-She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Her second prescription will require her to pay the full cost out-of-pocket. (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 tell him . An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. 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. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. a. 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. Answer: Mr. Singh can enroll in a stand-alone However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. 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. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? a. Medicare Advantage is a new name for the Original Medicare program. She agreed to sign a scope of appointment form and meet with you on October 15. B. At that time, he had employer group coverage that was creditable. (Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. As a result, this method of payment is no longer an option for Part D premium payments. (Chronic condition SNPs (C-SNPs) restrict enrollment and tailor services to individuals with chronic conditions, such as Mr. Sinclair. During the appointment, what are you permitted to do? Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. Add your answer and earn points. 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. He will incur a late enrollment penalty. Which of the following statements about Medicare Part D are correct? Mr. Shultz was still working when he first qualified for Medicare. d. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. When expanded it provides a list of search options that will switch the search inputs to match the current selection. What could you tell her? 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. WebCorporate and commercial > Commercial contracts Tier 1 Addleshaw Goddards dedicated commercial group provides strong commercially focused advice, and demonstrates a keen willingness to get into the operational side of the business, covering a varied range of high-value contract agreements.Leveraging its expertise across the retail, financial services, III. She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security benefits. (Mrs. Kendrick will soon enter her MA Initial Coverage Election Period (ICEP) which begins three months immediately before the individual's first entitlement to both Medicare Part A and Part B. Mrs. Kendrick will become eligible for Part A and Part B upon turning age 65. (Individuals who drop their Medigap policy to enroll in a MA plan for the first time are eligible for a Special Enrollment Period (SEP) within 12 months after enrolling in that MA plan. What should you tell her? She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. 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. You may offer meals to existing enrollees of the plan(s) you represent, but potential enrollees may not have a meal. c. Medicare does not cover acupuncture, or, in general, glasses or dentures. c. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage. 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. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. 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. Mr. Wu is eligible for Medicare. b. How would you respond? Since SNPs don't cover prescription drugs Mr. Sinclair should consider a different option. 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. Correct. Correct. 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. b. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. d. This could be considered discriminatory activity and a prohibited practice. If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. What you should tell him is: He can enroll in a stand-alone prescription II. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. WebGet the right Medicare drug plan for you. a. Helena, an overseas college student who has overstayed her visa. Anita intends to enroll in Original Medicare Part A and Part B. Learn about formularies, tiers of coverage, name brand and generic drug coverage. a. I and II only Explain. What should you tell him about the types of health plans that are available through the Medicare Advantage program? The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. c. She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. b. It is not necessary for ABC to obtain an authorization to simply explain pending state or federal legislation since there is no anticipation of selling a non-health related product in these circumstances. Individuals who enroll into any portion of their state Medicaid program cannot participate in either MA or Part D. 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%. Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. b. a. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. (In most Medicare Advantage HMOs, as a general rule, an enrollee must obtain services only from providers who have a contractual relationship with the plan. He should drop the employer coverage and enroll in a Medicare prescription drug plan. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. a. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15%of the Medicare rate. Why do you think Seamus Heaney might have chosen this rhyme scheme for a poem about a couples relationship Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. She will have a six-month window during which she can select a plan other than the one into which she has been automatically enrolled. The Supreme Court must decide whether the treaty is constitutional, but Congress can override the court with approval of the president. 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. b. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. He called you to ask what he could do? Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation? Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. When putting together advertisements for this event, what should you do? Otherwise, they face a permanent premium penalty of 1% of the national average premium for each month the individual does not have Part D coverage. He has chronic bronchitis, putting him at severe risk for pneumonia. (Mr. Carlini can stay in Original Medicare and obtain prescription drug benefits through a stand-alone Part D plan. a. 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). a. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. He is wondering whether he can obtain coverage under Medicare. 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. 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. Using evidence from Document 2, explain why the Great War was not the last world war. a. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through their plan. c. Yes. a. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. b. What is t Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program. c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. PCs are also able to function as phones. (MSA enrollees must enroll in a stand-alone prescription drug plan (PDP) if they want prescription drug benefits.). 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. Correct. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. a. In addition to drugs on his plan's formulary he takes several other medications. -He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. What should you tell him? c. He may receive services from any physician, regardless of whether or not that physician participates in the plan or Original Medicare. (Marketing representatives may engage in marketing activities in common areas in a health care setting.). Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. WebMr. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. You would like to market a MA plan at a neighborhood pharmacy. (Mr.Greco's circumstances would not meet the eligibility criteria to qualify him for any of the SNPs.). a. Apply those guidelines to the following statements and identify which would be prohibited. Webc. Mrs. Kendrick is in good health, has worked for many years and is six months away from turning 65. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? 12. c. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. What should you tell her? He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. It is not available to those who chosen coverage through Original Medicare. Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. Many also cover Part D prescription drugs. 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. a. 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. 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. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? c. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy." d. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services. Though energy in him is mostly inbuilt, he does a lot of things to boost it. 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. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. The extra help is available only to Medicare beneficiaries who are enrolled in Medicaid. You may then proceed with the discussion. I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. Her husband worked for many years and contributed into the Medicare system. Mr. Wu is eligible for Medicare. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. Part B primarily covers physician services. Tell prospect Jerry Smith that he should keep his Medigap plan but he should supplement his healthcare coverage by purchasing a Medicare Advantage plan that offers prescription drug coverage (MA-PD). b. Mr. Torres has a small savings account. b. She could enroll in a PFFS plan, but not in a stand-alone drug plan. Correct. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. b. What do you need to do with your materials before using them for marketing purposes? (Discussion or distribution of plan-specific information is prohibited at any educational event.). d. Medicare Advantage is designed to pick up where Original Medicare leaves off, covering those health care services that would not normally be covered by Original Medicare. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. All plans must cover at least the standard Part D coverage or its actuarial equivalent. 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. (Agent John Miller can help prospect Jerry select a standalone Part D prescription drug plan that complements his current Original Medicare and Medigap coverage. This is a social security program. 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. 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. Anita comes to you for advice. 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. Fresenius ~ CCHT Certification Preparation Te. 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. Her recent videos also seem like the same old recycled jokes over and over again. Their coverage to generic drugs who applies regardless of health status except in limited circumstances a scope of appointment and. Enroll in a Medicare concept from one of her neighbors called TrOOP enrollees enroll. 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