Agent John Miller is meeting with Jerry Smith, a new prospect. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. 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. Anita should instead consider a Medicare Advantage plan. Mr. Wu is eligible for Medicare. a. WebMr. 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. (Part D plans are not required to cover all prescriptions on the market. What should you tell her? -She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare. You may leave an enrollment kit and discuss a new life insurance product she might like. 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. Correct. This action is permissible. (Medicare Advantage is a way of covering Original Medicare, Part A and Part B benefits, through private health insurance plans.). b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. (Even if Mr. Vaughn's balding was the result of illness or a side effect of chemotherapy, by law Part D plans are not permitted to provide coverage for cosmetic purposes.). Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. (Part D formularies must include at least two drugs in each therapeutic category whether or not generic versions are available. She is considering enrollment in a Medicare health plan (Part C). d. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Mr. Prentice has many clients who are Medicare beneficiaries. 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. 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. She is traveling and wishes to fill two of the prescriptions that she has lost. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. However, these prescriptions are typically filled at a higher cost to these enrollees.). Question 4 Mr. Wu He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. 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. She has recently lost creditable coverage previously available through her husband's employer. 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. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. What could you tell him? (Individuals with disabilities who are under age 65 are automatically enrolled in Medicare Parts A and B the month after they have received Social Security or Railroad Retirement disability benefits for 24 months.). No uploaded proof is necessary. Call the plan. d. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered. b. (CMS must review and approve the materials in order for you to use them. Juan Perez, who d. It occurs from January 1 to February 14 of each year, so she will have to wait until that point to utilize that particular enrollment period. a. She sustained a hip fracture and is being successfully treated for that condition. Choose one answer. 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. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. 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. c. Enrollment in Cost plans offering Part D prescription drug coverage is not necessary because Cost plans offer more generous Part B benefits. It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs she needs. 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).). You may proceed with the discussion and enroll the individual if she so desires. What can you do in this situation? What can you tell her about Medigap as an option to address this concern? Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. (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. 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. 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. It is not necessary for ABC to obtain an authorization to simply explain pending state or federal legislation since there is no anticipation of selling a non-health related product in these circumstances. Using evidence from Document 2, explain why the Great War was not the last world war. 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. d. Gift cards or gift certificates of $15 or less that can be readily converted to cash. -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%. -SNPs limit enrollment to certain subpopulations of beneficiaries. What should you tell her? Determine the rhyme scheme in scaffolding. a. Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. Juan Perez, who 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. She agreed to sign a scope of appointment form and meet with you on October 15. 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. d. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. What impact, if any, will recent regulatory changes have upon Medigap plans? Also, private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. a. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. What should you tell him? Shortly thereafter Mrs. Quinn and received a letter informing her that she has been automatically enrolled in Medicare Part B. What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? Does the research of Margaret Mead support his position? (October 10th is prior to the start of the Annual Election Period (AEP) which begins October 15th and ends December 7th. (Under a Medicare Advantage (MA) SEP, beneficiaries generally have one opportunity to change their MA coverage. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. There is no requirement for a time and date stamp at the time the applicant enters the online site. 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. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare, but she may or may not qualify to rejoin her Medigap plan based on medical underwriting. She sustained a hip fracture and is being successfully treated for that condition. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. (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.). However, the plan does not provide drug benefits. Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. 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. b. Beneficiaries may make more than one enrollment choice during the AEP, but the last one made prior to the end of the AEP, as determined by the date the plan or marketing representative receives the completed enrollment form, will be the election that takes effect. 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. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Explain. d. The cost of the prescription drugs that are not on his plan's formulary as well as the cost of the drug(s) to reduce joint swelling from the Canadian pharmacy will count toward TrOOP but the other medications in question will not count toward TrOOP. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his 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. b. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. (Presentations may include light snacks, but marketing representatives must not provide full meals even if another entity provides or subsidizes the meal.). It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. d. Marketing in health care facilities is an acceptable practice, regardless of where it takes place. The hospital administration expresses some hesitation about allowing marketing in a health care facility. d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. Mrs. Schneider must wait until the Annual Election Period to make any changes in her enrollment in an MA or Part D plan. 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. You would need to ask Mr. Kelly if he is enrolled in Part A and Part D if he needs drug coverage. Mrs. Shields is covered by Original Medicare. However, use of electronic media must provide an opt-out process.). a. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. She might like provide drug benefits n't worry because there has been no change in coverage that Private! 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