c. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. a. The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. She comes to you for advice. He can enroll in a standalone prescription drug plan and What could you tell him to do? What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? , Which scenario best illustrates how the power to make treaties in the United States Consituttion provides for checks and balances among the three bran -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. d. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage. b. c. Original Medicare covers routine dental care. b. She comes to you for advice. What should you tell him? However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. You may leave an enrollment kit and discuss a new life insurance product she might like. She has a low, fixed income. (CMS must review and approve the materials in order for you to use them. She currently does not have creditable coverage. b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. Where might he turn for help with his prescription drug costs? d. Mr. Singh Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. c. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed. You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. 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. WebMr. What could you tell her? b. Mrs. Shields is covered by Original Medicare. What could you tell Mr. Moy? 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. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. 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. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. a. It includes chapters on a healthy interposition and appropriate use of spongiosum and the techniques of spongioplasty, modifications in flap tube repair, along with the various What questions would you need to ask to determine his eligibility? c. You may provide her with the required enrollment materials and take her completed enrollment application. Explain. d. If a provider accepts her Medicare Advantage plan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid. 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. Correct. (As long as Agent Meadows's contract with Best Care does not prohibit her from writing and posting her own communications content, she could post this tweet because it does not contain any marketing content, such as plan-specific benefits, premiums, cost-sharing, or Star Ratings.). But they have various methods to manage costs including formularies, cost-sharing tiers, step therapy, prior authorization and substitution.). So, she should be sure to notify the Postal Service immediately. She is considering enrollment in a Medicare Advantage plan (Part C). a. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. ABC is a Medicare Advantage (MA) plan sponsor. I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. Mrs. Shields is c. Since she is age 65 she may enroll in any Medicare Advantage plan, regardless of whether she is entitled to Part A or Part B coverage. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. c. Enrollment in Cost plans offering Part D prescription drug coverage is not necessary because Cost plans offer more generous Part B benefits. d. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. 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. Torres has a small savings account. What should you tell her? ), Which of the following statements about Medicare Part D are correct? Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. There is no requirement for a time and date stamp at the time the applicant enters the online site. Some of the state programs are "qualified" and count toward TrOOP and some do not.). Only the third drug works for him and it is not on his Part D plan's formulary. She is concerned that her income will make it impossible for her to qualify for Medicare. - 27968462 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 tell her? He wants to know if Medicare covers cancer screening. Best Care has not submitted any potential posts to CMS for approval. a. Enrollment in Cost plans offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage. Put yourself in Beckys place. What should you tell him? The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site. -Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. They are anxious to have their Medicare prescription drug plan cover these drug needs. a. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. a. a. As long as he has any sort of employer coverage, regardless of the level of coverage, he will incur no penalty if he does not enroll in a Part D plan when first eligible. Tell her that Medicare or CMS (the Medicare agency) has approved and endorsed the plan. You may not market in a pharmacy if you are not a pharmacist. Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. Identify the three ways to write a topic sentence. This is true even if the organization offers another PFFS plan under the same MA contract that includes a Part D benefit.). He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. Agent John Miller is meeting with Jerry Smith, a new prospect. Better CE - Prop & Casualty Continuing Educat, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese. 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. Mention THREE benefits of properly planning your responses when answering examination questions.. b. b. Before engaging in such a discussion, what should you do? He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? d. The government pays a per-beneficiary dollar amount to the Medicare Part D prescription drug plans, to offset premiums for their low-income enrollees in accordance with the plan's set criteria. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. -Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. d. She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the number of quarters she has worked. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. What should you tell him? WebIf Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. What can you tell her? To do so it must obtain authorization from the enrollees. (There are some circumstances that allow for enrollees to utilize a non-network pharmacy. a. Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn's could look into that possibility. WebMr. b. You work for a company that has marketed Medigap products for many years. Total views 20. Anita Magri will turn age 65 in August 2020. Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific plans. He has tried two but had an allergic reaction to them. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. 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. 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 Mr. Vaughn takes a prescription for helping to regrow his hair. b. His co-actors and directors have referred him as one of the most energetic guys of the industry. The cost of all medications bought within the United States not covered by his plan would count toward TrOOP. