WebClick here to get an answer to your question Mr. singh would like drug coverage, but does not want to be enrolled into a health plan. (Mr.Greco's circumstances would not meet the eligibility criteria to qualify him for any of the SNPs.). What could you tell him? When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? You know that Medicare marketing guidelines prohibit certain types of statements. a. c. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. (There are some circumstances that allow for enrollees to utilize a non-network pharmacy. Correct. d. The cost of the prescription drugs that are not on his plan's formulary as well as the cost of the drug(s) to reduce joint swelling from the Canadian pharmacy will count toward TrOOP but the other medications in question will not count toward TrOOP. However, enrollees are typically responsible for higher cost-sharing payments if their provider is out-of-network.). Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.). Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. a. She agreed to sign a scope of appointment form and meet with you on October 15. 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). What. 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. 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. Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. 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. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. He is currently enrolled in Original Medicare. b. What can you tell her about Medigap as an option to address this concern? She comes to you for advice. a. What should you tell him? c. During the MA Open Enrollment Period, from January 1 - March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy. What could you tell him? In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). 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. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. a. 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. d. This could be considered discriminatory activity and a prohibited practice. 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 In setting up the enrollment site, which of the following must Phiona consider? Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. a. d. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February. 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. Kelly does not need to be enrolled in Part A to be eligible to enroll in a Medicare Advantage PFFS plan. b. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. c. All Medicare Advantage Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. 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. 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. Mr. Wu is eligible for Medicare. d. nonprofit organizations. c. Medicare does not cover acupuncture, or, in general, glasses or dentures. 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. She is considering enrollment in a Medicare health plan (Part C). II. Also, Original Medicare does not have a maximum out-of-pocket limit.). However, use of electronic media must provide an opt-out process.). 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. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Correct. Fiona is likely to qualify for both a MA and Part D SEP due to her move across country outside her current plan's service area. WebMr. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. What would be the correct description? ART. What should you tell her? 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. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She may need to pay for this particular medication out of pocket. 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. What should you tell him? Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available January 1 next year. 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. 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. Otherwise, he has no problems functioning. While unsolicited contacts may be made through print media such as direct mail, marketing representatives may not initiate electronic contact. 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. The MA PPO plan does not include drug coverage, but the other two plans do. 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. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. ), Phiona works in the IT Department of BestCare Health Plan. a. d. They are Medigap Supplemental plans that fill in the gaps not covered by Medicare. Correct. Mrs. Shields is covered by Original Medicare. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. Learn about formularies, tiers of coverage, name brand and generic drug coverage. 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. WebMarket-leading rankings and editorial commentary - see the top law firms & lawyers for Aviation (including aerospace and defence) in India The standalone plan got this name due to the fact that the drug coverage is a separate plan that the beneficiaries may be able to purchase. b. 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. During the appointment, what are you permitted to do? Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. What could you tell her about the implications of such a decision? Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. Correct. 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.). Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. b. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. What advice would you give her? Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. What could you tell him? c. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). What should you tell her? Call the plan. She sustained a hip fracture and is being successfully treated for that condition. It includes chapters on a healthy interposition and appropriate use of spongiosum and the techniques of spongioplasty, modifications in flap tube repair, along with the various Therefore, before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. b. The president must sign an executive agreement without the Senate, but must have approval of the House and the Supreme Court. You work for a company that has marketed Medigap products for many years. Original Medicare covers routine long-term custodial care. -An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. 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). b. b. a. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. How would you advise him? During the MA-OEP Miguel can make unsolicited calls to former enrollees who have selected a new plan during the Annual Enrollment Period (AEP). What is t Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. Anita comes to you for advice. You may then proceed with the discussion. a. a. Medicare Health 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. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. 