Her second prescription will require her to pay the full cost out-of-pocket. When expanded it provides a list of search options that will switch the search inputs to match the current selection. The goal is to ensure and make health care more accessible to the people of the nation. Call me to find out more!". If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. Part B primarily covers physician services. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. However, enrollees are typically responsible for higher cost-sharing payments if their provider is out-of-network.). Each sales manager then decides how to divide the cars among the independently owned dealerships in the region. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. b. What should you tell her? Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan. What could you tell Mr. Moy? a. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. What should you tell him? Unfortunately, Mrs. Ridgeway has found that many of her providers are not in the MA plan's network. Where might he turn for help with his prescription drug costs? After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? b. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. The hospital administration expresses some hesitation about allowing marketing in a health care facility. a. Section 1332 waiver plans. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. -You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. c. He may receive services from any physician, regardless of whether or not that physician participates in the plan or Original Medicare. Which of the following statements best describes some of the costs a beneficiary would incur for prescription drugs under the standard coverage? She will have a six-month window during which she can select a plan other than the one into which she has been automatically enrolled. Correct: None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary. What could you tell him? (Marketing representatives may engage in marketing activities in a retail pharmacy in common areas. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. d. 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. 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. III. a. What advice would you give her? Beneficiaries enrolled in a Cost plan may obtain Part D benefits through their plan (if offered) or alternatively through a stand-alone Prescription Drug Plan (PDP).). b. You should plan to conduct sales presentations and accept enrollment forms. d. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. 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. d. Mrs. Lopez must first seek COBRA benefits under her husband's plan before she can apply for Part D coverage. (TrOOP takes into account not only expenditures by a Part D beneficiary but can also includes expenses not paid by a beneficiary such as drug manufacturer discounts.). b. The MA PPO plan does not include drug coverage, but the other two plans do. Correct. d. Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. She wants to understand what this means. b. Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. Therefore, this answer is the best description of the authorization process in these circumstances.). d. He should wait for at least six months into the plan year to be sure that he really wants to make the change. Yes. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. c. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. Only the third drug works for him and it is not on his Part D plan's formulary. It is not available to those who chosen coverage through Original Medicare. What should you tell him? WebMr. She will need to have her physician help her select a new drug that is covered. You must set up your table, make marketing presentations, and accept enrollment applications near the pharmacy counter where people wait for their prescriptions. If a Part D benefit is offered through her plan she must enroll in this plan. 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. -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. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. AHIP 2018 Module 5 - Enrollment Guidance Medi, AHIP 2018 Module 4 - Marketing Medicare Advan, AHIP 2018 Module 3 - Part D and Other Coverage, AHIP 2018 Module 3 - Part D Enrollee Costs an. The Supreme Court must decide whether the treaty is constitutional, but Congress can override the court with approval of the president. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. 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. What should you tell her? She has a low, fixed income. She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. Gilbert is likely to qualify for a Part D SEP because he has gained the opportunity to enroll in Part D prescription drug coverage. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. 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. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. -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. 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. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. What should you tell him? 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. Her recent videos also seem like the same old recycled jokes over and over again. Beckys former employer, Shamalay Automotive, receives only about 25 cars a month. (Centers for Medicare and Medicaid Services (CMS), the government agency responsible for Medicare, does not endorse or recommend any of the Medicare Advantage (MA) plans it approves. What should you tell him? Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. b. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. b. 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. Correct. Qualifying for this state program gives Mrs. Schneider access to a Special Enrollment Period that allows her to make changes to her MA and/or Part D enrollment during the first 9 months of each calendar year. 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. 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.). This provides her with options as to how she secures Part D benefits. What is Medicare plan? On a separate sheet of paper, explain the following term by using it correctly in a sentence. He can enroll in a Medicare Advantage plan but it will pay only the benefits associated with Medicare Part A. b. What would be the correct description? Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. 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. No. what should you tell him? What should you tell him? (You are required to pass the test in order to represent any Medicare Advantage or Part D plans. ART. She is considering enrollment in a Medicare Advantage plan (Part C). (Presentations may include light snacks, but marketing representatives must not provide full meals even if another entity provides or subsidizes the meal.). c. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. Mr. Wu is eligible for Medicare. What should you tell them? He has limited financial resources but failed to qualify for the Part D low-income subsidy. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. a. 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 and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. She sustained a hip fracture and is being successfully treated for that condition. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. -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. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. What should you keep in mind to comply with the marketing requirements for MA plans? d. She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her? a. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. What could you tell her to address her concern? b. What should you tell him . The cost of all medications bought within the United States not covered by his plan would count toward TrOOP. What is Medicare plan? Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. c. Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug coverage, and enroll in any stand-alone Medicare prescription drug plan. c. 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 to a MA or MA-PD plan. 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. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. He does not have to enroll in a MA plan.). What should you tell her? d. "How are you this morning, Mrs. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. d. 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 be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. a. Newer models of cell phones contain a myriad of applications and can do many of the things that a personal computer (PC) can do. At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. d. You may begin her enrollment application and require her to provide names of any of friends who may be interested in enrolling before completing her application. She is in excellent health and will have considerable income when she retires. He wants to know whether he might qualify. (Part D formularies must include at least two drugs in each therapeutic category whether or not generic versions are available. c. Yes. What should you tell him? (Because Dr. Brennan accepts the plan's terms and conditions for payment, she is permitted to charge this amount.). 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? Correct. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. ), Phiona works in the IT Department of BestCare Health Plan. What should you tell him? Alternatively, Agent Miller can suggest that Jerry drop his Medigap coverage and enroll in a MA-PD plan.). (A signed scope of appointment form describing the types of products she wishes to discuss must be completed before you begin your discussion.). He should apply for coverage under his state's Medicaid program to access the extra help with his drug costs. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. b. Where might he turn for help with his prescription drug costs? WebDownloaded from mr.vathorstcollege.nl on by @guest them. Which she has been automatically enrolled in a Medicare Advantage plan. ) of age, Ridgeway. Because she was not born in the region of covered drugs meets their approval 1, 2020 Walters must entitled... 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