You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. What could you tell her? Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. 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. 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. Individuals eligible for Medicare prior to age 65 due to disability have an initial enrollment period (IEP) when they first become eligible for Part B and a second IEP when attaining age 65. She could enroll in the PFFS plan and a Medigap plan that offers drug coverage, but not in a stand-alone Medicare prescription drug plan. c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Beneficiaries may make more than one enrollment choice during the AEP, but the last one made prior to the end of the AEP, as determined by the date the plan or marketing representative receives the completed enrollment form, will be the election that takes effect. This is a social security program. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. a. C. upward sloping at low wage rates but becomes downward sloping at 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. Anita intends to enroll in Original Medicare Part A and Part B. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. a. ), Phiona works in the IT Department of BestCare Health Plan. 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. Some terms may not be used. The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. If the enrollment form is countersigned by one of Mr. Tully's treating physicians, she can sign it for him. (Betsy is not a United States citizen nor is she legally present in the country having overstayed her visa. He can enroll in a standalone prescription drug plan and Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. a. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields long-term care costs. a. TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include only expenses paid directly by a Medicare Part D beneficiary. WebMr. (Starting January 1, 2020, Medigap plans sold to individuals who are newly eligible to Medicare will not be allowed to cover the Part B deductible. An individual is eligible to enroll in Part D if the individual is entitled to Part A or enrolled in Part B. Shortly thereafter Mrs. Quinn and received a letter informing her that she has been automatically enrolled in Medicare Part B. Drugs cannot give you that kind of energy which Ranveer Singh has. The cost of all medications bought within the United States not covered by his plan would count toward TrOOP. What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? Mention THREE benefits of properly planning your responses when answering examination questions.. 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. 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). What should you tell her? -Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. b. 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. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? 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. She is considering enrollment in a Medicare Advantage plan (Part C). a. Choose one answer. c. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, she will have to pay a one-time penalty equal to 10% of the annual premium amount. 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. WebIt is one of three plans operated by the same organization in Mr. Lombardi's area. 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. b. a. Newer models of cell phones contain a myriad of applications and can do many of the things that a personal computer (PC) can do. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. 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. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. Call the plan. -She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Can his daughter fill out the enrollment form and sign it for him? Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. d. There is no possibility of obtaining coverage for her existing medications once coverage under the Medicare Part D plan begins. In order to join a Medicare Advantage plan, she must be enrolled in Parts A, B, and D. She is interested in selecting a Medicare Part D prescription drug plan. Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? Agent John Miller is meeting with Jerry Smith, a new prospect. d. During the MA Open Enrollment Period, from January 1 - March 31, she may only disenroll from a MA or MA-PD plan but cannot enroll in a stand-alone Part D plan. c. 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. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. What could you tell her? a. 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 It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs she needs. b. TTY: 1-877-486-2048. WebIn this review, we will focus our discussions on nutlin-based and spirooxindole class compounds given that they are the most widely used classes among the MDM2-p53 interaction inhibitors in breast cancer studies and display drug-like properties. (Medicare Advantage is a way of covering Original Medicare, Part A and Part B benefits, through private health insurance plans.). You may proceed with the discussion and enroll the individual if she so desires. d. There is no limitation on meals. What should you tell him about his concern? Consequently, Shamalay was not very profitable. a. For more details regarding drug coverage, visit: This site is using cookies under cookie policy . What should you tell him about the types of health plans that are available through the Medicare Advantage program? The answer that you can give to Mr. Singh would be that he can enroll in a stand-alone prescription drug plan and be receiving Part A and B services. She would also like to enroll in a Medicare Supplement (Medigap) plan. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Advantage plan. What should you tell him? What could you tell him? b. a. d. 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. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. Total views 20. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? The goal is to ensure and make health care more accessible to the people of the nation. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? Gifts of nominal retail value ($15 or less) Also, private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. Yes. Mr. Barker enjoys a comfortable retirement income. Otherwise, he has no problems functioning. Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. 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. Handing out enrollment forms, on the other hand, would not be permissible. What should you tell her? (Mrs. Walters is a dual-eligible. In what activity can you review reports about the patient's status, Drivers under the influence of alcohol and other drugs tend to. 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. What should you tell him? 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. b. a. -Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. a. What is Medicare plan? No. (Mr. Gomez may receive health care services from any doctor allowed to bill Medicare, provided he shows the doctor the plan's identification card, and the doctor accepts the PFFS's payment terms and conditions. What should you say? In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. Original Medicare covers routine long-term custodial care. b. Enrollment in Cost plans offering Part D coverage is generally available only 30 days per year, because of the more generous benefits of these plans. b. 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. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. Mr. Singh can enroll in a stand-alone 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. b. On December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-PD plan. He must return to Original Medicare but must then enroll in a Part D plan if he wants prescription drug coverage through Medicare. One might be right for you. Enrollees pay a monthly premium based on their income level and have 20 percent coinsurance cost-sharing with the exception of preventive benefits.). Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. 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. During the MA Open Enrollment Period, from January 1 - March 31, she may only add or drop Part D coverage, so she cannot switch back to Original Medicare. Put yourself in Beckys place. During the appointment, what are you permitted to do? d. Mr. Tully's daughter can do so because she is an immediate family member who has taken responsibility for her father's care. 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. 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