(Because Dr. Brennan accepts the plan's terms and conditions for payment, she is permitted to charge this amount.). In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). 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. PCs are also able to function as phones. 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. D. The Senate must approve a treaty by a two-thirds vote, and its terms must be found to be constitutional by the Supreme Court, what type of energy is obtain through food. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. b. Marketing representatives may respond to beneficiary requests for one-on-one meetings.). What could you tell him? d. I and II only. Best Care has not submitted any potential posts to CMS for approval. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. You must have her sign a scope of appointment form, indicating which products she wishes to discuss, and note on the form that she is a "walk in. " b. (Individuals who drop their Medigap policy to enroll in a MA plan for the first time are eligible for a Special Enrollment Period (SEP) within 12 months after enrolling in that MA plan. Correct. 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. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. She is interested in selecting a Medicare Part D prescription drug plan. She wants to understand what this means. What should you tell her? d. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Ms. Moore plans to retire when she turns 65 in a few months. b. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. d. Private long-term care policies for Medicare beneficiaries. 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. -Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Newer models of cell phones contain a myriad of applications and can do many of the things that a personal computer (PC) can do. She could enroll in a PFFS plan, but not in a stand-alone drug plan. 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? b. -Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. Complete a paper enrollment form. a. He has chronic bronchitis, putting him at severe risk for pneumonia. c. She cannot enroll in an MA Medical Savings Account (MSA) plan. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. c. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if his doctor will accept the terms and conditions of payment of the PFFS plan. d. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. b. Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area. c. All Medicare Advantage Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare. How would you advise her? Becky has just started a new job as controller for Mueller Imports, a much larger dealer for the same car manufacturer. 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. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. a. What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? What should you tell him? Tell her that Medicare or CMS (the Medicare agency) has approved and endorsed the plan. c. In general, Mrs. Ramos will need a referral to see specialists. c. She must wait until the next Annual Election Period (AEP) during which she may select another MA plan. d. Marketing in health care facilities is an acceptable practice, regardless of where it takes place. b. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. WebGet the right Medicare drug plan for you. Otherwise, he has no problems functioning. 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. What should you advise her to do before she will be able to enroll into a Medicare health plan? b. Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. They are custodial long-term care plans for people with Medicare. c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. WebMakenna Name Puns, I gotta admit lol I loved kolhatkars first comedy show, but the jokes I liked were the ones not necessarily related to his Indian heritage. Her husband worked for many years and contributed into the Medicare system. No. Mr. Vaughn takes a prescription for helping to regrow his hair. 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. WebMr. This is used as a supplement to Medicare. c. Since she is age 65 she may enroll in any Medicare Advantage plan, regardless of whether she is entitled to Part A or Part B coverage. However, this SEP is not an opportunity to select another MA plan.). b. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? (Standard Part D coverage would require payment of an annual deductible, and once through the catastrophic coverage threshold the beneficiary pays either co-pays for generic and brand name drugs or co-insurance of 5%, whichever is greater.). d. Gift cards or gift certificates of $15 or less that can be readily converted to cash. What single payment could be made at the beginning of the first year to achieve this objective? b. One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. Since SNPs don't cover prescription drugs Mr. Sinclair should consider a different option. a. What should you tell her about obtaining drug coverage? c. Mr. Carlini can obtain drug coverage through the Federal government's fallback plans, which are designed to provide an alternative to privately sponsored Medicare Advantage plans. Anita comes to you for advice. Medicare beneficiaries should choose either Original Medicare or a MA plan based on their particular needs and circumstances.). b. Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. 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. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. -You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participation in the Medicare system. 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. -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. How would you advise Agent John Miller to proceed? As long as her employer offers coverage that is equivalent to that available through Medicare, Mrs. Walters cannot enroll in a Medicare prescription drug plan. What should you tell her? Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's service area next month. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. 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. Her recent videos also seem like the same old recycled jokes over and over again. What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage. What should you tell him? d. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. a. Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case basis, whether they will treat her. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. Assets may not exceed a limited amount also specified by the government.). Anita comes to you for advice. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. d. 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. c. I only Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. 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. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. c. Despite the terms of her contract forbidding the use of social media, Agent Meadows could send out a tweet stating that "Best Care offers a Medicare Advantage benefit package offering the lowest cost comprehensive dental benefit package available. What should you tell her? (Mr. Kelly does not need to be enrolled in Part A to be eligible to enroll in a Medicare Advantage PFFS 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 types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? -Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Due to cybersecurity dangers, social media cannot be used in the promotion of Medicare Advantage products. 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. (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. 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. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. Also, Original Medicare does not have a maximum out-of-pocket limit.). During the MA Open Enrollment Period, from January 1 - March 31, she may only add or drop Part D coverage, so she cannot switch back to Original 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. The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. 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