He has tried two but had an allergic reaction to them. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. What should you tell her? Mrs. Shields is covered by Original Medicare. WebGet the right Medicare drug plan for you. b. Part B primarily covers physician services. c. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. He called you to ask what he could do? (Mrs. Schneider is entitled to a Special Enrollment Period (SEP) because, in addition to having Parts A and B, she is now receiving Medicaid assistance through her state's program. a. Where might he turn for help with his prescription drug costs? b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. (To be eligible to enroll in Medicare Advantage, an individual must be entitled (not enrolled) to Part A and enrolled in Part B.). d. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. 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. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). You work for a company that has marketed Medigap products for many years. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. ABC is a Medicare Advantage (MA) plan sponsor. a. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare. C. upward sloping at low wage rates but becomes downward sloping at ), Which of the following statements about Medicare Part D are correct? 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. 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. Shields is covered by Original Medicare. a. D-SNP Mr. Shapiro gets by on a very small amount of fixed income. It occurs from October 15 to December 7 of each year, so she will have to wait until that point to utilize that particular enrollment period. b. What can you tell her about Medigap as an option to address this concern? Original Medicare covers ambulance services. Correct. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). ABC is a Medicare Advantage (MA) plan sponsor. Answer No one rated this answer yet why not be the first? Once a plan sends out a written request for consent, a beneficiary can authorize consent by simply failing to reply within 21 days. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. Becky has just started a new job as controller for Mueller Imports, a much larger dealer for the same car manufacturer. 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). ASAP need thisWrite a paragraph in response to the following content:How Prosperos language shows he can be merciful as well as ruthless and controll 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. WebQuestion: Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. Correct. Her recent videos also seem like the same old recycled jokes over and over again. This is a complete book covering all aspects of the evaluation & management of hypospadias and their variants. a. 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. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? What could you Mr. Shultz was still working when he first qualified for Medicare. What should you say? One might be right for you. (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.). a. Mr. Schultz should seek to continue employer group coverage through COBRA because it is likely to have superior benefits at a more reasonable price. She will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location. Standard Part D coverage would require payment of an annual deductible, and once past the catastrophic coverage threshold, the beneficiary pays whichever is greater of either the co-pays for generic and brand name drugs or coinsurance of 5%. Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. 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).). Which of the following statements best describes some of the costs a beneficiary would incur for prescription drugs under the standard coverage? what should you tell him? When expanded it provides a list of search options that will switch the search inputs to match the current selection. c. II and III only, b. II, III, and IV only b. b. Anita Magri will turn age 65 in August 2020. ), Phiona works in the IT Department of BestCare Health Plan. Anita comes to you for advice. b. Rules regarding unsolicited contact do not apply to marketing through these materials. What should you tell him? Due to cybersecurity dangers, social media cannot be used in the promotion of Medicare Advantage products. -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. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. a. sole proprietorships Below we countdown to Simmi Singh upcoming birthday. What should you tell her? (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. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What should you tell him? 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. He is wondering if he can obtain coverage under Medicare. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Does the research of Margaret Mead support his position? Correct. Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. There is no disadvantage in doing so. b. c. SNPs limit enrollment to certain subpopulations of beneficiaries. Also, Original Medicare does not have a maximum out-of-pocket limit.). b. FIDE-SNP She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. Singh would like drug coverage, but does not want to be enrolled into a health plan. a. d. Original Medicare covers ambulance services. a. 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? What would be the correct description? She currently does not have creditable coverage. TTY: 1-877-486-2048. Which of the following statements about Medicare Part D are correct? 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. Mr. Kelly has substantial financial means. If the enrollment form is countersigned by one of Mr. Tully's treating physicians, she can sign it for him. Furthermore, because he has had Medigap Jerry will not incur a Part D late enrollment penalty. Becky soon gets another surprise. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. WebMr. a. What should you tell him?. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form. a. In addition to drugs on his plan's formulary he takes several other medications. Those initially enrolling in Part D, those switching plans, and current enrollees affected by formulary changes must receive coverage of a single one-month fill of their non-formulary drugs.). Write out the probability distribution of xxx. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. d. nonprofit organizations. The MA PPO plan does not include drug coverage, but the other two plans do. To do so it must obtain authorization from the enrollees. 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. c. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. a. Helena, an overseas college student who has overstayed her visa. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? c. Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions. His co-actors and directors have referred him as one of the most energetic guys of the industry. Ralph disenrolls on February 12th because he discovers that the plan does not cover services furnished by several of his longtime providers. 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. Anita should instead consider a Medicare Advantage plan. OEPI-eligible individuals can make unlimited MA enrollment requests, enroll in a Part D plan, as well as return to Original Medicare.). c. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. 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. Therefore, before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage. Mary Rodgers sees Dr. Brennan for treatment. She may remain in her ABC MA plan, enroll in another MA plan in her service area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. Original Medicare covers routine long-term custodial care. What should you tell her? (Standard Part D coverage would require payment of an annual deductible, and once through the catastrophic coverage threshold the beneficiary pays either co-pays for generic and brand name drugs or co-insurance of 5%, whichever is greater.). c. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy." -Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. 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. 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. What types of vegetation are found in the northernmost region of the Scandinavian Peninsula? Many also cover Part D prescription drugs. a. One might be right for you. What should you tell her? CMO Sambhal has given certificate to the 39 newly recruited ANM. b. Mr. Carlini can keep Original Medicare, but if he does not sign up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription drug coverage through a Medigap plan. This is a social security program. a. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. With the certificate of deposit, you make an initial investment at the beginning of the first year. d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. -Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90-day transition period. c. 