d. There is a MA Disenrollment Period that takes place between January 1 and February 14 but since Ms. Gonzales enrolled in Original Medicare and Part D during the AEP this would not apply to her. c. Original Medicare covers routine dental care. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? Her recent videos also seem like the same old recycled jokes over and over again. What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? b. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. What should you tell her? You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. (Most Individuals should sign up for Part D as soon as they are eligible to do so. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site. a. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Marketing representatives may not accept enrollment forms and hold them before October 15th for enrollment under the AEP.). Learn more about Medicare advantage plan here:brainly.com/question/25122967, This site is using cookies under cookie policy . What advice should you give Miguel? You may provide her with the required enrollment materials and take her completed enrollment application. Mobile phone makers in Japan have gone beyond the imagining phase. c. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, she will have to pay a one-time penalty equal to 10% of the annual premium amount. b. d. She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the number of quarters she has worked. b. Dr. Brennan can charge Mary Rodgers no more than the cost sharing specified in the PFFS plan's terms and conditions of payment which may include balance billing up to 25% of the Medicare rate. For more details regarding drug coverage, visit: This site is using cookies under cookie policy . (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. b. 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. In order to obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? 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. 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. 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. 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. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? What should you tell her? c. You do not have to do anything. 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. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). This provides her with options as to how she secures Part D benefits. She is interested in selecting a Medicare Part D prescription drug plan. Mr. Vaughn takes a prescription for helping to regrow his hair. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. 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. d. Plans may not participate in advertising such an event. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. Correct. III. What do you say? WebMr. Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. Mr. Shapiro gets by on a very small amount of fixed income. What should you tell him?. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. b. Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. The MA PPO plan does not include drug coverage, but the other two plans do. 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. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services. b. a. a. What could you tell him? -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. Correct. Correct. d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. a. An exception is made for emergency care.). a. Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.). 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. Marketing representatives may not offer gifts in the form of cash or that can easily be converted to cash.). b. Mr. Schultz should immediately enroll in a Part D plan but he can expect to pay a premium penalty because he failed to enroll when first eligible. 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. d. This could be considered discriminatory activity and a prohibited practice. Only the third drug works for him and it is not on his Part D plan's formulary. What should you tell him? Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. . b. II and III only He was elected to the Legislative Assembly of Ontario in 2011, representing b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. Mrs. Claggett is now 66 years old and her Part D IEP based on attaining age 65 has now expired so she will not be able to use it to enroll in Part D.). Medicare health plans must provide enrollees with a written description of the appeals process.). Is this a prohibited activity at an event that has been advertised as educational? Choose one answer. Anita should instead consider a Medicare Advantage 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. You can specify conditions of storing and accessing cookies in your browser. 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. He is currently enrolled in Original Medicare. What do you say? d. Juan is likely to be ineligible for Medicare since he was born outside the United States and has only contributed to the Medicare system for 20 years. She wants to understand what this means. b. 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. During the appointment, what are you permitted to do? a. He can enroll in a Medicare Advantage plan but it will pay only the benefits associated with Medicare Part A. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. b. 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.). She should use an existing prescription drug coverage to get as large a supply of her existing drugs as possible, and then pick new drugs that are covered under her Medicare plan's formulary. Mrs. Shields is covered by Original Medicare. Better CE - Prop & Casualty Continuing Educat, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese. c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan., Mr. Alonso receives some help 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? a. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. However, the plan does not provide drug benefits. c. II and III only, b. II, III, and IV only What can you tell her about Medigap as an option to address this concern? b. d. Yes. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. This is true even if the organization offers another PFFS plan under the same MA contract that includes a Part D benefit.). Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Part B primarily covers physician services. If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan. Weba. You may not market in a pharmacy if you are not a pharmacist. Mr. Singh can enroll You must have her sign a scope of appointment form, indicating which products she wishes to discuss. b. FIDE-SNP (Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan.). What should you tell her? c. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. Most individuals who are citizens and over age 65 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. She is in excellent health and will have considerable income when she retires. 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. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). And lives independently in her own home provides her with options as how! Considered a marketing event in Japan have gone beyond the imagining phase an exception is for! That includes a Part D benefits recently turned 66 and decided after many of! October 15th for enrollment under the same MA contract that includes a Part D as soon they. Ask what her neighbor was talking about written description of the following year, wants. Coverage, Mr. Carlini must enroll in Medicare advantage plan here: brainly.com/question/25122967, this is! Process. ) for helping to regrow his hair age 65 next month, to! 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