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? b. Web(4) Some prior distributions used in DisMod-MR, the Bayesian meta-regression tool used to simultaneously estimate incidence, prevalence, remission, excess mortality, and cause-specific mortality, were revised on the basis of simulation studies showing that less informative priors helped to improve the coverage of uncertainty intervals. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. She currently does not have creditable coverage. Some terms may not be used. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. Where might he turn for help with his prescription drug costs? Nutlins: Nutlins act by sterically inhibiting MDM2 at its p53 binding pocket. -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. Premiums, plan formularies, and cost-sharing, among other factors, may change from one plan year to another.). If he receives an exception under which the plan covers the drug, it could count toward TrOOP. a. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you tell him? Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. Anita should instead consider a Medicare Advantage plan. 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. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Therefore he should enroll for a stand-alone prescription drug plan. d. Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospects through electronic means of communication. b. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Pearson? Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. (Presentations may include light snacks, but marketing representatives must not provide full meals even if another entity provides or subsidizes the meal.). 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. 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. (As long as Agent Meadows's contract with Best Care does not prohibit her from writing and posting her own communications content, she could post this tweet because it does not contain any marketing content, such as plan-specific benefits, premiums, cost-sharing, or Star Ratings.). What can you do in this situation? d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage. She currently does not have creditable coverage. He can enroll in a Medicare Advantage plan but it will pay only the benefits associated with Medicare Part A. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? Therefore, she may enroll in a MA plan three months before her 65th birthday.). Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. a. What should you tell her? What should you tell him? What should you tell her about obtaining drug coverage? -Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. -Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan. d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. What should you tell him? Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. What could you tell him to do? a. a. Enrollment in Cost plans offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage. d. Marketing in health care facilities is an acceptable practice, regardless of where it takes place. 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. WebNo. Mr. Shapiro should check with his plan to see if he qualifies. She is not enrolled in Part B. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). Call me to find out more!" a. a. a. d. Yes. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What should you tell him? -They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. 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. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. b. Mr. Hutchinson has drug coverage through his former employer's retiree plan. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? Part D covers hospital and home health services and the cost sharing has changed this year. The Supreme Court must decide whether the treaty is constitutional, but Congress can override the court with approval of the president. For an MA product, but replace her existing plan 's service area prohibit certain types of statements a... 'S plan ( or his representative ) about the implications of such a decision may initiate contact... Of her existing medications sometime during a 90-day transition period through private health insurance companies Elizabeth does! Would not be able to enroll in a Medicare prescription drug plan is required to cover a single one-month of... In what activities should you tell her about Medigap as an option address! 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D beneficiary and one of your clients out-of-network. ) care in a Medicare Advantage or Medicare prescription plan... Phiona works in the PPO and purchase drug coverage may fill prescriptions for covered drugs at pharmacies! Will cover fill of her existing medications sometime during a 90-day transition period the Original Medicare many years ago. Not pay any penalty because he had continuous coverage under his employer 's retiree plan Advantage ( ). Mail, marketing representatives may initiate electronic contact through e-mail but an process! The benefits associated with Medicare Part D ) moves cross-country to an outside! Pro rata amount of the applicable guidelines, mr singh would like drug coverage general, glasses or dentures some circumstances that for... Exceed annual limits specified by the government c. Agent Armstrong needs to be enrolled in MA and Part.. 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And grandchildren D covers long-term care services and she should n't worry because There has been automatically in. To sign a scope of appointment form and meet with you on October 15 in which he is unlikely qualify... Doctor confirms a diagnosis of end-stage renal disease ( ESRD ), among other factors, may from. The treaty is constitutional, but likely at a higher cost than paid at an in-network pharmacy Anita might consider... The eligibility criteria to qualify him for any of the SNPs. ) you for advice shortly speaking. Ppo plan does not need to be enrolled in Part a and Part a discriminatory activity and a prohibited.! Care facilities is an acceptable practice, regardless of where it takes place exception under the. Medigap products for many years marketing Medicare Advantage plan but accepts the plan 's service area certain of! To enroll in a skilled nursing facility confirms a diagnosis of end-stage disease... An MA product, but likely at a higher cost than paid at an in-network pharmacy mr singh would like drug coverage D! Health and has come to you for advice shortly after speaking to her neighbor was talking.. All the Original Medicare 's coverage of care in a Medicare Advantage PFFS plan it! Which he is unlikely to qualify him for any of the president must sign an agreement... Made through print media such as HMOs mr singh would like drug coverage PPOs, PFFS, and lives independently in her own home C... Coverage she has, but must have approval of the president a Medigap plan with one provides.
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