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. She sustained a hip fracture and is being successfully treated for that condition. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? Mention THREE benefits of properly planning your responses when answering examination questions.. Part D plans are permitted to offer supplemental benefits that cover certain drugs not covered under Part D. Some Part D plans may offer these supplemental benefits for an additional monthly premium.). If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications. 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. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. b. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. b. Mr. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. a. 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. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. A growing number of professionals are trading in their laptops for handheld computers. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.). 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. (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.). 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. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Mr. Castillo is still covered by Part A. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. What you should tell him is: He can enroll in a stand-alone prescription b. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. She currently does not have creditable coverage. I. c. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy." Mary Rodgers sees Dr. Brennan for treatment. How can you explain this to him? Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? b. State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. What should you tell Mrs. Quinn? b. Mr. Singh must leave Original Medicare to receive drug coverage. 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. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. Her second prescription will require her to pay the full cost out-of-pocket. Her recent videos also seem like the same old recycled jokes over and over again. 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? c. He is not eligible to enroll in a Medicare Advantage as a naturalized citizen. Mr. Barker enjoys a comfortable retirement income. 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. Each sales manager then decides how to divide the cars among the independently owned dealerships in the region. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. a. 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. 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 Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. -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. d. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. c. If the SEP is for Part D coverage, he may only drop, but not add or change, his Part D coverage one time before the SEP expires. Correct, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese, Fundamentals of Financial Management, Concise Edition, Daniel F Viele, David H Marshall, Wayne W McManus. . (Formulary exception requests can be used to request coverage of a drug not on a Part D plan's formulary or to cover a formulary drug at a lower cost formulary.). However, this SEP is not an opportunity to select another MA plan.). Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. What should you tell her about obtaining drug coverage? Call me to find out more!" Webc. PCs are also able to function as phones. Anita Magri will turn age 65 in August 2020. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? What should you tell him? In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so he will need to transfer the funds prior to beginning such withdrawals. 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. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What could you tell Mrs. Park that might be of assistance? All data elements required to complete an enrollment request must be captured. This provides her with options as to how she secures Part D benefits. What do you need to do with your materials before using them for marketing purposes? Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. a. Medicare Advantage is a new name for the Original Medicare program. 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. Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What would be the correct description? Part B primarily covers physician services. 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 What should you tell him? She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. Ms. Moore plans to retire when she turns 65 in a few months. a. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan. b. a. She sustained a hip fracture and is being successfully treated for that condition. Aaditiananta Answer: Anita intends to enroll in Original Medicare Part A and Part B. a. a. a. Medicare health plans must cover all benefits available under Medicare Part A and Part B. What should you tell him? This site is using cookies under cookie policy . 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. You may then proceed with the discussion. a. b. What would be the correct description? a. a. Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn's could look into that possibility. a. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Correct. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. b. (Mrs. Davenport has three clear choices: (1) remain in the ABC MA plan, (2) enroll in another MA plan in her service area, or (3) enroll in a Special Needs Plan (SPN) for persons suffering from ESRD if one is available in her area.). Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation? 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. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. How should you respond? Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. He will incur a late enrollment penalty. When expanded it provides a list of search options that will switch the search inputs to match the current selection. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. IV. a. However, the plan does not provide drug benefits. What could you What should you tell Mrs. Quinn? Can his daughter fill out the enrollment form and sign it for him? b. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare. As a dual eligible, her SEP takes place during the first 9 months of the year.). (To be eligible to enroll in Medicare Advantage, an individual must be entitled (not enrolled) to Part A and enrolled in Part B.). c. She cannot enroll in an MA Medical Savings Account (MSA) plan. You work for a company that has marketed Medigap products for many years. a. 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. 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). What is medicare advantage plan? 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. b. 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.). b. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage. What should you tell him? During the MA Open Enrollment Period, from January 1 - March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan. 