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. 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. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Anita intends to enroll in Original Medicare Part A and Part B. Choose one answer. What should you tell Mrs. Quinn? What should you tell her? 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. (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.). 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. Wu is eligible for Medicare. -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. 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. d. She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. (Discussion or distribution of plan-specific information is prohibited at any educational event.). During the appointment, what are you permitted to do? Part D covers hospital and home health services and the cost sharing has changed this year. a. Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. 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. 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. AHIP 2018 Module 5 - Enrollment Guidance Medi, AHIP 2018 Module 4 - Marketing Medicare Advan, AHIP 2018 Module 3 - Part D and Other Coverage, AHIP 2018 Module 3 - Part D Enrollee Costs an. -SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. c. You may provide her with the required enrollment materials and take her completed enrollment application. 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. c. This is not a discriminatory activity since it is based on the incomes of likely prospects and not based on race or gender. b. 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. (This statement may discourage Mrs. Pearson from enrollment due to her health status. What should you tell him? He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Mrs. Shields is covered by Original Medicare. "If you're not in very good health, you will probably do better with a different product." Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. b. Betsy, a grandmother from overseas who has overstayed her visa. 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. State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. a. c. You do not have to do anything. What should you tell him? Mr. Zachow has a condition for which three drugs are available. Mr. Castillo is still covered by Part A. You can specify conditions of storing and accessing cookies in your browser. b. Mr. Prentice has many clients who are Medicare beneficiaries. 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. To do so it must obtain authorization from the enrollees. d. She is eligible for a Special Election Period that begins either the month before her permanent move, if the plan is notified in advance, or the month she provides notice of the move, and this period typically lasts an additional two months. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. -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. 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. WebDownloaded from mr.vathorstcollege.nl on by @guest them. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. d. Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospects through electronic means of communication. d. "How are you this morning, Mrs. a. As a result, this method of payment is no longer an option for Part D premium payments. 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. WebThe answer that you can give to Mr. Singh would be that he can enroll in a stand-alone prescription drug plan and be receiving Part A and B services. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. He wants to know if Medicare covers cancer screening. If Mrs. Ridgeway wants to return to Original Medicare, she may use this SEP to disenroll from her MA plan and return to Original Medicare. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. , ches of government? d. I-SNP, c. C-SNP What should you tell him? On December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-PD plan. a. PCs are also able to function as phones. ABC is a Medicare Advantage (MA) plan sponsor. What should you tell him? a. (Part D plans are not required to cover all prescriptions on the market. In what activity can you review reports about the patient's status, Drivers under the influence of alcohol and other drugs tend to. What should you tell him?. What should you tell her? a. a. 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. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. d. Gift cards or gift certificates of $15 or less that can be readily converted to cash. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. Juan Perez, who 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. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. a. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. a. Her husband worked for many years and contributed into the Medicare system. What should you tell her about how the Part D Initial Enrollment Period applies to her situation? d. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? 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. If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan. She is concerned about whether or not Medicare will cover these items and services. (A signed scope of appointment form describing the types of products she wishes to discuss must be completed before you begin your discussion.). Unfortunately, Mrs. Ridgeway has found that many of her providers are not in the MA plan's network. b. Mr. Kelly has substantial financial means. c. TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances drug manufacturer discounts. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives. d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. (Mrs. Walters is eligible to enroll in Part D because she is entitled to Part A. One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. His co-actors and directors have referred him as one of the most energetic guys of the industry. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. This could be considered discriminatory activity and a prohibited practice. This is not a discriminatory activity since this is merely a widely recommended sales practice. In order to join a Medicare Advantage plan, she must be enrolled in Parts A, B, and D. In addition to drugs on his plan's formulary he takes several other medications. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. a. d. 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 be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. He was elected to the Legislative Assembly of Ontario in 2011, representing b. 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. Correct. c. Standard Part D coverage would require payment of an annual deductible, fixed per-prescription co-payments, and once catastrophic coverage begins, the plan covers 100% of all costs. She is 4 pounds 4 ounces. She could enroll in a PFFS plan, but not in a stand-alone drug plan. 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. 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. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. Many also cover Part D prescription drugs. -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. a. Medicare health plans must cover all benefits available under Medicare Part A and Part B. b. Where might he turn for help with his prescription drug costs? 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. What could you Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. WebMr. The standalone plan got this name due to the fact that the drug coverage is a separate plan that the beneficiaries may be able to purchase. 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. -In order to join a Medicare Advantage plan, she also must enroll in Part B. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. c. In general, Mrs. Ramos will need a referral to see specialists. 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. c. 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 to a MA or MA-PD plan. The most energetic guys of the products Initial enrollment Period applies to her health status but not in a plan. 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