b. Madeline Martinez was widowed several years ago. -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. ), Fresenius ~ CCHT Certification Preparation Te. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. Choose one answer. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part 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. What should you tell her? -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. a. Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case basis, whether they will treat her. Mr. Barker enjoys a comfortable retirement income. What advice should you give Miguel? Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. a. None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary. b. c. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. What should you tell him? She agreed to sign a scope of appointment form and meet with you on October 15. (Medicare Advantage is a way of covering Original Medicare, Part A and Part B benefits, through private health insurance plans.). In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? (MA-PPO enrollees may seek care from any provider who accepts Medicare. (MSA enrollees must enroll in a stand-alone prescription drug plan (PDP) if they want prescription drug benefits.). Henry makes a permanent move to a new state providing him with new MA and Part D options. a. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. b. You would be happy to help Anita enroll in a Medigap plan but before she can do so, she must also enroll in a Medicare Part D prescription drug plan. 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. b. He is wondering whether he can obtain coverage under Medicare. (Part D plans must cover at least the Part D standard benefits or its actuarial equivalent. 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. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. He should drop the employer coverage and enroll in a Medicare prescription drug plan. d. Only scripts and marketing practices must be approved by CMS, so you do not need to do anything further with your marketing materials, so long as you make them available to anyone who attends your marketing event(s). b. 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. 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. Call me to find out more!" Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. 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. The SEP continues for two months either after it begins or the month of the move, whichever is later.). c. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred more than 30 days after the effective date of coverage. c. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed. No. (Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan.). State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. Becky Knauer recently resigned from her position as controller for Shamalay Automotive, a small, struggling foreign car dealer in Upper Saddle River, New Jersey. Complete a paper enrollment form. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs Correct. 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. 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. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. d. This could be considered discriminatory activity and a prohibited practice. (Formulary exception requests can be used to request coverage of a drug not on a Part D plan's formulary or to cover a formulary drug at a lower cost formulary.). b. c. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D to a MA or MA-PD plan. She would also like to enroll in a Medicare Supplement (Medigap) plan. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. b. -Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. All individuals who are citizens and age 65 or over will be covered under Part A. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. He has tried two but had an allergic reaction to them. b. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare, but she may or may not qualify to rejoin her Medigap plan based on medical underwriting. 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. You will have to attend one of several remedial training events sponsored by the Medicare agency before being allowed to retake the test. To reduce his expenses, he should look for a plan with a zero premium. -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. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields long-term care costs. d. Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. To do so it must obtain authorization from the enrollees. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What questions would you need to ask to determine his eligibility? d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. Web39 ANMs successfully completed 12-days induction training at ANMTC Chandausi. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. 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. The Part D Initial Enrollment Period occurs only when a beneficiary turns 62 so it cannot be used as the justification for allowing her to enroll at this point. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Mrs. Kendrick is in good health, has worked for many years and is six months away from turning 65. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. (Mr. Kelly does not need to be enrolled in Part A to be eligible to enroll in a Medicare Advantage PFFS plan. b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. because the content does not contain any plan-specific information about benefits, premiums, cost-sharing, or Star Ratings. d. Dr. Brennan can charge the beneficiary the same cost-sharing as Original Medicare as long as she sends the claim to Medicare and not the plan. Best Care has not submitted any potential posts to CMS for approval. Original Medicare covers ambulance services. b. Explain. Part B primarily covers physician services. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. Gifts of nominal retail value ($15 or less) 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. Enrollees pay a monthly premium based on their income level and have 20 percent coinsurance cost-sharing with the exception of preventive benefits.). What should you tell him? c. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage. b. a. Correct, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese, Fundamentals of Financial Management, Concise Edition, Daniel F Viele, David H Marshall, Wayne W McManus. What should you keep in mind to comply with the marketing requirements for MA plans? 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. b. Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days. What could you tell her? Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? b. Mr. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. b. d. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage. Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. b. d. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. Anita comes to you for advice. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. WebMarket-leading rankings and editorial commentary - see the top law firms & lawyers for Aviation (including aerospace and defence) in India What should you tell him? -Original Medicare covers ambulance services. d. 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. (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.). For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. 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. Correct. What should you tell her? (During the MA OEP, as an MA-PD enrollee Mrs. Goodman may disenroll from her plan, return to Original Medicare and enroll in a stand-alone Part D prescription drug plan. d. She must remain enrolled in her ABC MA plan unless the plan terminates. Part B primarily covers physician services. Every couple of months, a local jeweler bills the dealer $5,000 for miscellaneous services. Franz Mueller, the owner of the dealership, personally approves payment of these invoices, noting that each invoice is a selling expense. From casual conversations with a salesperson, Becky learns that Mueller frequently gives Rolex watches to the manufacturers regional sales manager and other sales executives. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. What should you tell her? a. SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. c. If the SEP is for Part D coverage, he may only drop, but not add or change, his Part D coverage one time before the SEP expires. She would also like to enroll in a Medicare Supplement (Medigap) plan. c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. d. You may begin her enrollment application and require her to provide names of any of friends who may be interested in enrolling before completing her application. What should you tell her? c. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy." One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. b. 1 See answer Advertisement MrsCA Answer: She could enroll in a PFFS plan and a stand-alone Medicare prescription c. Part D plans may use varying co-payments, but they are required to cover all prescription medications on the market. Correct. 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). She agreed to sign a scope of appointment form and meet with you on October 15. 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. II, III, and IV only What you should tell him is: He can enroll in a stand-alone prescription Mr. Barker enjoys a comfortable retirement income. However, the plan does not provide drug benefits. 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. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Melissa would like to use the power of social media to reach potential prospects. Because of high demand for these cars, dealerships all want to receive as many cars as they can from the regional sales manager. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. How would you advise Agent John Miller to proceed? Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through their plan. 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. Becky is surprised to learn that her new employer, Mueller Imports, receives over 200 cars a month. Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the companies John represents offer more comprehensive coverage for a lower price. b. Which of the following statements about Medicare Part D are correct? They are anxious to have their Medicare prescription drug plan cover these drug needs. c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? b. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a 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. c. You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans. Juan Perez, who Mr. Shultz was still working when he first qualified for Medicare. Juan Perez, who However, enrollees are typically responsible for higher cost-sharing payments if their provider is out-of-network.). Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. The cost of the Canadian bought medications would not count toward TrOOP. Yes. ), Which of the following individuals are likely to qualify for a special enrollment period (SEP) for either a MA and/or Part D due to a change of residence? Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. (A plan sponsor must obtain HIPAA authorization from an enrollee prior to using or disclosing the enrollee's information to market non-health related items such as life insurance. What should you tell Mrs. Quinn? Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program. If Mrs. Ridgeway wants to return to Original Medicare, she may use this SEP to disenroll from her MA plan and return to Original Medicare. You work for a company that has marketed Medigap products for many years. 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. 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. Marketing representatives may not accept enrollment forms and hold them before October 15th for enrollment under the AEP.). 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. Fresenius ~ CCHT Certification Preparation Te. As a result, this method of payment is no longer an option for Part D premium payments. His current situation, he should drop the employer coverage and enroll in the SNP amounts and mr. Greco like., age 65 and has questions about which providers she can go for... 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