You would like to market a MA plan at a neighborhood pharmacy. a. Costs for Medicare drug coverage Learn about the types of costs youll pay in a Medicare drug plan. It is not necessary for ABC to obtain an authorization to simply explain pending state or federal legislation since there is no anticipation of selling a non-health related product in these circumstances. How would you advise Agent John Miller to proceed? Which of the following statements about Medicare Part D are correct? a. She would also like to enroll in a Medicare Supplement (Medigap) plan. How can you explain this to him? Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan., Mr. Alonso receives some help What should you tell him? What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? This is true even if the organization offers another PFFS plan under the same MA contract that includes a Part D benefit.). What can you tell her about Medigap as an option to address this concern? What should you do? They are anxious to have their Medicare prescription drug plan cover these drug needs. Under what circumstances can she do this? Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. 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. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. d. She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. d. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? What should you tell him? c. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. Melissa would like to use the power of social media to reach potential prospects. 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. Singh would like drug coverage, but does not want to be enrolled into a health plan. Henry makes a permanent move to a new state providing him with new MA and Part D options. Mr. Castillo is still covered by Part A. c. He must apply for the extra help at the same time he applies for enrollment in a Part D plan. This could be considered discriminatory activity, but it is not a prohibited practice. (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. a. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. ), Daniel is a middle-income Medicare beneficiary. 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. Standard Part D coverage would require payment of an annual deductible, and once past the catastrophic coverage threshold, the beneficiary pays whichever is greater of either the co-pays for generic and brand name drugs or coinsurance of 5%. You must set an appointment for another time, at least 48 hours from the point when she walked into your office. 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. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. c. Tell prospect Jerry Smith that he should drop his Medigap coverage and put those premium dollars toward the purchase of a standalone Part D prescription drug plan because he can always reactivate his Medigap policy on a guaranteed issue basis. b. d. Mr. Tully's daughter can do so because she is an immediate family member who has taken responsibility for her father's care. She is traveling and wishes to fill two of the prescriptions that she has lost. -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. b. d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. c. Part B will cover her dental and vision needs. d. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. d. Original Medicare covers ambulance services. -You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. (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.). What could you tell her? You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. 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. What should you tell him? What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? What should you tell him? One might be right for you. Singh would like drug coverage, but does not want to be enrolled into a health plan. d. If the SEP is for MA coverage, he may make as many changes to his MA enrollment as he wants and the last choice made before the end of the SEP period will be the effective one. IV. She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. d. 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. Eligibility to enroll in a PFFS plan is based on entitlement to Medicare Part A and enrollment in Part B. b. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. The manufacturers regional sales managers are each given a certain number of cars. c. 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. He should apply for coverage under his state's Medicaid program to access the extra help with his drug costs. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. So long as the hospital or its physician staff don't object, marketing anywhere in the hospital is an acceptable practice. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. 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. b. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? Total views 20. Correct. a. c. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. (During the MA-OEP, those enrolled in a Medicare Advantage plan have the opportunity to change plans or enroll in Original Medicare. d. 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. b. She wants to understand what this means. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. Correct. No. a. -She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. What could you tell her to address her concern? She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. What impact, if any, will recent regulatory changes have upon Medigap plans? Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. a. What advice would you give her? b. How much may Dr. Brennan charge? (Medicare Part B primarily covers physician services. 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. (Individuals who attain age 65 on or after January 1, 2020 cannot purchase a Medigap plan that pays the Part B deductible. c. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. 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. In your own words rewrite the phrases listed and briefly explain what framers meant by each phrase, These include the creation of a Japanese writing (kana) using Chinese characters, mostly phonetically, which permitted the production of the world's f -An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. To qualify for enrollment into a Medicare prescription drug plan, Mrs. Mulcahy must be entitled to Part A and enrolled under Part B. a. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. He is wondering if he can obtain coverage under Medicare. What should you tell her? a. b. 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