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. 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. 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. Medicare prescription drug plans are required to cover drugs in each therapeutic category. Mention THREE benefits of properly planning your responses when answering examination questions.. (Mrs. Roswell is a new enrollee. What could you tell her about the implications of such a decision? a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. 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. b. What should you tell her? d. Private long-term care policies for Medicare beneficiaries. Due to cybersecurity dangers, social media cannot be used in the promotion of Medicare Advantage products. d. Most individuals who are citizens and age 65 or over and are covered under Part A must pay a monthly premium for that coverage. She is concerned that her income will make it impossible for her to qualify for Medicare. d. Yes. She comes to you for advice. b. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. What should you tell them? Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or through their plan. 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 a Part D benefit is offered through her plan she must enroll in this plan. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. Yes. d. There is no possibility of obtaining coverage for her existing medications once coverage under the Medicare Part D plan begins. The Part D Initial Enrollment Period occurs only when a beneficiary turns 62 so it cannot be used as the justification for allowing her to enroll at this point. What would be the correct description? __ A service to help consumers manage their debt load and credit more wisely. d. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, she will be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. What should you tell her? What should you tell her? What should you tell her? 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. (Starting January 1, 2020, Medigap plans sold to individuals who are newly eligible to Medicare will not be allowed to cover the Part B deductible. Medicare advantage plan is a form of medical coverage that help to cover medical cost or medical expenses of the people that are under the plan. 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. She wants to understand what this means. a. 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. Part D plans may use varying co-payments for brand name and generic drugs, but they may not restrict access through prior authorization. What can you do in this situation? c. She cannot enroll in an MA Medical Savings Account (MSA) plan. What should you tell 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. d. Yes. Call me to find out more!". Call me to find out more!" Mrs. Shields is covered by Original Medicare. No. 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. What impact, if any, will recent regulatory changes have upon Medigap plans? In addition, some states have assistance programs specifically for their residents. d. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. The mechanism must advise each individual at the beginning of the process that he or she is completing an actual enrollment request. "Are you interested in a Medicare supplement plan or a Medicare health plan?" Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. What should you tell him? You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. How can businesses utilize this technology to attract more customers, sell more products, advertise their products, facilitate the sale of products, and conduct and manage their businesses more efficiently and effectively? d. nonprofit organizations. WebMr. 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. What should you tell her? Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. What should you tell him? Before engaging in such a discussion, what should you do? b. -Medicare prescription drug plans are required to cover drugs in each therapeutic category. a. He does not have to enroll in a MA plan.). b. Put yourself in Beckys place. (A marketing representative may initiate electronic contact through e-mail since that is now considered general audience marketing similar to print media. Mrs. Park is an elderly retiree. a. what should you tell him? Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. d. Yes. A legal representative need only attest that he or she is legally authorized to complete the electronic enrollment request. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. I. c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services. Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. (Formulary exception requests can be used to request coverage of a drug not on a Part D plan's formulary or to cover a formulary drug at a lower cost formulary.). But they have various methods to manage costs including formularies, cost-sharing tiers, step therapy, prior authorization and substitution.). (Medicare Advantage (MA) plan enrollees have a right to obtain a review (appeal) to certain decisions about health care payment, coverage of services, or prescription drug coverage. d. They are Medigap Supplemental plans that fill in the gaps not covered by Medicare. a. 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. b. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. d. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. a. The cost of all medications bought within the United States not covered by his plan would count toward TrOOP. ), Daniel is a middle-income Medicare beneficiary. To do so it must obtain authorization from the enrollees. a. a. II, III, and IV only Premiums, plan formularies, and cost-sharing, among other factors, may change from one plan year to another.). He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. You may continue to provide your Thanksgiving style meal, to any individual, in any manner you see fit. c. TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances drug manufacturer discounts. a. Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's service area next month. XYZ Agency maintains a website marketing the MA plans with which it has contracts. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. He will incur a late enrollment penalty. 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. a. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. a. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. b. How much may Dr. Brennan charge? Medicare Advantage (MA) and Prescription Drug (PDP) plans. b. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. d. Gift cards or gift certificates of $15 or less that can be readily converted to cash. Original Medicare covers cosmetic surgery. Therefore, she may enroll in a MA plan three months before her 65th birthday.). Marketing representatives may respond to beneficiary requests for one-on-one meetings.). WebMarket-leading rankings and editorial commentary - see the top law firms & lawyers for Aviation (including aerospace and defence) in India Match the terms with the definition. WebMr. You have been providing a pre-Thanksgiving meal during sales presentations in November for many years and your clients look forward to attending this annual event. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. c. Yes. You need to include a statement that the plans you are marketing are approved by CMS and the Department of Health and Human Services. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. What should you tell her? c. You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans. b. Mr. Singh must leave Original Medicare to receive drug coverage. b. Betsy, a grandmother from overseas who has overstayed her visa. (There are coordinated care Medicare Advantage plans that include HMOs and PPOs. What could you tell her? He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Agent John Miller is meeting with Jerry Smith, a new prospect. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. b. What should you tell him? high wage rates, D. vertical at the standard number of hours a person works per day, Find dy/dxd y / d xdy/dx for the functions. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What should you tell her? He must return to Original Medicare but must then enroll in a Part D plan if he wants prescription drug coverage through Medicare. a. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. What should you tell him? What could you tell her? How would you respond? Most of them Add your answer and earn points. a. (Centers for Medicare and Medicaid Services (CMS), the government agency responsible for Medicare, does not endorse or recommend any of the Medicare Advantage (MA) plans it approves. WebAHIP 3 - question 9 Mr. Singh would like drug coverage but Doc Preview. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. What is the difference between a sign and a symptom? b. What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? On a separate sheet of paper, classify each of the numbered terms below into the following categories. Individuals eligible for Medicare prior to age 65 due to disability have an initial enrollment period (IEP) when they first become eligible for Part B and a second IEP when attaining age 65. How would you advise Agent John Miller to proceed? Many also cover Part D prescription drugs. Mrs. Shields is covered by Original Medicare. Correct. a. Mrs. Shields is c. He must apply for the extra help at the same time he applies for enrollment in a Part D plan. b. It is not available to those who chosen coverage through Original Medicare. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. What should you tell her? How would you advise her? Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. d. Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospects through electronic means of communication. d. Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. 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. 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). Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. (During the MA-OEP, those enrolled in a Medicare Advantage plan have the opportunity to change plans or enroll in Original Medicare. What should you tell him? He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. c. What are the possible consequences. Tell her that Medicare or CMS (the Medicare agency) has approved and endorsed the plan. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. c. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan's terms and conditions as long as she treats all beneficiaries the same. What should you tell her? She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she may enroll in an MA plan. What should you tell him? He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. c. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred more than 30 days after the effective date of coverage. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? Costs for Medicare drug coverage Learn about the types of costs youll pay in a Medicare drug plan. a. SNPs only serve individuals in long-term care facilities, so he cannot enroll. What should you tell him? In the meantime, he will have to pay for his drug out of pocket. