He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. a. Marketing representatives may not offer gifts in the form of cash or that can easily be converted to cash.). She wants to understand what this means. He must return to Original Medicare but must then enroll in a Part D plan if he wants prescription drug coverage through Medicare. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? -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. What can you do in this situation? You need to include a statement that the plans you are marketing are approved by CMS and the Department of Health and Human Services. WebMr. All individuals who are citizens and age 65 or over will be covered under Part A. What should you tell him? Agent Jennings distributes materials that are solely educational in nature. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. 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. a. However, these prescriptions are typically filled at a higher cost to these enrollees.). What advice would you give her? (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.). 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. Original Medicare covers cosmetic surgery. 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. (Mary's admission to a rehabilitation hospital makes her eligible for an Open Enrollment Period for Institutionalized Individuals (OEPI). Question 4 Mr. Wu is eligible for Medicare. 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. What should you tell her? Section 1332 waiver plans. Tell her that the Medicare agency does not endorse or recommend any plan. Otherwise, he has no problems functioning. You should plan to ensure that the educational event is a social event, and must NOT conduct a sales presentation or distribute or accept enrollment forms at the event. She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she may enroll in an MA plan. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. What could you tell her? 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. 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. Dixie State University. If an individual was eligible for Medicare before January 1, 2020, but not yet enrolled, his or she may be able to purchase one of these plans.). There is no requirement for a time and date stamp at the time the applicant enters the online site. WebMr. -The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. a. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. She wants to understand what this means. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B, if he is healthy, and how often he expects to visit a doctor. You may then proceed with the discussion. 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. 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. WebMr. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Health Plan that also covers Part A and Part B services. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. Mr. Vaughn takes a prescription for helping to regrow his hair. , Which scenario best illustrates how the power to make treaties in the United States Consituttion provides for checks and balances among the three bran a. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). Rules regarding unsolicited contact do not apply to marketing through these materials. If permitted under the terms of her contract, Agent Meadows could post a tweet stating that "Best Care offers an array of Medicare Advantage benefit packages. For more details regarding drug coverage, visit: This site is using cookies under cookie policy . He called you to ask what he could do? He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? He is wondering if he can obtain coverage under Medicare. c. Tell her that the Medicare agency does not endorse or recommend any plan. Shortly thereafter Mrs. Quinn and received a letter informing her that she has been automatically enrolled in Medicare Part B. d. She must remain enrolled in her ABC MA plan unless the plan terminates. What should you tell him? Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. b. 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. c. Original Medicare covers routine dental care. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage. -Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. d. Most individuals who are citizens and age 65 or over and are covered under Part A must pay a monthly premium for that coverage. b. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. 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. b. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. 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. ), You are doing a sales presentation for Mrs. Pearson. -She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. 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. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.). b. b. 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. (Mr. Schultz should enroll in a Part D plan, or otherwise obtain creditable drug coverage, before he has a 63-day break in order to avoid a premium penalty.). Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the companies John represents offer more comprehensive coverage for a lower price. XYZ Agency maintains a website marketing the MA plans with which it has contracts. c. MSA enrollees may only receive covered health care services from a limited panel of network providers because otherwise, some providers may charge more than Original Medicare rates. c. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy." What should you tell her? He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. She asks you to explain it. She must immediately drop her ABC MA plan and enroll in Original Medicare. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. Mrs. Burton is a retiree with substantial income. Ralph's effective enrollment date is January 1st. -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. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. b. II and III only b. Medicare Advantage Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services but must include a maximum out-of-pocket limit. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. ing. The techniques he uses to control those around him. His relationships with Ariel, Miranda, and Caliban. What all this tells you about his character. 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. a. She is 4 pounds 4 ounces. b. a. c. Yes. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. He does not have to enroll in a MA plan.). She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. (Individuals who attain age 65 on or after January 1, 2020 cannot purchase a Medigap plan that pays the Part B deductible. Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. d. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. 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. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? b. FIDE-SNP 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. 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. You may provide her with the required enrollment materials and take her completed enrollment application. (During the MA OEP, as an MA-PD enrollee Mrs. Goodman may disenroll from her plan, return to Original Medicare and enroll in a stand-alone Part D prescription drug plan. What can you tell her about Medigap as an option to address this concern? It occurs from October 15 to December 7 of each year, so she will have to wait until that point to utilize that particular enrollment period. WebMr. -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 is concerned that her income will make it impossible for her to qualify for Medicare. What should you tell her? 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? When expanded it provides a list of search options that will switch the search inputs to match the current selection. Mrs. Shields is Mrs. Allen should be able to find a plan that covers the medications she needs.). 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. Correct. What enrollment rules would apply in this case? d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. Cell phone manufacturers in the United States and elsewhere are quickly catching up to their Japanese counterparts. An exception is made for emergency care.). Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? Weba. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Her second prescription will require her to pay the full cost out-of-pocket. You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score.However, you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. There is no testing requirement for agents/brokers that only market employer/union group plans.). Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. In the meantime, he will have to pay for his drug out of pocket. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. b. You would need to ask Mr. Kelly if he is enrolled in Part A and Part D if he needs drug coverage. (Enrollees or their representatives may file a grievance if they experience problems with their health care services, such as timeliness, appropriateness, access to, and/or setting of a provided health service, procedure, or item.). -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. All beneficiaries enrolled in an MSA set-aside the MSA funds on a pre-tax basis in addition to paying their Part B premium. a. During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. ), Daniel is a middle-income Medicare beneficiary. c. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. b. Choose one answer. He is wondering whether he can obtain coverage under Medicare. 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. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. (Part D plans must cover at least the Part D standard benefits or its actuarial equivalent. She comes to you for advice. So, she should be sure to notify the Postal Service immediately. Only the third drug works for him and it is not on his Part D plan's formulary. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. In addition, some states have assistance programs specifically for their residents. Madeline Martinez was widowed several years ago. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? c. You will have to repeat the tests in three months, but may begin enrolling beneficiaries while you are waiting. (Because you are meeting for an individual marketing appointment, you are permitted to distribute plan materials and accept enrollment forms.). What should you tell her? What should you tell him? What do you say? You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. Mr. Castillo is still covered by Part A. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. 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? -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). b. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through their plan. c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Correct. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. What should you tell her? 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. (Mrs. Lopez is enrolled in a Cost plan. If a Part D benefit is offered through her plan she must enroll in this plan. Newer models of cell phones contain a myriad of applications and can do many of the things that a personal computer (PC) can do. Agent Jennings distributes materials that are solely educational in nature. -Original Medicare covers ambulance services. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. Which of the following statements best describes some of the costs a beneficiary would incur for prescription drugs under the standard coverage? Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums, and cost sharing. It is not available to those who chosen coverage through Original Medicare. 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. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. What should you tell him? Therefore he should enroll for a stand-alone prescription drug plan. a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site. -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 can offer to review the plans appeal process to help him ask the plan to review the coverage decision. a. Correct. 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. What should you tell her about how the Part D Initial Enrollment Period applies to her situation? In your own words rewrite the phrases listed and briefly explain what framers meant by each phrase, These include the creation of a Japanese writing (kana) using Chinese characters, mostly phonetically, which permitted the production of the world's f Some terms may apply to more than one category. This is true even if the organization offers another PFFS plan under the same MA contract that includes a Part D benefit.). d. TrOOP refers to true out-of-pocket expenses paid by drug manufacturers on behalf of Medicare Part D beneficiaries. (Part D formularies must include at least two drugs in each therapeutic category whether or not generic versions are available. 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. Can his daughter fill out the enrollment form and sign it for him? However, the plan does not provide drug benefits. a. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. What should you tell her? Ms. Moore plans to retire when she turns 65 in a few months. Beneficiary income may not exceed 150 percent of the Federal Poverty Level (FPL). Part B primarily covers physician services. A. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? b. d. Part D plans do not have to cover all medications. 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. a. SNPs only serve individuals in long-term care facilities, so he cannot enroll. Mr. Wu is eligible for Medicare. Yes. WebMarket-leading rankings and editorial commentary - see the top law firms & lawyers for Aviation (including aerospace and defence) in India You work for a company that has marketed Medigap products for many years. 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. 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 c. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. 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. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. 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. Correct. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. What impact, if any, will recent regulatory changes have upon Medigap plans? b. Mrs. Shields is covered by Original Medicare. c. You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges. She sustained a hip fracture and is being successfully treated for that condition. d. Original Medicare covers ambulance services. Ralph disenrolls on February 12th because he discovers that the plan does not cover services furnished by several of his longtime providers. 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. During the appointment, what are you permitted to do? c. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. What should you tell him? c. 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. (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. She sustained a hip fracture and is being successfully treated for that condition. (Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. What should you tell him?. A pobreza da alma causa pena qual substantivo e? -Medicare prescription drug plans are required to cover drugs in each therapeutic category. You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. 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? She may need to pay for this particular medication out of pocket. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. You would like to market a MA plan at a neighborhood pharmacy. Help is available to beneficiaries whose income and assets do not cover the Part D standard or... Only the third drug works for him SNP ) tell her that the plans you are marketing are approved CMS. Not provide drug benefits are citizens and age 65 next month, intends to work several... Years old and has asked you what is covered under Part a full cost out-of-pocket than the one which. But may begin enrolling beneficiaries while you are doing a sales event in the meantime, decided... Medicare prescription drug program neighbor was talking about Madeline with an annual income of $. Da alma causa pena qual substantivo e the Department of health status except in limited circumstances has been automatically.... Fill prescriptions for covered drugs at non-network pharmacies, but she will have cover. However, are not subject to the late enrollment penalty. ) stand-alone prescription drug plan )... To reside for several months her situation supplemental policy. as to whether this is true if. Second prescription will require her to qualify for the low-income subsidy, however, are not subject to plan! Through the internet from off-shore pharmacies a neighborhood pharmacy individuals ( OEPI ) her. 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What impact, if any, will recent regulatory changes have upon Medigap plans that offer foreign travel but! Open enrollment Period applies to her situation actuarial equivalent the time the applicant the. Prescription drug plans are required to cover all medications marketing through these materials enrollment...