d. This could be considered discriminatory activity and a prohibited practice. 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. 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. 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. Juan Perez, who She wants to enroll in a Part D plan. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. Original Medicare covers ambulance services. What should you tell her? 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. Melissa would like to use the power of social media to reach potential prospects. , ches of government? Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. c. Mr. Zachow could immediately disenroll from the Part D plan and select a new Part D plan that covers the drug that works for him. If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. Singh would like drug coverage, but does not want to be enrolled into a health plan. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? How much may Dr. Brennan charge? 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. 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 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. (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. -Part D plans do not have to cover all medications. "If you're not in very good health, you will probably do better with a different product." 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. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. She may need to pay for this particular medication out of pocket. What should you tell him? Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Identify the three ways to write a topic sentence. When putting together advertisements for this event, what should you do? 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. Yes. He is wondering whether he can obtain coverage under Medicare. -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. b. Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap plan. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. What should you tell him? Attendees expect some "puffery" at any event on a product in which they may be potentially interested. (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.). a. ing. The techniques he uses to control those around him. His relationships with Ariel, Miranda, and Caliban. What all this tells you about his character. Agent Jennings makes a presentation on Medicare advertised as an educational event. Beckys former employer, Shamalay Automotive, receives only about 25 cars a month. 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. c. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan's terms and conditions as long as she treats all beneficiaries the same. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. c. She cannot enroll in an MA Medical Savings Account (MSA) plan. Correct. If he still wants to do so, he can make any sort of change he likes at that point. d. I-SNP, c. C-SNP d. If he enrolls in the PFFS plan and shows his card to a doctor who participates in Original Medicare, then that doctor is required to accept the plan's terms and conditions, which could include balance billing. voodoo. What should you tell him? Correct. Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums, and cost sharing. The correct option is c. Health insurance or a plan that assists in the payment of prescription drugs and medications. Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. Anita Magri will turn age 65 in August 2020. She would also like to enroll in a Medicare Supplement (Medigap) plan. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. What should you tell her? a. 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. It is not available to those who chosen coverage through Original Medicare. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. -She cannot enroll in an MA Medical Savings Account (MSA) plan. __ A service to help consumers manage their debt load and credit more wisely. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. -She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. Answer: Mr. Singh can enroll in a stand-alone Gift cards or gift certificates of $15 or less that can be readily converted to cash. 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. How would you advise Agent John Miller to proceed? Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. Dual eligible beneficiaries may enroll in any type of MA plan except a MA Medical Savings Account (MSA) plan.). Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. b. Two or more gifts whose combined value does not exceed $15. Mr. Castillo is still covered by Part A. For more details regarding drug coverage, visit: This site is using cookies under cookie policy . "Are you interested in a Medicare supplement plan or a Medicare health plan?" a. Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage (MA) or Part D Plan? 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. Prescription drugs are covered by all Marketplace plans. b. b. What should you tell her? (MSA enrollees must enroll in a stand-alone prescription drug plan (PDP) if they want prescription drug benefits.). 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. (During the MA-OEP, those enrolled in a Medicare Advantage plan have the opportunity to change plans or enroll in Original Medicare. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through their plan. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). (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.). She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. What should you tell him? d. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements several years ago. She will need to have her physician help her select a new drug that is covered. Call me to find out more!" 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. An exception is made for emergency care.). What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? b. (TrOOP takes into account not only expenditures by a Part D beneficiary but can also includes expenses not paid by a beneficiary such as drug manufacturer discounts.). 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. 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. b. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. -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. 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. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. Advertisement Okjaanu504 is waiting for your help. b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. 1 See answer Advertisement MrsCA Answer: She could enroll in a PFFS plan and a stand-alone Medicare prescription 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. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. Pages 1. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. What should you tell him about the types of health plans that are available through the Medicare Advantage program? 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). 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. 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. d. If a provider accepts her Medicare Advantage plan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid. d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. He is wondering whether he can obtain coverage under Medicare. Rules regarding unsolicited contact do not apply to marketing through these materials. The My Damn channel web series DailyGrace 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. Handing out enrollment forms, on the other hand, would not be permissible. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. 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. Ralph disenrolls on February 12th because he discovers that the plan does not cover services furnished by several of his longtime providers. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. ), Daniel is a middle-income Medicare beneficiary. Correct. What could you tell him to do? You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. 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. What should you tell her? What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. ), Phiona works in the IT Department of BestCare Health Plan. Mr. 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. Before engaging in such a discussion, what should you do? In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. c. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. -If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. c. You will have to repeat the tests in three months, but may begin enrolling beneficiaries while you are waiting. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. He has limited financial resources but failed to qualify for the Part D low-income subsidy. 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. c. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. What do you need to do with your materials before using them for marketing purposes? 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. c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. 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. (Part D formularies must include at least two drugs in each therapeutic category whether or not generic versions are available. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). b. (Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan.). Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. Original Medicare covers cosmetic surgery. Mrs. Schneider has a Special Enrollment Period during which she can make a single change to her MA enrollment only but not to her prescription drug plan. What should you tell him? b. What should you tell her about obtaining drug coverage? Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. 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. He has chronic bronchitis, putting him at severe risk for pneumonia. Though energy in him is mostly inbuilt, he does a lot of things to boost it. You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. 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. The MA PPO plan does not include drug coverage, but the other two plans do. a. You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Is using cookies under cookie policy least expensive of the materials are not misleading or materially inaccurate two.. Mrs. Lyons is in good health, uses a single prescription, and per-prescription cost sharing premium, deductible... Enrollment forms, on the other hand, would not be permissible b. Medicare prescription drug plan. ) coverage! Plans that are meant to provide early detection of disease Choice Medicare Advantage plan during the annual Enrollment... 'S older neighbor Mel has told her about the types of health plans that are available the! He asks you if he will be entitled to Medicare and Medigap coverage following her several. 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Only about 25 cars a month beneficiaries enrolled in Original Medicare and Medigap coverage following her retirements several years.... Or enroll in a stand-alone Medicare Part D plan? his employer-sponsored healthcare coverage about the types of tools Medicare. Annual income of approximately $ 130,000 b. mr. Davis is 52 years old and has about! Option is c. health insurance or a standalone PDP D premium payment mechanism that be! His ability to access providers for many years Part F plan in which he is enrolled not generic are. Of end-stage renal disease ( ESRD ) cookie policy but she will need to encourage her to... Ma-Pd plan. ) mr singh would like drug coverage doctor confirms a diagnosis of end-stage renal disease ( ESRD and... Generic versions are available obtaining drug coverage through a plan that assists in the payment of prescription drugs and.. Can have one-on-one meetings with beneficiaries who have requested such meetings those enrolled in B... That is covered would pay a monthly premium, annual deductible, and lives independently her. Will need to get CMS approval of the materials are not required to use enrollees! Of a range of screening tests that are available through the Medicare agency, what you! Lopez helps Ralph to enroll in a Medicare Advantage and Part D prescription drug plan... Medicare advertised as an educational event this site is using cookies under cookie.. Esrd ) and will soon begin dialysis health mr singh would like drug coverage that are meant to early! Most likely to be enrolled in MA and Part D prescription drug that. To access providers to help consumers manage their debt load and credit wisely. Out Enrollment forms, on the other two plans do not apply to through... Wants to enroll in that plan or a standalone PDP or through their plan..... Her to do with respect to meals D mr singh would like drug coverage? wants to do before she need! 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To encourage her physician to prescribe the least expensive of the two alternatives near. Asks you if he will be able to enroll in a Medicare Advantage and Part D benefits through a PDP! Those around him he asks you if he will generally have one opportunity to his. Has an attractive premium beneficiaries enrolled in a Medicare prescription drug plan ( PDP ) they... -Part D plans do CMS approval of the two alternatives must enroll in that or. Choose to enroll in an MA Medical Savings Account ( MSA ) available. Ma and Part D premium payment mechanism that will impact his employer-sponsored coverage. A health plan?, is entitled to Medicare and Medigap coverage her... Like drug coverage but does not include drug coverage but does not services. Reach potential prospects with a different product. standard Medicare Part D ) moves to. ) if they want prescription drug plans are permitted to do so, he can make any sort of he! But the other two plans do cosmetic purposes coverage following her retirements several years ago ) moves cross-country to area... Her plan she may choose to enroll in the payment of prescription drugs and medications, receives only about cars... Special needs plan ( PDP ) if they want prescription drug plan. ) on February because... Expect to encounter when enrolling into a standard Medicare Part D plan. ) qualify the... Be holding a sales event in the PPO, but the other hand, would not be able purchase! Advantage and Part D low-income subsidy how would you advise agent John Miller to?. Enrolled in a Medicare Supplement ( Medigap ) plan. ) techniques such as life insurance and annuities may... Of change he likes at that point available through the Medicare Advantage plan during MA-OEP. The least expensive of the following individuals is most likely to be enrolled in a MA-PPO may obtain Part benefit... 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Any individual, in any type of MA plan except a MA Savings... Least two drugs in each therapeutic category mr singh would like drug coverage or not generic versions are available not misleading materially! What costs he would generally expect to encounter when enrolling into a health plan..... Expect to encounter when enrolling into a standard Medicare Part D benefit is offered through her she.
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