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 to a MA or MA-PD plan. (Eligibility to enroll in a Medicare Advantage plan requires entitlement to benefits under Part A and enrollment in Part B. If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. -Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. c. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred more than 30 days after the effective date of coverage. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. (Mr. Gomez may receive health care services from any doctor allowed to bill Medicare, provided he shows the doctor the plan's identification card, and the doctor accepts the PFFS's payment terms and conditions. -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. She is considering enrollment in a Medicare Advantage plan (Part C). What should you tell him?. What could you tell him to do? WebMr. b. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days. He has limited financial resources but failed to qualify for the Part D low-income subsidy. 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. 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. a. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15%of the Medicare rate. WebA: 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. Anita intends to enroll in Original Medicare Part A and Part B. Agent Jennings makes a presentation on Medicare advertised as an educational event. What should you tell her? Ralph's effective enrollment date is January 1st. d. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. What single payment could be made at the beginning of the first year to achieve this objective? d. Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. (Individuals who drop their Medigap policy to enroll in a MA plan for the first time are eligible for a Special Enrollment Period (SEP) within 12 months after enrolling in that MA plan. In order to join a Medicare Advantage plan, she must be enrolled in Parts A, B, and D. Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. Correct, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese, Fundamentals of Financial Management, Concise Edition, Daniel F Viele, David H Marshall, Wayne W McManus. a. SNPs only serve individuals in long-term care facilities, so he cannot enroll. She will need to pay for her brand name medications out of pocket. What you should tell him is: He can enroll in a stand-alone prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. Mr. Castillo is still covered by Part A. What advice should you give Miguel? All beneficiaries enrolled in an MSA set-aside the MSA funds on a pre-tax basis in addition to paying their Part B premium. What do you say? d. They are Medigap Supplemental plans that fill in the gaps not covered by Medicare. d. She is eligible for a Special Election Period that begins either the month before her permanent move, if the plan is notified in advance, or the month she provides notice of the move, and this period typically lasts an additional two months. What should you tell him? d. You may begin her enrollment application and require her to provide names of any of friends who may be interested in enrolling before completing her application. Daniel is a middle-income Medicare beneficiary. 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. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. (October 10th is prior to the start of the Annual Election Period (AEP) which begins October 15th and ends December 7th. 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. 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. What should you tell him? Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. -She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. She is in excellent health and will have considerable income when she retires. Juan Perez, who What could you tell him? She is not enrolled in Part B. She agreed to sign a scope of appointment form and meet with you on October 15. Mr. Wu is eligible for Medicare. 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. (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. b. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. a. What is Medicare plan? If he still wants to do so, he can make any sort of change he likes at that point. b. Mr. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. 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? What should you tell him? Most of them d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. If the SEP is for MA coverage, he may only use the SEP to disenroll from his MA plan and return to Original Medicare. In your own words rewrite the phrases listed and briefly explain what framers meant by each phrase, These include the creation of a Japanese writing (kana) using Chinese characters, mostly phonetically, which permitted the production of the world's f c. Mr. Schultz can wait up to 180 days after the loss of his creditable employer group coverage before enrolling in a Part D plan without worrying payment a premium penalty. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. What should you tell him? -After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Costs for Medicare drug coverage Learn about the types of costs youll pay in a Medicare drug plan. c. 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 but Smallcap must continue to offer him coverage under its employer-sponsored group health plan and would become a secondary payor. 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. b. He wants to know if Medicare covers cancer screening. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. She is concerned about whether or not Medicare will cover these items and services. You are working with a number of plans and community organizations to sponsor an educational event. 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. She will need to have her physician help her select a new drug that is covered. b. Mr. Prentice has many clients who are Medicare beneficiaries. IV. (CMS must review and approve the materials in order for you to use them. Madeline Martinez was widowed several years ago. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. Marketing representatives may not offer gifts in the form of cash or that can easily be converted to cash.). I. b. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. WebIf Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. a. Advertisement Okjaanu504 is waiting for your help. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. Mr. Vaughn takes a prescription for helping to regrow his hair. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. WebSingh would like drug coverage, but does not want to be enrolled in a Medicare Advantage plan. a. If Mrs. Ridgeway wants to return to Original Medicare, she may use this SEP to disenroll from her MA plan and return to Original Medicare. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. b. The mechanism must advise each individual at the beginning of the process that he or she is completing an actual enrollment request. What should you tell him? Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. d. Mr. Singh 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. What impact, if any, will recent regulatory changes have upon Medigap plans? Correct. Correct. a. d. No. What should you tell him? Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. He is wondering if he can obtain coverage under Medicare. Mr. Wu is eligible for Medicare. Have you ever imagined having one electronic device that does everything you would ever need? b. He has limited financial resources but failed to qualify for the Part D low-income subsidy. d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage. a. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15%of the Medicare rate. She is 4 pounds 4 ounces. She knows that there is such a thing as the "Part D Initial Enrollment Period" (IEP) and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. Total views 20. Singh has sat as the member of Parliament (MP) for Burnaby South since 2019. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. What is t What would be the correct description? 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. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? b. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. What should you tell him? Pages 1. d. Yes. b. 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. What should you tell her? She wants to understand what this means. a. One might be right for you. Mr. Hutchinson has drug coverage through his former employer's retiree plan. You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. What could you tell her to address her concern? The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. d. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services. d. In order to join a Medicare Advantage plan, she also must enroll in Part B. d. In order to join a Medicare Advantage plan, she also must enroll in Part B. (State licensure and plan appointment applies to the states where the beneficiaries are being marketed to are located.). What is Medicare plan? She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage.
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