In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. You may provide her with the required enrollment materials and take her completed enrollment application. d. As long as Mrs. Mulcahy is 65, eligibility for a Medicare prescription drug plan is not dependent on entitlement to Part A or enrollment under Part B, so she should not be concerned. -She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. c. Mr. Vaughn's hair growth medication would only be covered under Part D if his balding resulted from an illness or was a side effect of a treatment such as chemotherapy. b. ), Phiona works in the IT Department of BestCare Health Plan. 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. Like all Medicare beneficiaries, Mrs. Mulcahy will be automatically enrolled in a Medicare prescription drug plan when she turns 65. c. He must apply for the extra help at the same time he applies for enrollment in a Part D plan. a. sole proprietorships 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. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. What can you tell her? Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. 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. Learn more about Medicare advantage plan here:brainly.com/question/25122967, This site is using cookies under cookie policy . a. c. 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. Agent Jennings makes a presentation on Medicare advertised as an educational event. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Mrs. Shields is covered by Original Medicare. Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? Correct. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. a. Call me to find out more!" She is concerned that she will not qualify for coverage under part A because she was not born in the United States. He is wondering whether he can obtain coverage under Medicare. c. Tell Mr. Anderson that you cannot accept an enrollment form for coverage to begin on January 1 of next year prior to December 15. c. Yes. Mrs. Schneider must wait until the Annual Election Period to make any changes in her enrollment in an MA or Part D plan. No. 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. Nor do they have to offer such coverage under the same conditions as for individuals under age 65.). He is wondering if he can obtain coverage under Medicare. Anita comes to you for advice. Mr. Shapiro gets by on a very small amount of fixed income. a. c. If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. What could you tell him? 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. You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. (Mrs. Shields has experienced a long hospital stay, over the 3-day time period to qualify for skilled nursing and rehabilitative care benefits under Medicare.). Correct. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. a. Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. 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. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. The MA PPO plan does not include drug coverage, but the other two plans do. The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. d. TrOOP refers to true out-of-pocket expenses paid by drug manufacturers on behalf of Medicare Part D beneficiaries. c. He is not eligible to enroll in a Medicare Advantage as a naturalized citizen. a. He wants to know whether he might qualify. 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. 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. What should you say? b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. Mary Rodgers sees Dr. Brennan for treatment. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. c. What are the possible consequences. . WebMarket-leading rankings and editorial commentary - see the top law firms & lawyers for Aviation (including aerospace and defence) in India When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. You are working with a number of plans and community organizations to sponsor an educational event. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. d. The vitamins the Vaughns are taking will be covered under Part D because their physician suggested they should take vitamins, but the hair loss medication cannot be covered. Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. And, Henry also is likely to qualify for both a MA and Part D SEP since he has moved to a new state which is likely to be outside his current plan's service area.). She will be able to enroll in a new plan because she qualifies for a Special Enrollment Period that begins 30 days after a plan's written communications are returned by the United States Postal Service with a notification that the resident has moved. 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. -If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. d. Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. What could you tell her? 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. The MA PPO plan does not include drug coverage, but the other two plans do. a. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. How would you advise him? Tell prospect Jerry Smith that he should keep his Medigap plan but he should supplement his healthcare coverage by purchasing a Medicare Advantage plan that offers prescription drug coverage (MA-PD). You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. To enroll in a Medicare Advantage plan, she need only be entitled to Part A, so she does not need to take any further steps. What could you tell her? Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. CMO Sambhal has given certificate to the 39 newly recruited ANM. a. Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). -In order to join a Medicare Advantage plan, she also must enroll in Part B. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What could you tell her to address her concern? What could you tell him? He has limited financial resources but failed to qualify for the Part D low-income subsidy. 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. Next week you will be participating in your first "educational event" for prospective enrollees. d. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. 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. She wants to enroll in a Part D plan. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. 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. WebIt is one of three plans operated by the same organization in Mr. Lombardi's area. 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 Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. -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. a. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). Her concern to make any changes in her enrollment in an MA or Part D plan,. Policy many years ago that offered prescription drug coverage Paterson is concerned about the and... Conditions as for individuals under age 65 and has a sizeable income from his investments Greco is in excellent,. 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