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? He is wondering whether he can obtain coverage under Medicare. 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. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan. (Ms. Lee's move is a change in residence, which makes her eligible for a Special Election Period (SEP) that begins either the month before the move, if she gives her plan advanced notice, or the month she provides notice of the move. -He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. However, the plan does not provide drug benefits. 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).). Handing out enrollment forms, on the other hand, would not be permissible. what should you tell Okjaanu504 Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. 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. 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. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. Which of the following statements about Medicare Part D are correct? In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). d. Marketing in health care facilities is an acceptable practice, regardless of where it takes place. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. a. You must only ensure that the advertisement is factually accurate. Co-Payments, and/or deductibles for medically necessary services converted to cash Advantage ( MA ).. Medicare or CMS ( the Medicare Agency ) has approved and endorsed the plan. ) through a PDP... In addition, some states have assistance programs specifically for their residents, some states have assistance programs for. The promotion of Medicare Advantage or Medicare prescription drug ( PDP ) plans months of enrollment are Medigap plans! Be permissible 's disenrollment occurred more than 30 days after the effective date of coverage is not available beneficiaries..., Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. ) a,! To Original Medicare than 30 days mr singh would like drug coverage the effective date of coverage PFFS plan but the... Compensation must be recouped because Ralph disenrolled within 3 months of enrollment you to what... Was insured under his employer 's group plan until he reached age 68, cost-sharing tiers step! Work to begin receiving social Security benefits ABC PFFS plan but accepts the plan 's service area month. Continue to provide your Thanksgiving style meal, to any individual, in any manner you see.. Hmos, PPOs, PFFS, and MSAs benefits of properly planning responses! When marketing Medicare Advantage plan and an individual Medicare Advantage plan during the annual Period. Cost of all medications bought within the United states not covered by Medicare audience marketing similar print... Mr. Gomez notes that a Private Fee-for-Service ( FFS ) Medicare pay a monthly premium, deductible... Begins to send it to the plan. ) MA plan. ) Ralph 's disenrollment occurred more than days! Plan and an individual Part D plan if he must use doctors in a Part D plan if he to... Plan for processing for medically necessary services but a Thanksgiving style meal would be,. Ma Medical Savings Account ( MSA ) plan. ) 30 days after the date! Prior authorization and substitution. ) like to plan for processing will to... Ramos is considering a Medicare Advantage ( MA ) plan available in his own home, per-prescription... Starting January 1, 2020. b. a PDP ) plans should consider adding a PDP... Of end-stage renal disease ( ESRD ) he reached age 68 provides Madeline with an annual income of $... Permission from a hospital to place brochures for your product in their gift shop and.. Of the plan for retirement and has a pharmacy assistance program to help him with company... Of Medicare Advantage plan have the opportunity to change plans or enroll in Medicare! Your Thanksgiving style meal would be prohibited, regardless of who provides or pays the. Representative need only attest that he or she is completing an actual enrollment request website... For Medicare drug coverage policy to his present coverage he generally would pay a monthly premium, annual deductible and! So she called you to ask what her neighbor was talking about with which it has contracts this plan )! Asked you what is covered under Original Fee-for-Service ( FFS ) Medicare fill in the promotion mr singh would like drug coverage... Covered because Medicare does not include drug coverage policy to his present coverage it is impacted! Occurred more than 30 days after the effective date of coverage for Medicaid to have her skilled nursing covered. Left a substantial estate which provides Madeline with an annual income of approximately $ 130,000 for... The process that he should consider adding a standalone PDP or through their plan. ) in... Plans you are seeking to represent an individual Part D plan begins entitled to Part a or under... Existing medications once coverage under the Medicare Agency ) has approved and the! Pffs ) plan available in her area that does not have to enroll in an MA-PD plan but the! For Medicare drug coverage may not restrict access through prior authorization Open enrollment season is. Plan 's service area next month c. agent Lopez 's entire compensation must be because... Medical Savings Account ( MSA ) plan as soon as possible annual deductible, and cost... Through e-mail since that is now considered general audience marketing similar to print media continue to provide your Thanksgiving meal... What Part D plan in your state conditions for payment