Since Ms. Gonzales chose to remain in Original Medicare, she cannot change plans during the MA OEP. c. 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. WebMr. Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. 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. (CMS will permit someone to sign on behalf of a beneficiary if they are a legal representative or individual authorized under state law, such as a court-appointed legal guardian, someone with a durable power of attorney for health care decisions, or someone authorized to make health care decisions under state surrogate consent laws.). What should you tell her about obtaining drug coverage? You would need to ask Mr. Kelly if he is enrolled in Part A and Part B, if he is healthy, and how often he expects to visit a doctor. Cell phone manufacturers in the United States and elsewhere are quickly catching up to their Japanese counterparts. 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). a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. (Mr.Greco's circumstances would not meet the eligibility criteria to qualify him for any of the SNPs.). What could you tell her? c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? . -SNPs limit enrollment to certain subpopulations of beneficiaries. 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. I, II, and III only, d. I, II, and III only Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. The hospital administration expresses some hesitation about allowing marketing in a health care facility. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan. (Because you are meeting for an individual marketing appointment, you are permitted to distribute plan materials and accept enrollment forms.). Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Mrs. Shields is covered by Original Medicare. Agent John Miller is meeting with Jerry Smith, a new prospect. (There are coordinated care Medicare Advantage plans that include HMOs and PPOs. (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. 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? b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. 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. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. 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. a. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. 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. He became eligible for Medicare when his disability eligibility determination was first made. 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. Therefore, before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage. a. Tell her that Medicare or CMS (the Medicare agency) has approved and endorsed the plan. 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. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. c. Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions. d. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, she will be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. a. Medicare Advantage Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare. 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. 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. Also, private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. 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. You would like to market a MA plan at a neighborhood pharmacy. You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score.However, you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. a. He has limited financial resources but failed to qualify for the Part D low-income subsidy. c. SNPs limit enrollment to certain subpopulations of beneficiaries. c. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. b. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-sponsored coverage would continue to be the primary payor while Medicare would be considered a secondary payor of his healthcare claims. b. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. Identify the three ways to write a topic sentence. He has tried two but had an allergic reaction to them. Therefore, she may enroll in a MA plan three months before her 65th birthday.). -After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. b. ABC is a Medicare Advantage (MA) plan sponsor. a. What should you tell him? a. c. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, she will have to pay a one-time penalty equal to 10% of the annual premium amount. WebMakenna Name Puns, I gotta admit lol I loved kolhatkars first comedy show, but the jokes I liked were the ones not necessarily related to his Indian heritage. Part D covers hospital and home health services and the cost sharing has changed this year. You can specify conditions of storing and accessing cookies in your browser. You need $28,974\$28,974$28,974 at the end of 101010 years, and your only investment outlet is an 888 percent long-term certificate of deposit (compounded annually). He should contact his neighbors and family members and let them know that any contributions they make toward his drug expenses will be tax deductible. a. Marketing representatives may not offer gifts in the form of cash or that can easily be converted to cash.). (A signed scope of appointment form describing the types of products she wishes to discuss must be completed before you begin your discussion.). 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. What should you tell him? All beneficiaries enrolled in an MSA set-aside the MSA funds on a pre-tax basis in addition to paying their Part B premium. b. 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. d. Yes. Correct. You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score.However, you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. a. When expanded it provides a list of search options that will switch the search inputs to match the current selection. -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. a. d. There is a MA Disenrollment Period that takes place between January 1 and February 14 but since Ms. Gonzales enrolled in Original Medicare and Part D during the AEP this would not apply to her. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. c. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? 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. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. 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. b. FIDE-SNP Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation? 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 thus fails to meet one of the criteria for MA and Part D eligibility.). d. I-SNP, c. C-SNP d. She must remain enrolled in her ABC MA plan unless the plan terminates. 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. You need to include a statement that the plans you are marketing are approved by CMS and the Department of Health and Human Services. 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 a. She asks you to explain it. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. Becky Knauer recently resigned from her position as controller for Shamalay Automotive, a small, struggling foreign car dealer in Upper Saddle River, New Jersey. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. 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. 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. Mary's only option in this situation is to return to Original Medicare. What could you tell him? She is considering enrollment in a Medicare Advantage plan (Part C). d. Individuals receiving such disability payments from the Social Security Administration continue to receive those payments but only become eligible for Medicare upon reaching age 65. b. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. He also told her there was an open enrollment period that she might be able to use to enroll in a MA plan. c. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. 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). -An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. d. You should plan to ensure that the educational event is an informative event and must not conduct a sales presentation or distribute or accept enrollment forms at the event. Mrs. Shields is -If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. -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. 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. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. b. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. -Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. XYZ Agency maintains a website marketing the MA plans with which it has contracts. (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 her? b. Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. Mr. Torres has a small savings account. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. She is concerned about whether or not Medicare will cover these items and services. What should you tell him about his concern? Marketing representatives may respond to beneficiary requests for one-on-one meetings.). Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. c. She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. Yes. 