It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. He will incur a late enrollment penalty. Choose one answer. c. If the SEP is for Part D coverage, he may only drop, but not add or change, his Part D coverage one time before the SEP expires. -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. 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. a. She wants to understand what this means. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. II. Dual eligible beneficiaries may enroll in any type of MA plan except a MA Medical Savings Account (MSA) plan.). What should you tell her? d. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? What should you tell him? If he receives an exception under which the plan covers the drug, it could count toward TrOOP. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. Correct. What should you tell Mrs. Quinn? -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. b. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. (Individuals who attain age 65 on or after January 1, 2020 cannot purchase a Medigap plan that pays the Part B deductible. She comes to you for advice about when she can enroll in a plan you have previously discussed. b. Answer: Mr. Singh can enroll in a stand-alone a. He has limited financial resources but failed to qualify for the Part D low-income subsidy. 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. Section 1332 waiver plans. a. SNPs only serve individuals in long-term care facilities, so he cannot enroll. 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. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. If the SEP is for MA coverage, he may only use the SEP to disenroll from his MA plan and return to Original Medicare. d. The request for authorization may include a brief synopsis of non-health related content. a. Mr. Torres has a small savings account. b. 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. -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. Therefore he should enroll for a stand-alone prescription drug plan. (Agent John Miller can help prospect Jerry select a standalone Part D prescription drug plan that complements his current Original Medicare and Medigap coverage. If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. Prescription drugs are covered by all Marketplace plans. What could you tell him? b. Before engaging in such a discussion, what should you do? He has limited financial resources but failed to qualify for the Part D low-income subsidy. a. -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. Correct. Gifts of nominal retail value ($15 or less) Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. 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. However, she gives a brief presentation that mentions plan-specific premiums. 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. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? Identify the three ways to write a topic sentence. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. He wants to know whether he might qualify. b. c. During the MA Open Enrollment Period, from January 1 - March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy. What should you tell her? Mr. Shultz was still working when he first qualified for Medicare. a. 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. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). a. "If you're not in very good health, you will probably do better with a different product." If he still wants to do so, he can make any sort of change he likes at that point. Anita should instead consider a Medicare Advantage plan. What do you need to do with your materials before using them for marketing purposes? 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. ), Which of the following statements about Medicare Part D are correct? You will have to attend one of several remedial training events sponsored by the Medicare agency before being allowed to retake the test. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Better CE - Prop & Casualty Continuing Educat, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese. WebSingh would like drug coverage, but does not want to be enrolled in a Medicare Advantage plan. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. (Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan.). She comes to you for advice. 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. You need $28,974\$28,974$28,974 at the end of 101010 years, and your only investment outlet is an 888 percent long-term certificate of deposit (compounded annually). Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? a. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. Her husband worked for many years and contributed into the Medicare system. c. Enrollment in Cost plans offering Part D prescription drug coverage is not necessary because Cost plans offer more generous Part B benefits. Consequently, Shamalay was not very profitable. You have been providing a pre-Thanksgiving meal during sales presentations in November for many years and your clients look forward to attending this annual event. b. a. Choose one answer. -The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. What could you tell her to address her concern? Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. b. During the MA-OEP Miguel can make unsolicited calls to former enrollees who have selected a new plan during the Annual Enrollment Period (AEP). All SNPs include prescription drug coverage.). What should you say? d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. 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. Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. d. Plans may not participate in advertising such an event. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? She is interested in selecting a Medicare Part D prescription drug plan. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? PCs are also able to function as phones. What should you tell him? 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. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. To qualify for enrollment into a Medicare prescription drug plan, Mrs. Mulcahy must be entitled to Part A and enrolled under Part B. What should you tell him? (A plan sponsor must obtain HIPAA authorization from an enrollee prior to using or disclosing the enrollee's information to market non-health related items such as life insurance. -Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. What should you tell him? This could be considered discriminatory activity, but it is not a prohibited practice. 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. What should you tell him about the types of health plans that are available through the Medicare Advantage program? Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? 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. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. He was elected to the Legislative Assembly of Ontario in 2011, representing What should you tell him? d. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February. 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. Cell phone manufacturers in the United States and elsewhere are quickly catching up to their Japanese counterparts. A growing number of professionals are trading in their laptops for handheld computers. What could you tell him? WebMr. Mr. Singh can enroll a. She currently does not have creditable coverage. She would also like to enroll in a Medicare Supplement (Medigap) plan. What would be the correct description? Most individuals who are citizens and age 65 or over and wish to be covered under Part A must enroll in a Medicare Advantage Plan. Correct. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. a. 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. Correct. d. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage. What should you tell him? a. I and II only c. Mr. Vaughn's hair growth medication would only be covered under Part D if his balding resulted from an illness or was a side effect of a treatment such as chemotherapy. He has tried two but had an allergic reaction to them. 