Anita comes to you for advice. Mrs. Burton is a retiree with substantial income. b. Tell her that the Medicare agency does not endorse or recommend any plan. What could you tell him? The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. What should you tell her? b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. 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. She sustained a hip fracture and is being successfully treated for that condition. a. a. D-SNP (Sales presentations and distribution or acceptance of enrollment forms are prohibited when an event is advertised as educational.). 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. What is medicare advantage plan? a. a. Medicare Advantage is a new name for the Original Medicare program. What should you tell him? Medicare advantage plan is a form of medical coverage that help to cover medical cost or medical expenses of the people that are under the plan. I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. (Edward is not likely to qualify for either a MA or Part D SEP because he has moved within his existing plan's service area. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. 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. a. WebThis button displays the currently selected search type. c. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. 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. 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. Medicare health plans must provide enrollees with a written description of the appeals process.). a. What should you do? In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. a. He can enroll in a standalone prescription drug plan and d. Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. b. c. Mr. Kumar will be able to obtain routine care outside of the plan's service area but will pay a higher co-payment (except in an emergency). d. She should wait to fill her prescriptions until she is back home since only her local pharmacy is likely to be in her plan's network. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. You can specify conditions of storing and accessing cookies in your browser, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. (Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. What should you tell him?. If he still wants to do so, he can make any sort of change he likes at that point. She will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location. No. During the MA Open Enrollment Period, from January 1 - March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan. b. b. SNPs do not provide Part D prescription drug coverage, so if he does enroll, he should be aware that he will not have coverage for any medications he may need now or in the future. What should you tell her? d. This could be considered discriminatory activity and a prohibited practice. Match the terms with the definition. d. Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. No. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. Her husband worked for many years and contributed into the Medicare system. 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. 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, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. 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. d. The government bases its payments to Part D plans on the standard benefit model. 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. 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. "If you're not in very good health, you will probably do better with a different product." If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. ABC is a Medicare Advantage (MA) plan sponsor. c. Tell Mr. Anderson that you cannot accept an enrollment form for coverage to begin on January 1 of next year prior to December 15. How can you explain this to him? What should you tell him? -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. what should you tell Okjaanu504 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. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. Basic Drawing - Non Majors/ONLINE. Anita intends to enroll in Original Medicare Part A and Part B. c. You must set up your table and make marketing presentations only in common areas, but you may accept enrollment applications anywhere in the pharmacy. 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. IV. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. WebGet the right Medicare drug plan for you. a. 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. What advice would you give her? a. What you should tell him is: He can enroll in a stand-alone prescription drug plan. c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. She has recently lost creditable coverage previously available through her husband's employer. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. What should you tell him? a. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. What should you tell him? Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. a. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. Mr. Wu is eligible for Medicare. d. Marketing in health care facilities is an acceptable practice, regardless of where it takes place. Mr. Castillo is still covered by Part A. What should you tell him?. d. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. b. (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.). What should you tell him? d. Mrs. Lopez must first seek COBRA benefits under her husband's plan before she can apply for Part D coverage. c. You will have to repeat the tests in three months, but may begin enrolling beneficiaries while you are waiting. d. Original Medicare covers ambulance services. Determine the rhyme scheme in scaffolding. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? The mechanism must advise each individual at the beginning of the process that he or she is completing an actual enrollment request. 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. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. a. What could you tell him? b. What you should tell him is: He can enroll in a stand-alone prescription What should you tell her? Weba. What could you tell her? WebIt is one of three plans operated by the same organization in Mr. Lombardi's area. The cost of the Canadian bought medications would not count toward TrOOP. a. 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. a. What could you tell her? Due to cybersecurity dangers, social media cannot be used in the promotion of Medicare Advantage products. -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. Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. (October 10th is prior to the start of the Annual Election Period (AEP) which begins October 15th and ends December 7th. a. Mr. Zachow has a condition for which three drugs are available. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. Singh has sat as the member of Parliament (MP) for Burnaby South since 2019. c. Medicare prescription drug plans are required to cover drugs in each therapeutic category. a. When putting together advertisements for this event, what should you do? WebMr. a. c. He may receive services from any physician, regardless of whether or not that physician participates in the plan or Original Medicare. Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. No. a. c. 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. Mr. Torres has a small savings account. a. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. At that time, he had employer group coverage that was creditable. -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. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. Ms. Moore plans to retire when she turns 65 in a few months. What should you tell them? c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). d. Tell her that, because you represent a Medicare health plan, you therefore work for Medicare, and the information you offer her is a good basis of any decision she makes. WebIn this review, we will focus our discussions on nutlin-based and spirooxindole class compounds given that they are the most widely used classes among the MDM2-p53 interaction inhibitors in breast cancer studies and display drug-like properties. -Part D plans do not have to cover all medications. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. c. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. Correct. Mobile phone makers in Japan have gone beyond the imagining phase. 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 only to a MA plan that includes prescription drug coverage. This is a complete book covering all aspects of the evaluation & management of hypospadias and their variants. WebOnce you choose a Medicare drug plan, here's how to get prescription drug coverage: Enroll on the Medicare Plan Finder or on the plan's website. a. Agent Jennings distributes materials that are solely educational in nature. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. Which type of SNP is likely to be most appropriate for him? Below we countdown to Simmi Singh upcoming birthday. -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. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. Correct. Learn more about Medicare advantage plan here:brainly.com/question/25122967, This site is using cookies under cookie policy . (Mr. Carlini can stay in Original Medicare and obtain prescription drug benefits through a stand-alone Part D plan. 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. They are anxious to have their Medicare prescription drug plan cover these drug needs. He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What can you tell her? One might be right for you. You are working with a number of plans and community organizations to sponsor an educational event. 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. 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. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. This is the health plan in the United States that helps to provide the people of the nation with health insurance. She wants to understand what this means. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What is Medicare plan? Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. What should you tell her? 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. Question 4 Mr. Wu 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. Medicare beneficiaries should choose either Original Medicare or a MA plan based on their particular needs and circumstances.). What should you tell her? A growing number of professionals are trading in their laptops for handheld computers. Correct. What should you tell him? Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program. 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. WebMr. Mr. Barker enjoys a comfortable retirement income. What advice should you give Miguel? What can you tell her about Medigap as an option to address this concern? Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. And, Henry also is likely to qualify for both a MA and Part D SEP since he has moved to a new state which is likely to be outside his current plan's service area.). a. b. c. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy." 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 him?
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