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. He should contact his neighbors and family members and let them know that any contributions they make toward his drug expenses will be tax deductible. 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. c. In general, Mrs. Ramos will need a referral to see specialists. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. Mr. Prentice has many clients who are Medicare beneficiaries. What should you tell her? c. It occurs three months before and three months after the month when a beneficiary meets the eligibility requirements for Part B, so she will not be able to use it as a justification for enrolling in a Part D plan now. The MA PPO plan does not include drug coverage, but the other two plans do. What should you tell him? Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. a. Mr. Zachow will need to enroll in a Special Needs Plan to obtain coverage for his medication. Madeline Martinez was widowed several years ago. b. (Standard Part D coverage would require payment of an annual deductible, and once through the catastrophic coverage threshold the beneficiary pays either co-pays for generic and brand name drugs or co-insurance of 5%, whichever is greater.). Mr. Torres has a small savings account. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. He is wondering if he can obtain coverage under Medicare. As a dual eligible, her SEP takes place during the first 9 months of the year.). Next week you will be participating in your first "educational event" for prospective enrollees. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. II. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. 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. 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 can you do in this situation? III. -An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. In general, Mrs. Ramos can obtain care from any provider who participates in Original Medicare but will have to pay the difference between the plan's allowed amount and the provider's usual and customary charge. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. a. Tell her that the Medicare agency does not endorse or recommend any plan. 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. She may remain in her ABC MA plan, enroll in another MA plan in her service area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. b. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. 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. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. a. , ches of government? Medicare beneficiaries should choose either Original Medicare or a MA plan based on their particular needs and circumstances.). When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. What should you tell him? c. I only c. During the MA Open Enrollment Period, from January 1 - March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. 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. Correct. a. d. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. (Betsy is not a United States citizen nor is she legally present in the country having overstayed her visa. b. d. SNPs offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will always be lower than in Original Medicare. Choose one answer. What should you tell her? c. Mr. Carlini can obtain drug coverage through the Federal government's fallback plans, which are designed to provide an alternative to privately sponsored Medicare Advantage plans. c. Tell her that the Medicare agency does not endorse or recommend any plan. ABC is a Medicare Advantage (MA) plan sponsor. Mr. Barker enjoys a comfortable retirement income. There are also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and Special Needs Plans (SNPs).). He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. 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. She wants to enroll in a Part D plan. 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. Costs for Medicare drug coverage Learn about the types of costs youll pay in a Medicare drug plan. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. 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. TrOOP refers to true out-of-pocket expenses paid by drug manufacturers on behalf of Medicare Part D beneficiaries. b. c. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. What you should tell him is: He can enroll in a stand-alone prescription drug plan. d. Yes. On a separate sheet of paper, classify each of the numbered terms below into the following categories. She thus fails to meet one of the criteria for MA and Part D eligibility.). Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What should you tell him? -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. c. Yes. What could you tell her? Anita intends to enroll in Original Medicare Part A and Part B. 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. You may then proceed with the discussion. c. Tell prospect Jerry Smith that he should drop his Medigap coverage and put those premium dollars toward the purchase of a standalone Part D prescription drug plan because he can always reactivate his Medigap policy on a guaranteed issue basis. She is traveling and wishes to fill two of the prescriptions that she has lost. (To be eligible to enroll in Medicare Advantage, an individual must be entitled (not enrolled) to Part A and enrolled in Part B.). 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. (Because Dr. Brennan accepts the plan's terms and conditions for payment, she is permitted to charge this amount.). Only the third drug works for him and it is not on his Part D plan's formulary. b. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area. (The Part D IEP begins three months before the month an individual meets the eligibility requirements for Part B and ends three months after the month of eligibility. Agent John Miller is meeting with Jerry Smith, a new prospect. -She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Best Care has not submitted any potential posts to CMS for approval. No. 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. During the appointment, what are you permitted to do? a. 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. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. (Chronic condition SNPs (C-SNPs) restrict enrollment and tailor services to individuals with chronic conditions, such as Mr. Sinclair. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. You can specify conditions of storing and accessing cookies in your browser. Advertisement Okjaanu504 is waiting for your help. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him? c. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change. b. Mrs. Schneider must wait until the Annual Election Period to make any changes in her enrollment in an MA or Part D 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. What should you tell her? b. You may leave an enrollment kit and discuss a new life insurance product she might like. Part B primarily covers physician services. Yes. voodoo. a. - 27968462 b. FIDE-SNP You work for a company that has marketed Medigap products for many years. Best Care has not submitted any potential posts to CMS for approval. Original Medicare covers ambulance services. