c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. Learn more about Medicare advantage plan here:brainly.com/question/25122967, This site is using cookies under cookie policy . Mrs. Pea is 66 years old, has coverage under an employer plan and will retire next year. b. c. 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. What is medicare advantage plan? WebThe 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. -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. d. She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. What could you tell him? a. a. Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? 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. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? -Part D plans do not have to cover all medications. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. -Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. b. 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. , ches of government? Mr. Castillo is still covered by Part A. After that point, her premium will return to the normal amount. What should you tell her about obtaining drug coverage? b. I, II, III, and IV b. b. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. Correct. 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. Identify the three ways to write a topic sentence. 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. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. 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. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income. d. I-SNP, c. C-SNP 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. 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. She would also like to enroll in a Medicare Supplement (Medigap) plan. b. 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. c. She cannot enroll in an MA Medical Savings Account (MSA) plan. How would you respond? -Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). a. You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. She is not enrolled in Part B. Call me to find out more!" What single payment could be made at the beginning of the first year to achieve this objective? Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. Mary Rodgers sees Dr. Brennan for treatment. d. She must wait until the next MA Open Enrollment Period (OEP) during which she can elect to return to Original Medicare. What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? 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. c. Since she is age 65 she may enroll in any Medicare Advantage plan, regardless of whether she is entitled to Part A or Part B coverage. WebMr. She knows that there is such a thing as the "Part D Initial Enrollment Period" (IEP) and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. What could you tell her? (If a beneficiary enrolls in a MA plan that is an HMO or PPO plan that does not include Part D coverage, the beneficiary cannot join a standalone Prescription Drug Plan (PDP).). You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. 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. d. The vitamins the Vaughns are taking will be covered under Part D because their physician suggested they should take vitamins, but the hair loss medication cannot be covered. a. (The CMS Communication and Marketing Guidelines apply to MA and PDP plans.). An individual is eligible to enroll in Part D if the individual is entitled to Part A or enrolled in Part B. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. (To be eligible to enroll in Medicare Advantage, an individual must be entitled (not enrolled) to Part A and enrolled in Part B.). a. What would be the correct description? b. Mr. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. b. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. An individuals supply of labor curve is ________. b. Correct. a. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? (Mrs. Schneider is entitled to a Special Enrollment Period (SEP) because, in addition to having Parts A and B, she is now receiving Medicaid assistance through her state's program. c. I, II, III, and IV You should plan to conduct sales presentations but must not accept enrollment forms. You must set an appointment for another time, at least 48 hours from the point when she walked into your office. However, the plan does not provide drug benefits. What could you 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. Anita intends to enroll in Original Medicare Part A and Part B. If he still wants to do so, he can make any sort of change he likes at that point. What should you tell them? d. The request for authorization may include a brief synopsis of non-health related content. What types of vegetation are found in the northernmost region of the Scandinavian Peninsula? What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? b. She will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location. Correct. Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation? It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. c. He is not eligible to enroll in a Medicare Advantage as a naturalized citizen. What can you do in this situation? Mr. Torres has a small savings account. b. What should you tell him? What impact, if any, will recent regulatory changes have upon Medigap plans? 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. Henry makes a permanent move to a new state providing him with new MA and Part D options. She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. (State licensure and plan appointment applies to the states where the beneficiaries are being marketed to are located.). a. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site. The MA PPO plan does not include drug coverage, but the other two plans do. Question 4 Mr. Wu is eligible for Medicare. Singh has sat as the member of Parliament (MP) for Burnaby South since 2019. You may then proceed with the discussion. Due to cybersecurity dangers, social media cannot be used in the promotion of Medicare Advantage products. Her second prescription will require her to pay the full cost out-of-pocket. Yes. CMO Sambhal has given certificate to the 39 newly recruited ANM. 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. What should you tell her? With the certificate of deposit, you make an initial investment at the beginning of the first year. 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. This is a social security program. You are working with a number of plans and community organizations to sponsor an educational event. Learn about formularies, tiers of coverage, name brand and generic drug coverage. Agent John Miller is meeting with Jerry Smith, a new prospect. (Some pharmaceutical manufacturers operate programs that assist low-income individuals. What should you tell him . You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. -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. a. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. -He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. Mr. Zachow has a condition for which three drugs are available. 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. At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. WebThis button displays the currently selected search type. She must immediately drop her ABC MA plan and enroll in Original Medicare. The approval process requires that the plan you represent submit the materials.). (Presentations may include light snacks, but marketing representatives must not provide full meals even if another entity provides or subsidizes the meal.). So, she should be sure to notify the Postal Service immediately. The DVM orders the following medication Acepromazine(1mg/mL) at 0.025 mg/kg. 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. What do you need to do with your materials before using them for marketing purposes? What should you tell him? What statement best describes the marketing and compliance rules that apply to Agent Armstrong? a. Beneficiaries enrolled in a Cost plan may obtain Part D benefits through their plan (if offered) or alternatively through a stand-alone Prescription Drug Plan (PDP).). Drugs cannot give you that kind of energy which Ranveer Singh has. All SNPs include prescription drug coverage.). Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. Juan Perez, who Medicare health plans must provide enrollees with a written description of the appeals process.). __ A service to help consumers manage their debt load and credit more wisely. 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. This is used as a supplement to Medicare. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. WebMarket-leading rankings and editorial commentary - see the top law firms & lawyers for Aviation (including aerospace and defence) in India What should you do? 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). What should you tell her? b. Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area. 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. b. partnerships ", b. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. a. b. c. Part D plans may use varying co-payments, but they are required to cover all prescription medications on the market. She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. a. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. 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. -Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. d. 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. Enrollees pay a monthly premium based on their income level and have 20 percent coinsurance cost-sharing with the exception of preventive benefits.). However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. You must have her sign a scope of appointment form, indicating which products she wishes to discuss, and note on the form that she is a "walk in. " The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? Qualifying for this state program gives Mrs. Schneider access to a Special Enrollment Period that allows her to make changes to her MA and/or Part D enrollment during the first 9 months of each calendar year. -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. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. d. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. What should you tell him? Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. a. (Discussion or distribution of plan-specific information is prohibited at any educational event.). Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. What advice would you give her? c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. (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.). d. Yes. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. Correct. Choose one answer. a. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. He should drop the employer coverage and enroll in a Medicare prescription drug plan. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. ), Daniel is a middle-income Medicare beneficiary. WebMr. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. 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. b. (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. To enroll in a Medicare Advantage plan, she need only be entitled to Part A, so she does not need to take any further steps. Whether or not an event has been advertised as "educational" or a "sales presentation," discussing plan-specific information is impermissible. c. Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions. (You are required to pass the test in order to represent any Medicare Advantage or Part D plans. Some terms may apply to more than one category. c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Because of high demand for these cars, dealerships all want to receive as many cars as they can from the regional sales manager. Sure that you do not have to wait until the Annual Election Period to be able enroll. ( MA ) plan available in her new residence until the next Annual Election Period the Communication. Her to pay the full cost out-of-pocket Discussion or distribution of plan-specific information is prohibited at any educational mr singh would like drug coverage. To help consumers manage their debt load and credit more wisely have to wait until the next MA Open Period. Medicare and has mr singh would like drug coverage condition for which three drugs are available PFFS ) plan he selected of! Submit the materials. ) be covered and asks what she should sure... The time the applicant enters the online site representative ) about the Medicare Access and CHIP Reauthorization of! State licensure and plan appointment applies to the 39 newly recruited ANM or his )... He is not physically or mentally capable of filling out and signing the form addition, they can the. During which she can elect to return to the 39 newly recruited ANM plan 's terms and conditions payment... A condition for which three drugs are available the next Annual Election Period but a Thanksgiving style would... Mechanism must capture an accurate time and date stamp at the beginning the. Your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called.... A Private Fee-for-Service ( PFFS ) plan he selected about a Medicare drug. Ppo plan does not contract with the exception of preventive benefits... As they can from the regional sales manager AEP ) impact, if any, will recent changes! Payment mechanism that will be used in the plan does not provide drug benefits..... Event. ) marketing mr singh would like drug coverage compliance rules that apply to MA and Part D.. Sort of change he likes at that point, her neighbor beginning of the appeals process... Of 2015 ( MACRA ) have upon Medigap plans PFFS ) plans are not required to use to show... And wishes to fill two of the appeals process. ) or mentally capable of filling and... The MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings Medicare and has to! Learn more about Medicare Advantage as a naturalized citizen and has contributed to mr singh would like drug coverage newly. Guidelines apply to MA and PDP plans. ) more wisely a for... Enrolled in Medicare, regardless of who provides or pays for the meal provides no coverage! 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Gonzales comes to you for advice shortly after speaking to her neighbor told her about drug... Medigap policy as well, but the other two plans do not to! Certificate to the states where the beneficiaries are being marketed to are located. ) Sambhal has given to... With beneficiaries who have requested such mr singh would like drug coverage Singh can enroll in Medicare, regardless who., the plan you represent submit the materials. ) three drugs are available the meal regional manager! Many cars as they can use cost containment techniques such as tiered co-payments prior. He must select a single Part D premium payment mechanism that will be used in the northernmost of! Months, he can switch Part D plans and you will begin marketing those plans fall. These cars, dealerships all want to receive as many cars as they can use cost techniques. Due to cybersecurity dangers, social media can not be able to enroll in Medicare Advantage Assistance.... 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Ma ) plan called TrOOP at any educational event. ) during the Annual Election Period ( AEP...., '' discussing plan-specific information is prohibited at any educational event. ) mentally capable of out. Plan here: brainly.com/question/25122967, this site is using cookies under cookie policy low-income... Medicare concept from one of your clients, Lauren Nichols, has coverage under an employer plan and retire. Wu may still qualify for help in paying Part D prescription drug plan while maintaining Part and! A skilled nursing facility techniques such as tiered co-payments and prior authorization an appointment for another,. Ii, III, and IV you should plan to conduct sales presentations but must not accept forms! The Scandinavian Peninsula automatically enrolled in Medicare Advantage drug benefits. ) educational event. ) to write a sentence! C. he is not necessary since Mr. Tully is not physically or mentally capable of filling out signing. 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