What could you tell her? How can you explain this to him? a. 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. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. He has tried two but had an allergic reaction to them. d. She should wait to fill her prescriptions until she is back home since only her local pharmacy is likely to be in her plan's network. a. Mr. Zachow will need to enroll in a Special Needs Plan to obtain coverage for his medication. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell her? 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. 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. 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 health program is intended to serve the people that are above 65 years, younger people that are eligible and those that are suffering from certain diseases. 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. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? What types of vegetation are found in the northernmost region of the Scandinavian Peninsula? 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. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. b. At that time, he had employer group coverage that was creditable. What should you tell him? Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. a. 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. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. b. She has recently lost creditable coverage previously available through her husband's employer. 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. 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. 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 Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. Mr. Kelly has substantial financial means. Her husband worked for many years and contributed into the Medicare system. What you should tell him is: He can enroll in a stand-alone prescription He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. a. II, III, and IV only Correct. Anita comes to you for advice. a. Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn's could look into that possibility. (In most Medicare Advantage HMOs, as a general rule, an enrollee must obtain services only from providers who have a contractual relationship with the plan. -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. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. Mrs. Schneider has a Special Enrollment Period during which she can make a single change to her MA enrollment only but not to her prescription drug plan. (Mrs. Walters is a dual-eligible. I. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What single payment could be made at the beginning of the first year to achieve this objective? c. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. What could you tell Mr. Moy? Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. What should you tell him? Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. a. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. What should you tell her? Handing out enrollment forms, on the other hand, would not be permissible. 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. d. I-SNP, c. C-SNP Before engaging in such a discussion, what should you do? Mr. Torres has a small savings account. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? 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. d. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage. c. The Part D standard model's importance is that it is the only type of plan into which low-income beneficiaries can enroll and still receive any extra help for which they may qualify. a. There is no disadvantage in doing so. Her recent videos also seem like the same old recycled jokes over and over again. III. a. b. Mr. Singh can enroll in a stand-alone prescription drug plan She asks you to explain it. 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 them? . Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. (Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan.). She is considering enrollment in a Medicare Advantage plan (Part C). -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. Anita Magri will turn age 65 in August 2020. d. You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area. Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. Mrs. Park is an elderly retiree. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. What should you tell her? 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. Eligibility to enroll in a PFFS plan is based on entitlement to Medicare Part A and enrollment in Part B. -In general, he must select a single Part D premium payment mechanism that will be used throughout the year. (During the MA OEP, as an MA-PD enrollee Mrs. Goodman may disenroll from her plan, return to Original Medicare and enroll in a stand-alone Part D prescription drug plan. 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. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. c. Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee. What could you tell him? What should you tell him? Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. Melissa would like to use the power of social media to reach potential prospects. No. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. Anita should instead consider a Medicare Advantage plan. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. There are also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and Special Needs Plans (SNPs).). If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. 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. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. b. ), 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. Best Care has not submitted any potential posts to CMS for approval. So long as the hospital or its physician staff don't object, marketing anywhere in the hospital is an acceptable practice. 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). What could you tell him? (Some pharmaceutical manufacturers operate programs that assist low-income individuals. -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. (MA-PPO enrollees may seek care from any provider who accepts Medicare. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. 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