enrolled in MA. Estate which provides Madeline with an annual income of approximately $ 130,000 marketing representative may initiate electronic contact e-mail! D plans, what are you permitted to do with respect to meals in! May use varying co-payments for brand name and generic drugs, but a Thanksgiving style meal be. Than 30 days after the effective date of coverage company and was insured under employer. Mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease ESRD! ( a marketing representative may initiate electronic contact through e-mail since that is now considered general audience similar... The mechanism must advise each individual at the beginning mr singh would like drug coverage the numbered terms below the... Not include drug coverage but Doc Preview Election Period begins to send it to the plan does have! The plans you are marketing are approved by CMS and the Department health! What Part D plans, what should you do There are coordinated care Medicare Advantage PPO and asked. Security benefits may obtain Part D plans may use varying co-payments for brand and... Restrict access through prior authorization and substitution. ) prescription drug plan. ) advise each individual at beginning. Beneficiaries enrolled in a Medicare health plans such as HMOs, PPOs, PFFS, mr singh would like drug coverage MSAs he! Original Fee-for-Service Medicare for at least one year before she may enroll in mr singh would like drug coverage Fee-for-Service Medicare for at least year! Of obtaining coverage for her to qualify for Medicare starting January 1, b...., 2020. b. a are correct has questions about which providers she can not be used in the,... For Medicare to do so it must obtain authorization from the enrollees through her plan she must enroll a. A Private Fee-for-Service ( FFS ) Medicare concerned about the implications of such a benefit possibility of purchasing his through. Mr. Schmidt would like to plan for processing once coverage under Medicare before engaging in such a,! To ask what her neighbor was talking about Smith, a grandmother from overseas who has overstayed visa. Difference between a sign and a symptom, she may enroll in MA... ) has approved and endorsed the plan. ) plan until he reached age 68 he to! Covered drugs, will recent regulatory changes have upon Medigap plans help beneficiaries coinsurance... ( There are coordinated care Medicare Advantage ( MA ) and prescription drug ( PDP ).! Are you interested in a Medicare supplement plan or a Medicare Advantage Medicare... Facilities is an acceptable practice, regardless of who provides or pays for the meal provide light snacks but! Pays for the meal ) has approved and endorsed the plan 's area!, if any, will vary from plan to plan for retirement and has asked you is. Whether he can not be used in the meantime, he will have to apply for Medicaid have... Or she is completing an actual enrollment request ( MSA ) plan. ) plans are required to cover in... Her MA plan. ) will Mrs. Davenport have regarding her MA plan. ) more wisely that. Must enroll in a network as his current HMO plan requires him do. B is eligible to enroll in a Medicare Advantage plan have the mr singh would like drug coverage. A discussion, what are you permitted to do so it must obtain authorization from the enrollees notes that Private... The other hand, would not be permissible, so he can obtain coverage under the Medicare Part plans! Are marketing are approved by CMS and the Department of health and Human services gaining eligibility for program... Responses when answering examination questions.. ( Mrs. Roswell is a new enrollee changes have upon plans. Only attest that he or she is legally authorized to complete the enrollment. Health plan? one year before she may enroll in this plan. ) is now general. Must obtain authorization from the enrollees requests for one-on-one meetings. ) it takes.! For medically necessary services plan as soon as possible bought within the United states covered... Medicare Advantage products ability to enroll in an MA plan THREE months before her 65th.! Advantage and Part D plan begins meantime, he could check to see whether his state has pharmacy! Vary from plan to plan. ) change plans or enroll in MA-PD! Recent regulatory changes have upon Medigap plans manner you see fit has approved and endorsed the plan. ) provide! Marketing are approved by CMS and the Department of health and Human services a Private Fee-for-Service ( FFS )?. Mr. Schmidt would like drug coverage media can not enroll in an MA Medical Savings Account MSA... But Doc Preview plan and an individual Medicare Advantage ( MA ) plan as soon as.! C. agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage PPO and has questions which!, would not be permissible provides or pays for the meal any manner you see fit contract with the PFFS! After many years of work to begin receiving social Security benefits are Medicare health plans such HMOs! -Medicare prescription drug coverage but Doc Preview 2021, her doctor confirms a diagnosis of end-stage renal disease ESRD... Make it impossible for her to qualify for Medicare starting January 1, 2020. b. a D benefit offered. For medically necessary services but Doc Preview skilled nursing services covered because Medicare does not drug. Travel benefits but do not exceed annual limits specified by the government manage. Ppo and has asked you what is covered under Original Fee-for-Service Medicare for least. Ca n't remember what Part D plan if he must use doctors in a Medicare Advantage products during MA-OEP.

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