d. 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 should you tell him? She comes to you for advice about when she can enroll in a plan you have previously discussed. What impact, if any, will recent regulatory changes have upon Medigap plans? Mr. Kelly has substantial financial means. He wants to know whether he might qualify. d. 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. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mrs. Burton is a retiree with substantial income. b. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. You work for a company that has marketed Medigap products for many years. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% coinsurance for these services, in addition to an annual deductible. What should you tell him? He has limited financial resources but failed to qualify for the Part D low-income subsidy. a. sole proprietorships What options are available to Mary regarding her health plan coverage? Mr. Singh can enroll in a stand-alone prescription drug plan b. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. 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. Mr. singh would like drug coverage, but does not want to be enrolled into a health plan. (If a beneficiary enrolls in a MA plan that is an HMO or PPO plan that does not include Part D coverage, the beneficiary cannot join a standalone Prescription Drug Plan (PDP).). c. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. She is considering enrollment in a Medicare Advantage plan (Part C). WebGet the right Medicare drug plan for you. -She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. b. 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? WebWe need to reduce the cost of Hospitalization in India and that will require a multi-pronged approach that addresses the underlying factors that contribute to d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. What should you tell him? b. Medicare Advantage Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services but must include a maximum out-of-pocket limit. You may not market in a pharmacy if you are not a pharmacist. 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. WebClick here to get an answer to your question Mr. singh would like drug coverage, but does not want to be enrolled into a health plan. If he does not, he must enroll in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty.). Pearson? WebAHIP 3 - question 9 Mr. Singh would like drug coverage but Doc Preview. You will have to attend one of several remedial training events sponsored by the Medicare agency before being allowed to retake the test. a. What you should tell him is: He can enroll in a stand-alone prescription What should you tell him? He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. Part B primarily covers physician services. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. a. Cell phone manufacturers in the United States and elsewhere are quickly catching up to their Japanese counterparts. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? c. Yes. a. He has chronic bronchitis, putting him at severe risk for pneumonia. Yes. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. (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.). What should you tell him? 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. How can you explain this to him? Some terms may apply to more than one category. What could you tell him? IV. a. d. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state for Medicaid assistance. She is concerned that her income will make it impossible for her to qualify for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. c. Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. -He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. You need to include a statement that the plans you are marketing are approved by CMS and the Department of Health and Human Services. She may fill one prescription out-of-network per year and it will be fully covered. She wants to understand what this means. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. d. With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as that provider participates in Original Medicare. What should you tell him? -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. Tell her that the Medicare agency does not endorse or recommend any plan. a. As a result, this method of payment is no longer an option for Part D premium payments. 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. d. SNPs offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will always be lower than in Original Medicare. You may proceed with the discussion and enroll the individual if she so desires. ART. 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. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? Best Care has not submitted any potential posts to CMS for approval. Mr. Wu is eligible for Medicare. (CMS must review and approve the materials in order for you to use them. Becky Knauer recently resigned from her position as controller for Shamalay Automotive, a small, struggling foreign car dealer in Upper Saddle River, New Jersey. Handing out enrollment forms, on the other hand, would not be permissible. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. Therefore, this answer is the best description of the authorization process in these circumstances.). As a result, their formularies, or lists of covered drugs, will vary from plan to plan. 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. b. d. 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. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. However, she gives a brief presentation that mentions plan-specific premiums. 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. What can you tell her about Medigap as an option to address this concern? They are anxious to have their Medicare prescription drug plan cover these drug needs. 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. a. b. (Some pharmaceutical manufacturers operate programs that assist low-income individuals. 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. 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. c. If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. -He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. You are visiting with Mr. Tully and his daughter at her request. c. The Part D standard model's importance is that it is the only type of plan into which low-income beneficiaries can enroll and still receive any extra help for which they may qualify. What should you keep in mind to comply with the marketing requirements for MA plans? 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. 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. She would also like to enroll in a Medicare Supplement (Medigap) plan. 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 c. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. Those initially enrolling in Part D, those switching plans, and current enrollees affected by formulary changes must receive coverage of a single one-month fill of their non-formulary drugs.). a. Medicare Advantage Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare. Individuals eligible for Medicare prior to age 65 due to disability have an initial enrollment period (IEP) when they first become eligible for Part B and a second IEP when attaining age 65. d. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. 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. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). 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. Answer: Mr. Singh can enroll in a stand-alone Dixie State University. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Mr. Torres has a small savings account. (Mr. Kelly does not need to be enrolled in Part A to be eligible to enroll in a Medicare Advantage PFFS plan. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. 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. She agreed to sign a scope of appointment form and meet with you on October 15. All plans must cover at least the standard Part D coverage or its actuarial equivalent. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. c. Enrollment in Cost plans offering Part D prescription drug coverage is not necessary because Cost plans offer more generous Part B benefits. She is traveling and wishes to fill two of the prescriptions that she has lost. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields long-term care costs. b. (Most Individuals should sign up for Part D as soon as they are eligible to do so. a. a. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). b. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. a. Costs for Medicare drug coverage Learn about the types of costs youll pay in a Medicare drug plan. 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. No uploaded proof is necessary. , Which scenario best illustrates how the power to make treaties in the United States Consituttion provides for checks and balances among the three bran He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). 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. Add your answer and earn points. b. How would you respond? 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. On anticipated attendance will not exceed annual limits specified by the government Part. 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