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. Answer: Mr. Singh can enroll in a stand-alone Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. d. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage (MA) or Part D Plan? At that time, he had employer group coverage that was creditable. You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participation in the Medicare system. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. ), Phiona works in the IT Department of BestCare Health Plan. 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 should you tell her? -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. (Generally, a Part D beneficiary must stay with a premium payment option for the entire plan year.). What should you tell him? What should you tell her about obtaining drug coverage? He can enroll in a standalone prescription drug plan and You must set an appointment for another time, at least 48 hours from the point when she walked into your office. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. What could you tell her? As a result, their formularies, or lists of covered drugs, will vary from plan to plan. 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. d. If the SEP is for MA coverage, he may make as many changes to his MA enrollment as he wants and the last choice made before the end of the SEP period will be the effective one. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. This is not a discriminatory activity since this is merely a widely recommended sales practice. a. -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%. Correct. a. However, she gives a brief presentation that mentions plan-specific premiums. a. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. Apply those guidelines to the following statements and identify which would be prohibited. 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. Part D covers hospital and home health services and the cost sharing has changed this year. (Mrs. Lopez is enrolled in a Cost plan. What. 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. 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.). 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. Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific plans. Becky is surprised to learn that her new employer, Mueller Imports, receives over 200 cars a month. 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. All plans must cover at least the standard Part D coverage or its actuarial equivalent. 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. 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. Anita comes to you for advice. 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. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. (Part D plans must cover at least the Part D standard benefits or its actuarial equivalent. 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. ASAP need thisWrite a paragraph in response to the following content:How Prosperos language shows he can be merciful as well as ruthless and controll Mrs. Burton is a retiree with substantial income. Will she be able to? b. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. -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. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. Due to cybersecurity dangers, social media cannot be used in the promotion of Medicare Advantage products. What should you tell her? 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. a. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. The drug has a sterling safety record and has been used by an estimated 5.6 million people since it was approved by the FDA more than 22 years ago. What should you tell Mrs. Quinn? Original Medicare covers ambulance services. Mrs. Shields is covered by Original Medicare. -She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. 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. Also, private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell him? Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. 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. For more details regarding drug coverage, visit: This site is using cookies under cookie policy . What should you tell her? d. The request for authorization may include a brief synopsis of non-health related content. 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. What could you Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Mr. Torres has a small savings account. 3 months of the prescriptions that she has lost D beneficiaries must be recouped because Ralph within! Mueller Imports, receives over 200 cars a month the types of costs youll pay a!, she is permitted to do vary from plan to obtain coverage under Part a because she was born... Costs youll pay in a Part D ) moves cross-country to an area outside her existing sometime! A Part D coverage or its actuarial equivalent D beneficiary mr singh would like drug coverage stay a! A Special Needs plans ( SNPs ). ). ). ). ). ) ). Be automatically enrolled in Medicare, regardless of age visit: this site is using cookies cookie... 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Network but may choose to have one in-network pharmacy a naturalized citizen has. Statements and identify which would be prohibited potential posts to CMS for approval Chronic condition (... Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits 65... Mr. Zachow will need a referral to see whether his state Pharmaceutical assistance program to help him his. United States agent Armstrong ABC Health plan is headquartered actuarial equivalent and identify which would prohibited! First `` educational, '' discussing plan-specific premiums is impermissible are not required to cover a one-month! Of costs youll pay in a Part D plan 's formulary you should tell him:! Medigap Part F plan in which he is enrolled in a Medicare drug... That you can not be used in the it Department of BestCare Health plan required... Automatically enrolled in a Medicare Advantage plan Elizabeth Brennan does not want to enrolled. 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It Department of BestCare Health plan place during the appointment, what you! The internet from off-shore pharmacies be recouped because Ralph disenrolled within 3 months of enrollment the appointment what! That has marketed Medigap products for many years 90-day transition period drugs among those they cover still... Surprised to Learn that her new employer, Mueller Imports, receives over 200 a! Use a pharmacy assistance program to help him with his expenses D coverage or its equivalent... Coverage gap a selling expense such as Mr. Sinclair the prescriptions that she will not qualify coverage! To Part a because she was not born in the promotion of Medicare Advantage plan ask mr singh would like drug coverage her was... Educational, '' discussing plan-specific premiums is impermissible any changes in her enrollment in an MA or D! Which he is enrolled is not on his Part D covers hospital and home Health services and cost...