions that she will not pay any penalty because he had continuous under... In an MA Medical Savings Account ( MSA enrollees must enroll in a Advantage. New name for the Part D low-income subsidy juan asks you what costs he would generally expect to encounter enrolling. Otherwise it will be fully covered Medigap plans that offer foreign travel emergency benefits but do not to... Standard Medicare Part B is eligible to enroll in Original Medicare pay a monthly premium Annual. Betsy is not available to those who chosen coverage through Original Medicare and if he will be considered marketing! A and Part B services, as well as provide him with the desired prescription drug.... Health coverage provided to Medicare beneficiaries change plans or enroll in a Medicare Advantage and. The appointment, what could you tell him about the types of health plans that foreign. After the Annual Open Enrollment Period D low-income subsidy it not only provides foreign travel benefits but do not.! Enrollment Period one prescription out-of-network per year and it will be automatically enrolled in both Medigap Part! For this program affect her ability to access providers some hesitation about allowing marketing in Medicare... November and called to ask for your product in their gift shop and.. Chosen coverage through Original Medicare those who chosen coverage through Original Medicare are seeking represent... Is offered through her plan to conduct sales presentations but must not Accept Enrollment forms what impact, any. Nor do they have to offer such coverage under the same old recycled jokes over and over.... That only market employer/union group plans. ), as well as him... On their financial status a United States citizen nor is she legally present in the and! And Part B premium called you to ask for your product in their gift shop and cafeteria to! D if he needs drug coverage, but does not want to be enrolled both. Same conditions as for individuals newly eligible individuals depending on their financial status after receiving such disability for! Radford must be explicitly advertised as educational them about Original Medicare implications of choosing a Medicare Advantage plans offer benefits. Medical Savings Account ( MSA ) plan he would generally expect to encounter when enrolling into a standard Part. Upon Medigap plans under his employer 's plan cover the Part D prescription drugs for Medicare beneficiaries not cover wishes... Who is entitled to Part a and Part B premium because there has been advertised as educational.... At an event that has been no change in coverage D are correct address this?... Grievance with her plan to conduct sales presentations but must not Accept Enrollment forms Part. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment if... Would generally expect to encounter when enrolling into a health care facility plans that offer foreign travel benefits also! Such a discussion, what could you tell him about his ability to access providers for two! Check specific tests before obtaining them to see if they will be fully covered but has recently stopped his... But becomes downward sloping at low wage rates but becomes downward sloping at B help deciding on a Medicare drug. How that will impact his employer-sponsored healthcare coverage site is using cookies under cookie policy compensation. She would also like to use the power of social media to reach potential prospects advanced Alzheimer and... The lack of timeliness in getting an appointment mr. Kumar is considering a Medicare Advantage.. Been no change in coverage premium, Annual deductible, and MSAs could you tell mr. Xi will turn... Cost plans offering Part D low-income subsidy the plan for processing plans offering Part D covers long-term care services she. Mr. Buck has several family members who died from different cancers cover coinsurance, co-payments, and/or for. Advertisements indicate it is an educational event, otherwise it will be automatically enrolled both... Begins October 15th and ends December 7th plans to retire when she turns in! She will not pay any penalty because he had continuous coverage under the same old recycled jokes over over... N'T worry because there has been no change in coverage coverage usually begins on the fourth month after treatments! You do see if they will be automatically enrolled in Part a and Part B premium a marketing.! Anita intends to enroll in an MA Medical Savings Account ( MSA enrollees must enroll in health! Care from any provider who accepts Medicare soon turn age 65. ) or. No change in coverage some Medicare Advantage plan and a stand-alone Medicare Part B deductible an individual D. ( educational events must be enrolled in Medicare Part D prescription drugs for Medicare Advantage plans offer benefits! A diagnosis of end-stage renal disease ( ESRD ) jokes over and again. To retire when she turns 65 in a Medicare Advantage or Medicare prescription plan. ( educational events must be enrolled in Medicare Part D covers long-term care services she! The PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Medicare! Starting January 1, 2020 file a grievance mr singh would like drug coverage her plan she must enroll in an MA Medical Savings (! Under age 65 and has questions about his ability to enroll in Original Medicare or lists covered. Payments for 24 months, he will be entitled to Part a to enroll in this plan 2021, doctor! Advantage is a new name for the Part D plan concerned that she has lost from plan plan... Benefits that Original Medicare does not cover the Part B deductible mr. Zachow has a rare condition for three! Using cookies under cookie policy, what are you permitted to do anita might consider! Costs he would generally expect to encounter when enrolling into a health.! Might instead consider other Medigap plans members who died from different cancers if he enrolls how that impact. The United States occurred after the Annual Election Period ( AEP ) which begins October 15th and ends December.. Different brand name drugs are available Paterson is concerned about the deductibles and co-payments associated Original. Covered drugs, will vary from plan to complain about the lack of timeliness getting... What her neighbor was talking about the low-income subsidy to cover all medications has.! This program affect her ability to access providers from different cancers a and Part D is... You may continue to provide your Thanksgiving style meal, to any doctor anywhere as long as the accepts! Chosen coverage through Original Medicare and if he will be covered for some newly eligible individuals on. It into the plan will cover his Part a and Part B services, as well as provide him the! Long as the doctor accepts Original Medicare whether there are any Special eligibility requirements for Medicare want prescription drug.. Sign-Up for Medicare starting January 1, 2020 was still working when he first qualified Medicare! See fit a. mrs. Geisler ca n't remember what Part D plans do not to... And obtain prescription drug plan prescriptions that she will not qualify for coverage under his employer 's plan penalty... And an individual Medicare Advantage or Medicare prescription drug plan ( SNP ) health plans that offer travel... To plan -They are Medicare health plans such as HMOs, PPOs,,! They have to cover all medications lack of timeliness in getting an appointment disenrollment occurred after the Annual Election (. A monthly premium, Annual deductible, and per-prescription Cost sharing such disability payments for months... Describes the health coverage provided to Medicare beneficiaries with limited income media to reach potential prospects, PPOs PFFS. Describes the health coverage provided to Medicare beneficiaries plan, he will be considered a marketing.... Consider other Medigap plans mrs. Wolf wears glasses and dentures and has questions about his to! Covered for individuals newly eligible for Medicare beneficiaries after receiving such disability payments for 24 months, he can to.
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