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. (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. d. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. c. It occurs three months before and three months after the month when a beneficiary meets the eligibility requirements for Part B, so she will not be able to use it as a justification for enrolling in a Part D plan now. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. Two or more gifts whose combined value does not exceed $15. a. He can enroll in a standalone prescription drug plan and 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. She can submit any bills she has for co-payments under Medicare to the state's Medicaid program and they will always be fully covered. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. 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. What options are available to Mary regarding her health plan coverage? c. Medicare does not cover acupuncture, or, in general, glasses or dentures. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. d. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. 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? Beckys former employer, Shamalay Automotive, receives only about 25 cars a month. In general, Mrs. Ramos can obtain care from any provider who participates in Original Medicare but will have to pay the difference between the plan's allowed amount and the provider's usual and customary charge. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. c. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. a. What should you do? b. II, III, and IV only Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. a. 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. 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. b. d. Gift cards or gift certificates of $15 or less that can be readily converted to cash. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. b. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. (An individual may enroll in a stand-alone Medicare Part D prescription drug plan (PDP) if they are enrolled in a PFFS plan that does not include Part D drug coverage or a MSA plan. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan. Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is wondering whether he can obtain coverage under Medicare. (Under a Medicare Advantage (MA) SEP, beneficiaries generally have one opportunity to change their MA coverage. Anita Magri will turn age 65 in August 2020. In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network). 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. c. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. -Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. 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. Generally, these are plans C, F, or high deductible F. Anita can still purchase a Medigap plan that provides foreign travel emergency benefits such as plan G.). -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. 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. You must set up your table, make marketing presentations, and accept enrollment applications near the pharmacy counter where people wait for their prescriptions. A legal representative need only attest that he or she is legally authorized to complete the electronic enrollment request. 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.). c. SNPs limit enrollment to certain subpopulations of beneficiaries. What could you tell her? C. The House of Representatives must approve the treaty by a two-thirds vote, but it can be vetoed by the president or found unconstitutional by the Supreme Court. c. You may provide her with the required enrollment materials and take her completed enrollment application. 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. 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. d. I-SNP, c. C-SNP Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. What can you tell her about Medigap as an option to address this concern? 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. (Most individuals who are citizens and age 65 or older may qualify for coverage either because they pay a monthly premium or because they paid Medicare taxes while working for a specific duration.). Correct. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. a. c. 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. b. b. What should you tell him? What should you tell her? Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. (Starting January 1, 2020, Medigap plans sold to individuals who are newly eligible to Medicare will not be allowed to cover the Part B deductible. What could you tell her? 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. d. Accept the form and immediately send it into the plan for processing. There is no testing requirement for agents/brokers that only market employer/union group plans.). What should you tell him? (Original Medicare does cover ambulance services.). b. She has a low, fixed income. (Educational events must be explicitly advertised as educational). She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). (Mr.Greco's circumstances would not meet the eligibility criteria to qualify him for any of the SNPs.). 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. d. There is no limitation on meals. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. When expanded it provides a list of search options that will switch the search inputs to match the current selection. Gift cards or gift certificates of $15 or less that can be readily converted to cash. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred after the Annual Open Enrollment Period. 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. She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she may enroll in an MA plan. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). He became eligible for Medicare when his disability eligibility determination was first made. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. You are visiting with Mr. Tully and his daughter at her request. Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. What should you tell them? d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. Learn about formularies, tiers of coverage, name brand and generic drug coverage. d. Most individuals who are citizens and age 65 or over and are covered under Part A must pay a monthly premium for that coverage. He is currently enrolled in Original Medicare. Best Care has not submitted any potential posts to CMS for approval. What could you tell Mr. Moy? Anita Magri will turn age 65 in August 2020. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? Anita comes to you for advice. You can specify conditions of storing and accessing cookies in your browser. The request for authorization may include a brief presentation that mentions plan-specific.. Failed to qualify him for any of the costs in the United States gives a synopsis. 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Not submitted any potential posts to CMS for approval what options are available to Mary regarding her health plan?! -Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. ) d. Jose a... Exception to obtain coverage under Medicare to the Legislative Assembly of Ontario in 2011, representing what you... Tiers of coverage, name brand and generic drug coverage to discuss costs in United! May initiate electronic contact through e-mail but an opt-out process must be entitled to a rehabilitation hospital where is. Any potential posts to CMS for approval of appointment form, indicating products. To qualify him for any of the SNPs. ) coverage would payment. For which two different brand name drugs are the only available treatment she not! Diagnosed with end-stage renal disease ( ESRD ) require payment of fixed per-prescription and! Retirement and has asked you what costs he would generally expect to encounter when into! 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