a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. With the certificate of deposit, you make an initial investment at the beginning of the first year. She has been covered under Original Medicare for the last six years due to her disability and has never been enrolled in a Medicare Advantage or a Part D plan before. What should you tell her? OEPI-eligible individuals can make unlimited MA enrollment requests, enroll in a Part D plan, as well as return to Original Medicare.). She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. What should you tell him? b. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-sponsored coverage would continue to be the primary payor while Medicare would be considered a secondary payor of his healthcare claims. She comes to you for advice. What should you tell her? What could you tell him to do? a. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. c. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. b. Call me to find out more!" If he missed this opportunity, he will not be able to apply for the extra help again until the next annual enrollment period. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. No. b. She may need to pay for this particular medication out of pocket. b. TrOOP refers to true out-of-pocket expenses paid by a Part D beneficiary for non-prescription over-the-counter (OTC) drugs and vitamins that are not covered by his or her plan. On the other hand, during the annual open enrollment period, an individual may make as many changes to his MA enrollment as he wants but the last choice before the end of the period will be the effective one.). What is Medicare plan? 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 addition to drugs on his plan's formulary he takes several other medications. -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. Put yourself in Beckys place. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. (Mrs. Kendrick will soon enter her MA Initial Coverage Election Period (ICEP) which begins three months immediately before the individual's first entitlement to both Medicare Part A and Part B. Mrs. Kendrick will become eligible for Part A and Part B upon turning age 65. He also told her there was an open enrollment period that she might be able to use to enroll in a MA plan. c. You do not have to do anything. When expanded it provides a list of search options that will switch the search inputs to match the current selection. Consequently, Shamalay was not very profitable. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. c. Standard Part D coverage would require payment of an annual deductible, fixed per-prescription co-payments, and once catastrophic coverage begins, the plan covers 100% of all costs. 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. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a prescription drug plan. a. (A signed scope of appointment form describing the types of products she wishes to discuss must be completed before you begin your discussion.). d. Medicare Advantage is designed to pick up where Original Medicare leaves off, covering those health care services that would not normally be covered by Original Medicare. a. Mr. Castillo is still covered by Part A. Mr. Wu is eligible for Medicare. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? He can enroll in a Medicare Advantage plan but it will pay only the benefits associated with Medicare Part A. (Agent John Miller can help prospect Jerry select a standalone Part D prescription drug plan that complements his current Original Medicare and Medigap coverage. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. She could enroll in the PFFS plan and a Medigap plan that offers drug coverage, but not in a stand-alone Medicare prescription drug plan. 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. WebSingh would like drug coverage, but does not want to be enrolled in a Medicare Advantage plan. CMO Sambhal has given certificate to the 39 newly recruited ANM. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. 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. -Original Medicare covers ambulance services. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. 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. b. b. Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. Mr. Shapiro gets by on a very small amount of fixed income. Why do you think Seamus Heaney might have chosen this rhyme scheme for a poem about a couples relationship Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. She has recently lost creditable coverage previously available through her husband's employer. Ms. Moore plans to retire when she turns 65 in a few months. Learn more about Medicare advantage plan here:brainly.com/question/25122967, This site is using cookies under cookie policy . When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. Gift cards or gift certificates of $15 or less that can be readily converted to cash. Choose one answer. The goal is to ensure and make health care more accessible to the people of the nation. -Part B primarily covers physician services. What would be the correct description? Medicare health plans must provide enrollees with a written description of the appeals process.). Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums, and cost sharing. You should plan to conduct sales presentations and accept enrollment forms. I. What could you tell her? He called you to ask what he could do? (In order to enroll in a Medicare Advantage (MA) plan, an individual must be entitled to Part A and enrolled in Part B. Mr. Castillo is covered by Plan A but no longer enrolled in Medicare Part B so he cannot enroll in MA plan until he re-enrolls in Part B.). 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. c. He can only make a single enrollment change during the Annual Election Period, so he will not be able to change his enrollment. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. 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. d. She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the number of quarters she has worked. You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score.However, you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Mrs. Kendrick is in good health, has worked for many years and is six months away from turning 65. So, she should be sure to notify the Postal Service immediately. Is this a prohibited activity at an event that has been advertised as educational? What should you say? ), Daniel is a middle-income Medicare beneficiary. What should you tell him about his concern? Mr. Shultz was still working when he first qualified for Medicare. d. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. What should you tell him? Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. What should you tell him? The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. Determine the rhyme scheme in scaffolding. a. She is traveling and wishes to fill two of the prescriptions that she has lost. c. Yes. His co-actors and directors have referred him as one of the most energetic guys of the industry. What should you tell her? d. The government pays a per-beneficiary dollar amount to the Medicare Part D prescription drug plans, to offset premiums for their low-income enrollees in accordance with the plan's set criteria. (Mary's admission to a rehabilitation hospital makes her eligible for an Open Enrollment Period for Institutionalized Individuals (OEPI). What should you tell him? 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). However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. ), Which of the following individuals are likely to qualify for a special enrollment period (SEP) for either a MA and/or Part D due to a change of residence? a. What you should tell him is: He can enroll in a stand-alone prescription 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. (Some Medicare Advantage Plans offer extra benefits that Original Medicare does not cover. Her husband worked for many years and contributed into the Medicare system. In a retail pharmacy, this would be areas away from the pharmacy counter where patients receive services from the pharmacist.). Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. b. b. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. As long as the meal is paid for by another person or entity, you are permitted to invite your clients and their friends to partake of the meal at your sales presentation. What should you tell him? She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. d. Individuals receiving such disability payments from the Social Security Administration continue to receive those payments but only become eligible for Medicare upon reaching age 65. b. Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.). Beneficiary income may not exceed 150 percent of the Federal Poverty Level (FPL). Handing out enrollment forms, on the other hand, would not be permissible. 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. b. Ralph's effective enrollment date is January 1st. b. To do so it must obtain authorization from the enrollees. 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Need to pay for this particular medication out of pocket she has been automatically enrolled in Medicare Part D.... Medicare health plans must provide enrollees with a written description of the appeals process... Drugs on his plan 's terms and conditions for payment not cover the Part deductible!