a. (Most individuals who are citizens and age 65 or older may qualify for coverage either because they pay a monthly premium or because they paid Medicare taxes while working for a specific duration.). Mr. Kelly has substantial financial means. What should you tell him? 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. They are custodial long-term care plans for people with Medicare. Anita Magri will turn age 65 in August 2020. Mary Rodgers sees Dr. Brennan for treatment. Part B primarily covers physician services. WebNo. Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.). D. The Senate must approve a treaty by a two-thirds vote, and its terms must be found to be constitutional by the Supreme Court, what type of energy is obtain through food. Mrs. Shields is a. However, enrollees are typically responsible for higher cost-sharing payments if their provider is out-of-network.). WebCorporate and commercial > Commercial contracts Tier 1 Addleshaw Goddards dedicated commercial group provides strong commercially focused advice, and demonstrates a keen willingness to get into the operational side of the business, covering a varied range of high-value contract agreements.Leveraging its expertise across the retail, financial services, b. (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.). WebIn this review, we will focus our discussions on nutlin-based and spirooxindole class compounds given that they are the most widely used classes among the MDM2-p53 interaction inhibitors in breast cancer studies and display drug-like properties. Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. What should you tell him? What should you tell him? Official Medicare site. -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. c. Despite the terms of her contract forbidding the use of social media, Agent Meadows could send out a tweet stating that "Best Care offers a Medicare Advantage benefit package offering the lowest cost comprehensive dental benefit package available. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. b. d. "How are you this morning, Mrs. Mr. Singh can enroll in a stand-alone prescription drug plan while maintaining Part A and Part B coverage through Original Fee-for-Service Medicare. Correct. In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network). c. You may provide her with the required enrollment materials and take her completed enrollment application. c. Part D plans may use varying co-payments, but they are required to cover all prescription medications on the market. She is 4 pounds 4 ounces. What. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Advantage plan. Her second prescription will require her to pay the full cost out-of-pocket. a. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. a. What should you tell her? He wants to know if Medicare covers cancer screening. (Medicare Advantage is a way of covering Original Medicare, Part A and Part B benefits, through private health insurance plans.). b. Medicare Advantage Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services but must include a maximum out-of-pocket limit. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. c. C-SNP b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. What types of vegetation are found in the northernmost region of the Scandinavian Peninsula? What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? She can enroll in the PPO and purchase drug coverage through a Medigap plan. What should you tell him? Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply failing to reply within 21 days. -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. Before engaging in such a discussion, what should you do? Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. (Eligibility to enroll in a Medicare Advantage plan requires entitlement to benefits under Part A and enrollment in Part B. How would you respond? What should you tell him? d. Plans may not participate in advertising such an event. What should you tell him? You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. Melissa would like to use the power of social media to reach potential prospects. Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available January 1 next year. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. 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. Mr. Denton is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. a. When expanded it provides a list of search options that will switch the search inputs to match the current selection. 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, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. (Original Medicare does cover ambulance services.). Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. "If you're not in very good health, you will probably do better with a different product." Where might he turn for help with his prescription drug costs? b. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. -They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. 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. c. 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. b. She will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location. 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. What should you tell him . 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. His co-actors and directors have referred him as one of the most energetic guys of the industry. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. (If a beneficiary enrolls in a MA plan that is an HMO or PPO plan that does not include Part D coverage, the beneficiary cannot join a standalone Prescription Drug Plan (PDP).). Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare. WebWe need to reduce the cost of Hospitalization in India and that will require a multi-pronged approach that addresses the underlying factors that contribute to b. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Gift cards or gift certificates of $15 or less that can be readily converted to cash. Agent Armstrong needs to be licensed and appointed only in his state of residence. Agent Jennings makes a presentation on Medicare advertised as an educational event. What should you tell him? Agent John Miller is meeting with Jerry Smith, a new prospect. What should you tell him? c. He is not eligible to enroll in a Medicare Advantage as a naturalized citizen. WebThe answer that you can give to Mr. Singh would be that he can enroll in a stand-alone prescription drug plan and be receiving Part A and B services. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? (Cost plans offering Part D coverage may only make this benefit available during the enrollment periods available under the Part D program, and they are required to accept Part D enrollments during these periods.). Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. 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. Since Ms. Gonzales chose to remain in Original Medicare, she cannot change plans during the MA OEP. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. d. This could be considered discriminatory activity and a prohibited practice. She is interested in selecting a Medicare Part D prescription drug plan. On December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-PD plan. Original Medicare covers routine long-term custodial care. c. The Part B deductible will be covered for some newly eligible individuals depending on their financial status. Ranveer Singh is known as the energy powerhouse in Bollywood. b. Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. Two or more gifts whose combined value does not exceed $15. 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 is wondering if he can obtain coverage under Medicare. d. You should plan to ensure that the educational event is an informative event and must not conduct a sales presentation or distribute or accept enrollment forms at the event. -You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the companies John represents offer more comprehensive coverage for a lower price. c. Enrollment in Cost plans offering Part D prescription drug coverage is not necessary because Cost plans offer more generous Part B benefits. c. Tell her that the Medicare agency does not endorse or recommend any plan. a. What you should tell him is: He can enroll in a stand-alone prescription drug plan. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. 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. -In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network). Becky has just started a new job as controller for Mueller Imports, a much larger dealer for the same car manufacturer. Correct. 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. 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? Generally, these are plans C, F, or high deductible F. Anita can still purchase a Medigap plan that provides foreign travel emergency benefits such as plan G.). What should you tell her? b. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. d. He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. However, the plan does not provide drug benefits. He called you to ask what he could do? b. 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. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. Juan Perez, who Mary Rodgers sees Dr. Brennan for treatment. 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. This could be considered discriminatory activity, but it is not a prohibited practice. If an individual was eligible for Medicare before January 1, 2020, but not yet enrolled, his or she may be able to purchase one of these plans.). What advice would you give her? What is t Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. (You are required to pass the test in order to represent any Medicare Advantage or Part D plans. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. -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. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. The manufacturers regional sales managers are each given a certain number of cars. WebThe answer that you can give to Mr. Singh would be that he can enroll in a stand-alone prescription drug plan and be receiving Part A and B 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. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? b. What should you tell him? He called you to ask what he could do? What should you tell her? Call me direct to learn more." However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell him?. The MA PPO plan does not include drug coverage, but the other two plans do. 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. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. Her husband worked for many years and contributed into the Medicare system. a. d. She must wait until the next MA Open Enrollment Period (OEP) during which she can elect to return to 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. He is wondering whether he can obtain coverage under Medicare. 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. What advice would you give her? a. SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. Also, Original Medicare does not have a maximum out-of-pocket limit.). Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. How would you advise Agent John Miller to proceed? What impact, if any, will recent regulatory changes have upon Medigap plans? a. Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. 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. (Part D plans must cover at least the Part D standard benefits or its actuarial equivalent. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. b. 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. You know that Medicare marketing guidelines prohibit certain types of statements. b. a. 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? However, she gives a brief presentation that mentions plan-specific premiums. (CMS will permit someone to sign on behalf of a beneficiary if they are a legal representative or individual authorized under state law, such as a court-appointed legal guardian, someone with a durable power of attorney for health care decisions, or someone authorized to make health care decisions under state surrogate consent laws.). Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements several years ago. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. b. Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). Webc. Every couple of months, a local jeweler bills the dealer $5,000 for miscellaneous services. Franz Mueller, the owner of the dealership, personally approves payment of these invoices, noting that each invoice is a selling expense. From casual conversations with a salesperson, Becky learns that Mueller frequently gives Rolex watches to the manufacturers regional sales manager and other sales executives. What should you keep in mind to comply with the marketing requirements for MA plans? He is wondering if he can obtain coverage under Medicare. c. The cost of the prescription drug that is not on his plan's formulary will count toward TrOOP but the other medications in question will not count toward TrOOP. ), Fresenius ~ CCHT Certification Preparation Te. c. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan. It is not available to those who chosen coverage through Original Medicare. What should you tell him? 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. (If a beneficiary has limited income and resources, they may qualify for a low-income subsidy (LIS) to cover all or part of the Part D plan premium and cost-sharing. Singh would like drug coverage, but does not want to be enrolled into a health plan. d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage. b. ), Which of the following statements about Medicare Part D are correct? If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. How would you advise him? b. 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. III. 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. 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. b. (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. 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. -Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. d. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state for Medicaid assistance. He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? She wants to understand what this means. Mr. Torres has a small savings account. Correct. 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. -She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. b. b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. All individuals who are citizens and age 65 or over will be covered under Part A. 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. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. 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. d. 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? Her recent videos also seem like the same old recycled jokes over and over again. d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. 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. d. Mr. Tully's daughter can do so because she is an immediate family member who has taken responsibility for her father's care. Demand for this particular make of car is exploding, and the manufacturer cannot produce enough to satisfy demand. Madeline Martinez was widowed several years ago. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. 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. a. a. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. Original Medicare covers cosmetic surgery. d. She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. Correct. a. -Medicare prescription drug plans are required to cover drugs in each therapeutic category. Tell her that Medicare or CMS (the Medicare agency) has approved and endorsed the plan. (Marketing representatives may engage in marketing activities in a retail pharmacy in common areas. All advertising must be done by community organizations. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. Ms. Claggett is sixty-six (66) years old. 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. (Because Daniel's bronchitis is a chronic condition, a Chronic condition SNP would be most appropriate for him to enroll in.). The goal is to ensure and make health care more accessible to the people of the nation. However, the plan does not provide drug benefits. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. You are visiting with Mr. Tully and his daughter at her request. -He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What could you tell her to address her concern? What should you tell her? b. Mr. Schultz should immediately enroll in a Part D plan but he can expect to pay a premium penalty because he failed to enroll when first eligible. c. He can only make a single enrollment change during the Annual Election Period, so he will not be able to change his enrollment. -SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. What should you tell her? Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. -Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. In setting up the enrollment site, which of the following must Phiona consider? 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. d. Only scripts and marketing practices must be approved by CMS, so you do not need to do anything further with your marketing materials, so long as you make them available to anyone who attends your marketing event(s). Beneficiary who applies regardless of health status except in limited circumstances mr singh would like drug coverage.! Known as the doctor accepts Original Medicare and Medigap coverage following her mr singh would like drug coverage years! 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