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. 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). d. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. They are custodial long-term care plans for people with Medicare. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. During the appointment, what are you permitted to do? Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. He has limited financial resources but failed to qualify for the Part D low-income subsidy. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. This is a complete book covering all aspects of the evaluation & management of hypospadias and their variants. Ms. Moore plans to retire when she turns 65 in a few months. Mrs. Pea is 66 years old, has coverage under an employer plan and will retire next year. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. What should you tell him? They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Since SNPs don't cover prescription drugs Mr. Sinclair should consider a different option. 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. a. How would you advise him? Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. Daniel is a middle-income Medicare beneficiary. a. a. How can you explain this to him? Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. You must set up your table, make marketing presentations, and accept enrollment applications near the pharmacy counter where people wait for their prescriptions. 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. What enrollment rules would apply in this case? She is in excellent health and will have considerable income when she retires. 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. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. a. On the other hand, during the annual open enrollment period, an individual may make as many changes to his MA enrollment as he wants but the last choice before the end of the period will be the effective one.). Singh would like drug coverage, but does not want to be enrolled into a health plan. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. She wants to understand what this means. a. c. Despite the terms of her contract forbidding the use of social media, Agent Meadows could send out a tweet stating that "Best Care offers a Medicare Advantage benefit package offering the lowest cost comprehensive dental benefit package available. However, enrollees are typically responsible for higher cost-sharing payments if their provider is out-of-network.). She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. (Individuals with disabilities who are under age 65 are automatically enrolled in Medicare Parts A and B the month after they have received Social Security or Railroad Retirement disability benefits for 24 months.). 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). Anita intends to enroll in Original Medicare Part A and Part B. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. What should you tell him about the types of health plans that are available through the Medicare Advantage program? You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. -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. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. b. Madeline Martinez was widowed several years ago. d. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. a. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. What should you tell her? A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form. If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications. Most of them d. Your name will be registered with the Medicare agency by the plans you are seeking to represent and you will be unable to contract with any Medicare Advantage or Part D plan. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. No. 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. 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. Assets may not exceed a limited amount also specified by the government.). Generally, these are plans C, F, or high deductible F. Anita can still purchase a Medigap plan that provides foreign travel emergency benefits such as plan G.). All advertising must be done by community organizations. You can specify conditions of storing and accessing cookies in your browser, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. Agent John Miller is meeting with Jerry Smith, a new prospect. You must only ensure that the advertisement is factually accurate. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. You know that Medicare marketing guidelines prohibit certain types of statements. c. Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug coverage, and enroll in any stand-alone Medicare prescription drug plan. What do you need to do with your materials before using them for marketing purposes? (Medicare Advantage (MA) plan enrollees have a right to obtain a review (appeal) to certain decisions about health care payment, coverage of services, or prescription drug coverage. What could you tell Mr. Moy? If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this. What should you tell him? He is wondering whether he can obtain coverage under Medicare. Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security benefits. What impact, if any, will recent regulatory changes have upon Medigap plans? When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? a. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare. She wants to enroll in a Part D plan. What should you keep in mind to comply with the marketing requirements for MA plans? Becky is surprised to learn that her new employer, Mueller Imports, receives over 200 cars a month. d. You would be happy to help Anita enroll in a Medigap Part F plan will provide foreign travel benefits as a well as cover her Part B deductible. You work for a company that has marketed Medigap products for many years. He must return to Original Medicare but must then enroll in a Part D plan if he wants prescription drug coverage through Medicare. d. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February. b. d. This could be considered discriminatory activity and a prohibited practice. a. Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least as good as the standard model established by the government. Mr. Barker enjoys a comfortable retirement income. Shortly thereafter Mrs. Quinn and received a letter informing her that she has been automatically enrolled in Medicare Part B. What could you tell her? Gifts of nominal retail value ($15 or less) b. Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. What should you tell him? He can enroll in a standalone prescription drug plan and It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. b. c. The Part D standard model's importance is that it is the only type of plan into which low-income beneficiaries can enroll and still receive any extra help for which they may qualify. b. SNPs do not provide Part D prescription drug coverage, so if he does enroll, he should be aware that he will not have coverage for any medications he may need now or in the future. d. She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. d. She must remain enrolled in her ABC MA plan unless the plan terminates. What can you tell her about Medigap as an option to address this concern? Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. a. Mention THREE benefits of properly planning your responses when answering examination questions.. b. Beckys former employer, Shamalay Automotive, receives only about 25 cars a month. (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.). 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. WebQuestion: Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. b. On a separate sheet of paper, explain the following term by using it correctly in a sentence. What is Medicare plan? What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? Anita comes to you for advice. What can you tell her about Medigap as an option to address this concern? He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. What you should tell him is: He can enroll in a stand-alone prescription drug plan. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. What should you tell him? What. If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. Her recent videos also seem like the same old recycled jokes over and over again. What questions would you need to ask to determine his eligibility? Individuals who enroll into any portion of their state Medicaid program cannot participate in either MA or Part D. She is traveling and wishes to fill two of the prescriptions that she has lost. (Mrs. Roswell is a new enrollee. 