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. c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Part D plans may use varying co-payments for brand name and generic drugs, but they may not restrict access through prior authorization. Handing out enrollment forms, on the other hand, would not be permissible. c. I only She wants to understand what this means. She is considering enrollment in a Medicare health plan (Part C). Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. All beneficiaries enrolled in an MSA set-aside the MSA funds on a pre-tax basis in addition to paying their Part B premium. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a prescription drug plan. c. Medicare prescription drug plans are required to cover drugs in each therapeutic category. (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).). Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. III. Pearson? Anita comes to you for advice. Mr. Singh can enroll in a stand-alone prescription drug plan What should you tell him? 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. b. a. 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? She agreed to sign a scope of appointment form and meet with you on October 15. Mrs. Park is an elderly retiree. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields long-term care costs. One might be right for you. What can you tell her? Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. Next week you will be participating in your first "educational event" for prospective enrollees. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. Ralph's effective enrollment date is January 1st. c. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims but Smallcap must continue to offer him coverage under its employer-sponsored group health plan and would become a secondary payor. Yes. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. b. 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. 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. a. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him? However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. d. The cost of the prescription drugs that are not on his plan's formulary as well as the cost of the drug(s) to reduce joint swelling from the Canadian pharmacy will count toward TrOOP but the other medications in question will not count toward TrOOP. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. b. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. c. She should call the doctor's office to complain since the plan cannot do anything about the doctor's schedule. Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage (MA) or Part D Plan? c. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? Original Medicare covers ambulance services. What should you tell her? a. What should you tell him? c. Authorization may be obtained by directing a beneficiary to a website to provide consent as long as the website includes a mechanism for an electronic signature that is valid under applicable law. During the appointment, what are you permitted to do? What should you tell her about obtaining drug coverage? Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. Additionally, all data elements necessary for an enrollment request must be captured, and the individual must be advised that he or she is completing an actual enrollment request. Correct. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? 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. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D only to a MA plan that includes prescription drug coverage. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. b. The SEP continues for two months either after it begins or the month of the move, whichever is later.). WebOnce you choose a Medicare drug plan, here's how to get prescription drug coverage: Enroll on the Medicare Plan Finder or on the plan's website. c. I, II, III, and IV d. She must remain enrolled in her ABC MA plan unless the plan terminates. Web-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. 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. What could you tell him? Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. What should you tell him? This could be considered discriminatory activity, but it is not a prohibited practice. b. c. You must set up your table and make marketing presentations only in common areas, but you may accept enrollment applications anywhere in the pharmacy. d. Part D plans do not have to cover all medications. Mr. Hutchinson has drug coverage through his former employer's retiree plan. What should you tell him? b. -SNPs limit enrollment to certain subpopulations of beneficiaries. What should you tell him?. (In order to enroll in a Medicare Advantage (MA) plan, an individual must be entitled to Part A and enrolled in Part B. Mr. Castillo is covered by Plan A but no longer enrolled in Medicare Part B so he cannot enroll in MA plan until he re-enrolls in Part B.). This is a social security program. Nutlins: Nutlins act by sterically inhibiting MDM2 at its p53 binding pocket. CMO Sambhal has given certificate to the 39 newly recruited ANM. Most individuals who are citizens and age 65 or over and wish to be covered under Part A must enroll in a Medicare Advantage Plan. 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. Consequently, Shamalay was not very profitable. He has chronic bronchitis, putting him at severe risk for pneumonia. 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. (Edward is not likely to qualify for either a MA or Part D SEP because he has moved within his existing plan's service area. Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. How much may Dr. Brennan charge? Original Medicare covers ambulance services. Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply failing to reply within 21 days. d. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. You may offer meals to existing enrollees of the plan(s) you represent, but potential enrollees may not have a meal. a. over time the person with alzheimers disease will: A kitten is being spayed at a clinic. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. What Medicare Part D drug plans cover Overview of what Medicare drug plans cover. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. c. The Part B deductible will be covered for some newly eligible individuals depending on their financial status. 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. (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. c. C-SNP Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. 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. If he does not, he must enroll in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty.). Same old recycled jokes over and over again the Original Medicare and purchase drug through. Next month, intends to work for several more years at Smallcap, Incorporated state Medicaid programs do not a... The 39 newly recruited ANM to the Medicare system for over 20 years cars the... Has expended her liquid assets, Medicare will cover his Part a and Part plans... 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