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. Singh would like drug coverage, but does not want to be enrolled into a health plan. d. Mrs. Lopez must first seek COBRA benefits under her husband's plan before she can apply for Part D coverage. Choose one answer. (Marketing representatives must not engage in any activity that would be considered discriminatory such as attempting to recruit Medicare beneficiaries from higher-income areas without making comparable efforts to recruit Medicare beneficiaries from lower-income areas.). You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. -After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. -Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. What should you tell her? One might be right for you. 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. Advertisement Okjaanu504 is waiting for your help. You may then proceed with the discussion. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. b. In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. 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. Mr. Kelly has substantial financial means. How can you explain this to him? What could you tell him to do? However, she gives a brief presentation that mentions plan-specific premiums. d. Juan is likely to be ineligible for Medicare since he was born outside the United States and has only contributed to the Medicare system for 20 years. Also, Original Medicare does not have a maximum out-of-pocket limit.). In general, Mrs. Ramos can obtain care from any provider who participates in Original Medicare but will have to pay the difference between the plan's allowed amount and the provider's usual and customary charge. 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. Learn about formularies, tiers of coverage, name brand and generic drug coverage. b. partnerships What should you tell her? The extra help is available only to Medicare beneficiaries who are enrolled in Medicaid. Which statement best describes the authorization process? (Agent John Miller can help prospect Jerry select a standalone Part D prescription drug plan that complements his current Original Medicare and Medigap coverage. What could you tell Mr. Moy? What should you tell her? Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. WebGet the right Medicare drug plan for you. If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. 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. The goal is to ensure and make health care more accessible to the people of the nation. The correct option is c. Health insurance or a plan that assists in the payment of prescription drugs and medications. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. (small GHPs do not have to continue to offer their age 65 and over employees and their spouses the same benefits under the GHP as individuals under age 65. III. -Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn's could look into that possibility. d. This could be considered discriminatory activity and a prohibited practice. What would be the correct description? I. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. 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. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. (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.). 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. 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? (Part D plans are not required to cover all prescriptions on the market. Medicare Advantage (MA) and Prescription Drug (PDP) plans. c. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred more than 30 days after the effective date of coverage. (October 10th is prior to the start of the Annual Election Period (AEP) which begins October 15th and ends December 7th. b. c. During the MA-OEP Miguel can send unsolicited print materials to seniors in his area advertising the opportunity to change from one MA plan to another. 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). 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. d. There is no limitation on meals. Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. a. If a legal representative is completing an electronic enrollment request, he or she must first upload proof of his or her authority. a. Official Medicare site. b. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. II. What should you tell him about the types of health plans that are available through the Medicare Advantage program? What should you tell her? After that point, her premium will return to the normal amount. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? What you should tell him is: He can enroll in a stand-alone prescription Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. c. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. , ches of government? b. (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.). 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. What options are available to Mary regarding her health plan coverage? What should you advise her to do before she will be able to enroll into a Medicare health plan? Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. (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.). During the MA-OEP Miguel can purchase a list of individuals who have chosen MA plans during Annual Enrollment Period (AEP) and create a marketing plan aimed at targeting them to select a plan he sells. d. Part A, which covers hospital, skilled nursing facility, hospice and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. He became eligible for Medicare when his disability eligibility determination was first made. 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. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. If the SEP is for MA coverage, he may only use the SEP to disenroll from his MA plan and return to Original Medicare. What should you tell her? 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. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. He is wondering if he can obtain coverage under Medicare. Marketing representatives may not accept enrollment forms and hold them before October 15th for enrollment under the AEP.). You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. Melissa Meadows is a marketing representative for Best Care which has recently introduced a Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Mr. Vaughn takes a prescription for helping to regrow his hair. c. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage. Anita Magri will turn age 65 in August 2020. 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 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. 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. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. What could you tell her to address her concern? Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred after the Annual Open Enrollment Period. Yes. 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. 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. He has tried two but had an allergic reaction to them. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). XYZ Agency maintains a website marketing the MA plans with which it has contracts. 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. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. When expanded it provides a list of search options that will switch the search inputs to match the current selection. Yes. c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start.