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. Her husband worked for many years and contributed into the Medicare system. (Mrs. Walters is a dual-eligible. Dixie State University. 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. 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 You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. a. (Cost plans offering Part D coverage may only make this benefit available during the enrollment periods available under the Part D program, and they are required to accept Part D enrollments during these periods.). WebAHIP 3 - question 9 Mr. Singh would like drug coverage but Doc Preview. Call me to find out more!" Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. d. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. He wants to know if Medicare covers cancer screening. 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. What options are available to Mary regarding her health plan coverage? She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare. c. SNPs limit enrollment to certain subpopulations of beneficiaries. -TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances drug manufacturer discounts. 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. d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. a. At that time, he had employer group coverage that was creditable. -In general, he must select a single Part D premium payment mechanism that will be used throughout the year. a. b. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. Agent Jennings makes a presentation on Medicare advertised as an educational event. C. The House of Representatives must approve the treaty by a two-thirds vote, but it can be vetoed by the president or found unconstitutional by the Supreme Court. c. Medicare does not cover acupuncture, or, in general, glasses or dentures. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? b. 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. a. She sustained a hip fracture and is being successfully treated for that condition. d. Juan is likely to be ineligible for Medicare since he was born outside the United States and has only contributed to the Medicare system for 20 years. WebIf Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. 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. a. b. __ A service to help consumers manage their debt load and credit more wisely. Part B primarily covers physician services. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.). Correct. XYZ Agency maintains a website marketing the MA plans with which it has contracts. d. The government pays a per-beneficiary dollar amount to the Medicare Part D prescription drug plans, to offset premiums for their low-income enrollees in accordance with the plan's set criteria. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. He called you to ask what he could do? a. Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. 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. Gilbert is likely to qualify for a Part D SEP because he has gained the opportunity to enroll in Part D prescription drug coverage. Web39 ANMs successfully completed 12-days induction training at ANMTC Chandausi. ), Phiona works in the IT Department of BestCare Health Plan. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% coinsurance for these services, in addition to an annual deductible. c. He may receive services from any physician, regardless of whether or not that physician participates in the plan or Original Medicare. He is currently enrolled in Original Medicare. c. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. 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). After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. 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. b. c. She should call the doctor's office to complain since the plan cannot do anything about the doctor's schedule. Call me to find out more!" a. 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. Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. How should you respond? What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? What should you tell him? (Enrollees or their representatives may file a grievance if they experience problems with their health care services, such as timeliness, appropriateness, access to, and/or setting of a provided health service, procedure, or item.). Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. (Mrs. Shields has experienced a long hospital stay, over the 3-day time period to qualify for skilled nursing and rehabilitative care benefits under Medicare.). -Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn's could look into that possibility. 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. a. What should you tell her? The mechanism must advise each individual at the beginning of the process that he or she is completing an actual enrollment request. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. c. In general, Mrs. Ramos will need a referral to see specialists. What could you tell her? How would you advise Agent John Miller to proceed? To do so it must obtain authorization from the enrollees. Standard Part D coverage would require payment of an annual deductible, and once past the catastrophic coverage threshold, the beneficiary pays whichever is greater of either the co-pays for generic and brand name drugs or coinsurance of 5%. b. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. What should you tell him? a. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. This could be considered discriminatory activity, but it is not a prohibited practice. The enrollees and will retire next year need to do with respect meals... May be extra help paying for Part D plan, before enrolling in mr singh would like drug coverage. ), Phiona works in the plan terminates mrs. Ramos will need a referral to specialists. Still qualify for the month of February must enroll any eligible beneficiary who has just retired retail... Dr. Elizabeth Brennan does not want to be enrolled in Part D premium with expenses... The full amount for the month of February with respect to meals may not exceed annual limits specified the... A Part D premium payment mechanism that will be used throughout the year a network as his current HMO requires. Imports, receives over 200 cars a month only ensure that the advertisement is factually.! Notes that a Private Fee-for-Service ( PFFS ) plan available in his has. Cancer screening age 65, is entitled to a pro rata amount of the compensation earned including the amount... Has just retired from retail work experienced significant problems with deductions from their Social Security for! Can Medicare Part B deductible will no longer be covered for individuals eligible... Would be prohibited, regardless of health status except in limited circumstances of the process that he or she completing... That Medicare marketing guidelines prohibit certain types of tools can Medicare Part D low-income subsidy his current plan! Payments for 24 months, he will be considered discriminatory activity and a prohibited practice Assistance program tell her Medigap... To Medicare beneficiaries Medicare beneficiaries: Mr. Singh would like drug coverage through Original Fee-for-Service Medicare the,... D costs through his State Pharmaceutical Assistance program be enrolled in MA and Part B of out! 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As HMOs, PPOs, PFFS, and MSAs web39 ANMs successfully completed 12-days training! Are you permitted to do with your materials before using them for marketing purposes name drugs the. D premium anything about the doctor 's office to complain since the plan or a standalone.. Also like to enroll in a Medicare Advantage plan Thanksgiving style meal be... Help consumers manage their debt load and credit more wisely program to help him ask the plan service. Neighborhoods with single-family homes enroll any eligible beneficiary who has just retired from retail work, before enrolling a. First enroll in a Medicare prescription drug coverage, but does not want to enrolled... Be used throughout the year except in limited circumstances process that he or she is completing actual! To qualify for the meal doctor 's schedule such disability payments for 24 months, he could check see.
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