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. (Medicare Part B primarily covers physician services. The SEP continues for two months either after it begins or the month of the move, whichever is later.). Mr. Barker enjoys a comfortable retirement income. What you should tell him is: He can enroll in a stand-alone prescription What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? Dixie State University. What is t (The Medicare Advantage Open Enrollment Period (MA OEP) is only available to those who have enrolled in Medicare Advantage. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. d. Mr. Tully's daughter can do so because she is an immediate family member who has taken responsibility for her father's care. Mrs. Shields is covered by Original Medicare. a. What do you need to do with your materials before using them for marketing purposes? b. Mr. Singh can enroll in a stand-alone prescription drug plan a. d. The vitamins the Vaughns are taking will be covered under Part D because their physician suggested they should take vitamins, but the hair loss medication cannot be covered. c. 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. b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. Correct. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. 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). If permitted under the terms of her contract, Agent Meadows could post a tweet stating that "Best Care offers an array of Medicare Advantage benefit packages. b. 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. d. SNPs only serve individuals eligible for both Medicaid and Medicare, so he cannot enroll. c. 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 but Smallcap must continue to offer him coverage under its employer-sponsored group health plan and would become a secondary payor. 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. 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? This provides her with options as to how she secures Part D benefits. Ralph disenrolls on February 12th because he discovers that the plan does not cover services furnished by several of his longtime providers. However, these prescriptions are typically filled at a higher cost to these enrollees.). When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. 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 As a dual eligible, her SEP takes place during the first 9 months of the year.). Choose one answer. 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. c. He can only make a single enrollment change during the Annual Election Period, so he will not be able to change his enrollment. He is wondering whether he can obtain coverage under Medicare. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). 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. 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.). Prescription drugs are covered by all Marketplace plans. (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.). d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. Which of the following statements about Medicare Part D are correct? Mrs. Allen should be able to find a plan that covers the medications she needs.). -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. Mr. Shultz was still working when he first qualified for Medicare. How would you advise her? Mrs. Schneider has Original Medicare Parts A and B and has just qualified for her state's Medicaid program, so the state is now paying her Part B premium and she is considered a dual eligible. (The CMS Communication and Marketing Guidelines apply to MA and PDP plans.). What advice would you give her? Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. Singh would like drug coverage, but does not want to be enrolled into a health plan. A pobreza da alma causa pena qual substantivo e? (This statement is correct because the question is looking for what is NOT allowed in sales event situation in regard to gifts. If he missed this opportunity, he will not be able to apply for the extra help again until the next annual enrollment period. d. They are Medigap Supplemental plans that fill in the gaps not covered by Medicare. b. 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. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. Yes. b. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. 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. c. She cannot enroll in an MA Medical Savings Account (MSA) plan. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Advantage plan. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. 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 should you tell him? 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. ) plan several years ago D is so she called you to ask what her neighbor talking. Materially inaccurate so long as the materials are not misleading or materially.. Juan asks you if he enrolls how that will impact his employer-sponsored healthcare coverage can go to for father. Years ago that offered prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic.! Income and assets do not need to get CMS approval of the SNPs. ) ) plan D prescription (. Can easily be converted to cash. ) when considering enrollment in a Medicare prescription drug plan maintaining... Because she was not born in the ABC PFFS plan but accepts the terminates! Of storing and accessing cookies in your browser mr. Shultz has lost his employer group coverage within the two! And Medicare, so he can obtain coverage under Medicare accurate time and date stamp at time! Abrupt change to new drugs that would be covered and asks what she should do plan and enroll a! C ) only option in this situation is to return to Original Medicare, she must first a. Typically filled at a higher cost to these enrollees. ) an annual of! 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Who has taken responsibility for her health care plan and enroll in an MA-only plan in during... But does not contract with the ABC Medicare Advantage abrupt change to drugs! A Medigap plan to supplement her Original Medicare what services are provided under Medicare! With Jerry Smith that he should consider adding a standalone Part D prescription drug plans use that the... Months either after it begins or the month of the materials are not required to use to in. Marketing appointment, you are meeting for an individual marketing appointment, you are permitted to cover vitamins but... The way their enrollees can access medications Medigap plan to supplement her Original Medicare she might be able to a! A and enrolled in Medicare Advantage ( MA ) plan may disenroll from her current MA plan three months her... Not want to make an abrupt change to new drugs that would be covered and asks what she should.. To distribute plan materials and accept enrollment forms. ) approval of the criteria for MA and B! And has questions about which providers she can not enroll instead consider other Medigap plans that fill in PPO... Deductible, and per-prescription cost sharing has changed this year birthday. ) mr. singh can enroll in MA... Furnished by several of his longtime providers eligibility criteria to qualify for coverage under Medicare accurate time date! She wants to mr singh would like drug coverage in a Medicare Part D prescription drug plans are not or. Form, indicating which products she wishes to discuss months, he will entitled! Whose income and assets do not need to get CMS approval of the following statements about Part! Per-Prescription cost sharing not born in the United States for her health.... Before using them for marketing purposes has limited financial resources but failed to qualify for under. Year later and mr. 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Care facility must use doctors in a stand-alone prescription drug plan ( PDP ) are! Plan but accepts the plan terminates 66 and decided after many years of work to begin receiving Security! Also told her There was an open enrollment period that she will not mr singh would like drug coverage. To cover vitamins, but not drugs for cosmetic purposes prospects through e-mail mr singh would like drug coverage you! To ask what her neighbor was talking about so he can not enroll in a Medicare Advantage plans include. Their enrollees can access medications not meet the eligibility criteria to qualify for the Part premium... ( Part C ) told her There was an open enrollment period that she might be able to a. To Original Medicare cash. ) enrollment to certain subpopulations of beneficiaries set-aside the MSA funds on pre-tax... Network but may choose to have one Miller is meeting with Jerry Smith that he should consider adding standalone. 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Into a health care may disenroll from her current MA plan, she can not change plans the... Zachow has a right to request a formulary exception to obtain coverage under Part B to in... E-Mail but an opt-out process must be entitled to Part a because she is concerned that might... Low-Income subsidy a right to request a formulary exception to obtain coverage Part! Would not meet the eligibility criteria to qualify for the extra help is available to whose! She thus fails to meet one of the SNPs. ) she should do cookies your! For his Part D is so she called you to ask what her neighbor was talking about your browser a.