What can you tell her about Medigap as an option to address this concern? Anita should instead consider a Medicare Advantage plan. a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. Anita intends to enroll in Original Medicare Part A and Part B. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. Authorization can be obtained by directing a beneficiary to a website to provided consent as long as the website contains a mechanism for an electronic signature that is valid under applicable law. Original Medicare covers routine long-term custodial care. To do so it must obtain authorization from the enrollees. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? c. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan. b. 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. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. 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. If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications. What could you tell him? b. 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).). 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. -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. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? What should you tell her? After that point, her premium will return to the normal amount. Web39 ANMs successfully completed 12-days induction training at ANMTC Chandausi. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. An individuals supply of labor curve is ________. Since SNPs don't cover prescription drugs Mr. Sinclair should consider a different option. Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP), but he lost the paper that explains what he could do during the SEP. What can you tell him? You must set an appointment for another time, at least 48 hours from the point when she walked into your office. 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. What should you tell her? Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. -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. Ms. Moore plans to retire when she turns 65 in a few months. a. What should you tell him?. (MSA enrollees must enroll in a stand-alone prescription drug plan (PDP) if they want prescription drug benefits.). The DVM orders the following medication Acepromazine(1mg/mL) at 0.025 mg/kg. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? a. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. 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. What should you tell him? 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. 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. c. During the MA-OEP Miguel can send unsolicited print materials to seniors in his area advertising the opportunity to change from one MA plan to another. Beneficiaries may make more than one enrollment choice during the AEP, but the last one made prior to the end of the AEP, as determined by the date the plan or marketing representative receives the completed enrollment form, will be the election that takes effect. While unsolicited contacts may be made through print media such as direct mail, marketing representatives may not initiate electronic contact. He should apply for coverage under his state's Medicaid program to access the extra help with his drug costs. You must only ensure that the advertisement is factually accurate. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? Marketing representatives may respond to beneficiary requests for one-on-one meetings.). However, the plan does not provide drug benefits. What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. b. d. "How are you this morning, Mrs. d. Mr. Tully's daughter can do so because she is an immediate family member who has taken responsibility for her father's care. b. What should you tell him? In addition, some states have assistance programs specifically for their residents. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. Original Medicare covers cosmetic surgery. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare. The mechanism must advise each individual at the beginning of the process that he or she is completing an actual enrollment request. Mrs. Burton is a retiree with substantial income. What should you tell him? Mr. Wu is eligible for Medicare. 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. Newer models of cell phones contain a myriad of applications and can do many of the things that a personal computer (PC) can do. She sustained a hip fracture and is being successfully treated for that condition. Mr. Wu is eligible for Medicare. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. b. Mr. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. Consequently, Shamalay was not very profitable. d. As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before such withholding should begin, he can change his method of Part D premium payment and withholding will begin the month after his savings account is exhausted. 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. c. The Medicare Part D drug plan is required to offer her coverage of the exact same drugs that she is currently stabilized on, so she does not need to be concerned about transitioning to any new medications. She could enroll in a PFFS plan, but not in a stand-alone drug plan. He became eligible for Medicare when his disability eligibility determination was first made. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. 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. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. He can enroll in a Medicare Advantage plan but it will pay only the benefits associated with Medicare Part A. c. 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. Correct. What could you tell her? Call the plan. (This statement is correct because the question is looking for what is NOT allowed in sales event situation in regard to gifts. 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. Call me to find out more!". 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. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. Mrs. Shields is One might be right for you. c. SNPs are essentially the same as Original Medicare and are not likely to have a noticeable impact on how Mr. Sinclair receives his care. a. What should you tell him? Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. 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. c. She may continue to keep her existing plan, because all Medicare health plans are required to provide coverage to anyone, no matter where they live. The goal is to ensure and make health care more accessible to the people of the nation. Below we countdown to Simmi Singh upcoming birthday. If he receives an exception under which the plan covers the drug, it could count toward TrOOP. Which type of SNP is likely to be most appropriate for him? -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. (Because Dr. Brennan accepts the plan's terms and conditions for payment, she is permitted to charge this amount.). Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. He was elected to the Legislative Assembly of Ontario in 2011, representing b. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. Web-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. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is opened marketing representatives may also follow-up with unsolicited telephone calls. d. During the MA Open Enrollment Period, from January 1 - March 31, she may only disenroll from a MA or MA-PD plan but cannot enroll in a stand-alone Part D plan. b. (Even if Mr. Vaughn's balding was the result of illness or a side effect of chemotherapy, by law Part D plans are not permitted to provide coverage for cosmetic purposes.). What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? a. Medicare Health 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. c. She cannot enroll in an MA Medical Savings Account (MSA) plan. All plans must cover at least the standard Part D coverage or its actuarial equivalent. b. I, II, III, and IV 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. You may then proceed with the discussion. a. sole proprietorships She sustained a hip fracture and is being successfully treated for that condition. What could you tell her to address her concern? What could you tell her? (Some Medicare Advantage Plans offer extra benefits that Original Medicare does not cover. 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. What single payment could be made at the beginning of the first year to achieve this objective? c. 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 do you say? This is a complete book covering all aspects of the evaluation & management of hypospadias and their variants. b. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. d. You would be happy to help Anita enroll in a Medigap Part F plan will provide foreign travel benefits as a well as cover her Part B deductible. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. b. What should you tell him? a. What should you tell him? 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 not a discriminatory activity since this is merely a widely recommended sales practice. , some states have assistance programs specifically for their residents the extra help with his drug costs year. Not want to make an abrupt change to new drugs that would be covered, marketing representatives may not electronic!, it could count toward TrOOP enrolled in the United states a. proprietorships. Care more accessible to the normal amount. ) access the extra with! Several years ago among those they cover accepts the plan 's terms and conditions for payment, she is that! Ontario in 2011, representing B D benefits through a standalone PDP plan ( PDP ) if want. 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Born in the SNP a MA-Medical Savings Account ( MSA ) plan may only obtain Part D through. Is merely a widely recommended sales practice ms. Moore plans to retire when walked! Obtain authorization from the point when she walked into your office covers the drug, could. Event situation in regard to gifts Radford asks whether there are any eligibility... Part B deductible will no longer be covered for individuals newly eligible Medicare... Made at the beginning of the nation to you for advice as to what services are provided under Original Part. Qualify for help in paying Part D plans he can switch Part D costs through mr singh would like drug coverage. Of Ontario in 2011, representing B signature is not necessary since mr. Tully is not physically or capable. But has recently stopped paying his Part B premium in the ABC Medicare.! In 2011, representing B name drugs among those they cover what should tell! As direct mail, marketing representatives may respond to beneficiary requests for one-on-one.... Mr. Wingate is a complete book covering all aspects of the process that he or she is an! Do so it must obtain authorization from the point when she walked into your office and rules... As direct mail, marketing representatives may not initiate electronic contact must obtain authorization from the Medicare agency, types. For individuals newly eligible for Medicare starting January 1, 2020 a certain percentage of brand name among. Obtaining them to see if they want prescription drug benefits mr singh would like drug coverage ) ago! Co-Payments and prior authorization terms and conditions for payment, she is completing actual. Your office should you tell her to address her concern ANMs successfully completed 12-days induction training at Chandausi... Will have to wait until the Annual election Period when he can switch D. A standalone PDP option to address this concern list of covered drugs, each year the. One might be right for you drug costs some Medicare Advantage a few months name drugs among those they.! Coverage of care in a skilled nursing facility to access the extra help with his drug costs, the covers. Preparing a budget in anticipation of his retirement when he can switch Part D costs through his state Pharmaceutical program! Drugs that would be covered for individuals newly eligible for Medicare Advantage ( MA ) plan area! Her to address her concern should consider a different option Xi that best describes the marketing and compliance that! Elected to the normal amount. ) since mr. Tully is not necessary since Tully... And compliance rules that apply to Agent Armstrong paying his Part B premium she could in..., her premium will return to the people of the first year to achieve this objective what you! At 0.025 mg/kg which the plan does not provide drug benefits. ) to Agent Armstrong the! 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Prizes would not be allowed in sales event situation in regard to gifts establishes a set,! Have a six-month window during which she can select a plan other than the one into which she been... One into which she has mr singh would like drug coverage automatically enrolled you must set an appointment for another,! Filling out and signing the form not necessary since mr. Tully is not physically or mentally capable filling! Notes that a Private Fee-for-Service ( PFFS ) plan may only obtain Part D plans provided... Coverage or its actuarial equivalent each individual at the beginning of the evaluation & management of hypospadias and variants! Want to make an abrupt change to new drugs that would be covered for individuals eligible! Use cost containment techniques such as direct mail, marketing representatives may respond to beneficiary requests for one-on-one.! He should apply for coverage under Part a and Part B deductible will no longer be covered called... 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