Mary Rodgers sees Dr. Brennan for treatment. What is Medicare plan? However, the plan does not provide drug benefits. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. Becky Knauer recently resigned from her position as controller for Shamalay Automotive, a small, struggling foreign car dealer in Upper Saddle River, New Jersey. Original Medicare covers cosmetic surgery. What. -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. ABC is a Medicare Advantage (MA) plan sponsor. Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. What should you tell him? 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. 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.). What could you tell her to address her concern? Apply those guidelines to the following statements and identify which would be prohibited. What should you tell him? c. Part D plans may use varying co-payments, but they are required to cover all prescription medications on the market. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. a. 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. 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. a. What should you tell him? Which of the following statements best describes some of the costs a beneficiary would incur for prescription drugs under the standard coverage? It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Though energy in him is mostly inbuilt, he does a lot of things to boost it. 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. What could 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. Anita comes to you for advice. a. Mr. Zachow will need to enroll in a Special Needs Plan to obtain coverage for his medication. Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. 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. (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. Therefore, this type of statement would be prohibited. c. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare. b. d. Mrs. Lopez must first seek COBRA benefits under her husband's plan before she can apply for Part D coverage. a. What can you tell her about Medigap as an option to address this concern? (Mrs. Schneider is entitled to a Special Enrollment Period (SEP) because, in addition to having Parts A and B, she is now receiving Medicaid assistance through her state's program. 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. 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. She comes to you for advice. In addition, in order to enroll in a specific PFFS plan, the individual must permanently reside in the plan's service area - not whether his doctor will accept the terms and conditions of the PFFS plan.). There is no disadvantage in doing so. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. Mr. Wu is eligible for Medicare. c. She cannot enroll in an MA Medical Savings Account (MSA) plan. What should you tell her? (Because you are meeting for an individual marketing appointment, you are permitted to distribute plan materials and accept enrollment forms.). He must return to Original Medicare but must then enroll in a Part D plan if he wants prescription drug coverage through Medicare. If he still wants to do so, he can make any sort of change he likes at that point. 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.). What should you say? Therefore he should enroll for a stand-alone prescription drug plan. 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. What should you tell him? She is interested in selecting a Medicare Part D prescription drug plan. Choose one answer. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. -Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. (Marketing representatives may engage in marketing activities in a retail pharmacy in common areas. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. 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. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. Correct. Attendees expect some "puffery" at any event on a product in which they may be potentially interested. What can you tell her about Medigap as an option to address this concern? -He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. a. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). a. If he does not, he must enroll in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty.). WebThis button displays the currently selected search type. If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this. d. The vitamins the Vaughns are taking will be covered under Part D because their physician suggested they should take vitamins, but the hair loss medication cannot be covered. You work for a company that has marketed Medigap products for many years. b. Otherwise, he has no problems functioning. (Betsy is not a United States citizen nor is she legally present in the country having overstayed her visa. Will she be able to? She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. b. Mr. Singh can enroll in a stand-alone prescription drug plan Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. -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. Anita comes to you for advice. 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. What should you tell Mrs. Quinn? (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.). 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. 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. Learn more about Medicare advantage plan here:brainly.com/question/25122967, This site is using cookies under cookie policy . b. (As long as Agent Meadows's contract with Best Care does not prohibit her from writing and posting her own communications content, she could post this tweet because it does not contain any marketing content, such as plan-specific benefits, premiums, cost-sharing, or Star Ratings.). 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. -Part B primarily covers physician services. 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? -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. c. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred more than 30 days after the effective date of coverage. b. Prescription drugs are covered by all Marketplace plans. c. What are the possible consequences. c. Medicare prescription drug plans are required to cover drugs in each therapeutic category. What can you tell her about Medigap as an option to address this concern? What impact, if any, will recent regulatory changes have upon Medigap plans? What could you tell her? She wants to understand what this means. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs.
