He is wondering if he can obtain coverage under Medicare. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. What could you She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. 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). Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. What should you tell her? a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. Correct. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. I. ), Fresenius ~ CCHT Certification Preparation Te. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. Agent Jennings makes a presentation on Medicare advertised as an educational event. (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.). c. Original Medicare covers routine dental care. (Chronic condition SNPs (C-SNPs) restrict enrollment and tailor services to individuals with chronic conditions, such as Mr. Sinclair. What could you tell her? He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? 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. Better CE - Prop & Casualty Continuing Educat, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese. c. The Part B deductible will be covered for some newly eligible individuals depending on their financial status. (There are some circumstances that allow for enrollees to utilize a non-network pharmacy. 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. What should you tell her? c. You do not have to do anything. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. -Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. - 27968462 Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. b. Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area. AHIP 2018 Module 5 - Enrollment Guidance Medi, AHIP 2018 Module 4 - Marketing Medicare Advan, AHIP 2018 Module 3 - Part D and Other Coverage, AHIP 2018 Module 3 - Part D Enrollee Costs an. The standalone plan got this name due to the fact that the drug coverage is a separate plan that the beneficiaries may be able to purchase. He will incur a late enrollment penalty. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. (In order to enroll in a Medicare Advantage (MA) plan, an individual must be entitled to Part A and enrolled in Part B. Mr. Castillo is covered by Plan A but no longer enrolled in Medicare Part B so he cannot enroll in MA plan until he re-enrolls in Part B.). c. Mr. Kumar will be able to obtain routine care outside of the plan's service area but will pay a higher co-payment (except in an emergency). d. SNPs offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will always be lower than in Original Medicare. a. a. -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. 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. Agent Jennings distributes materials that are solely educational in nature. This could be considered discriminatory activity, but it is not a prohibited practice. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. c. SNPs limit enrollment to certain subpopulations of beneficiaries. Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). (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.). a. Agent Jennings distributes materials that are solely educational in nature. d. Prior to speaking with the individual, you must inquire as to her eligibility for MA and Part D plans and then complete a scope of appointment form for the plans for which she is eligible. 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). 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. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because eligibility to use the OEP is available only to MA enrollees. WebThis button displays the currently selected search type. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. What could you tell her? 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. Part B primarily covers physician services. c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income. I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. 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. What could you tell her? He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). "Are you interested in a Medicare supplement plan or a Medicare health plan?" She is in excellent health and will have considerable income when she retires. a. sole proprietorships Mrs. Park is an elderly retiree. None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary. -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. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? b. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. (CMS must review and approve the materials in order for you to use them. You can specify conditions of storing and accessing cookies in your browser. What could you tell Mrs. Park that might be of assistance? 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. Call me to find out more!" 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. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. a. b. Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). What should you tell him? a. All advertising must be done by community organizations. (Edward is not likely to qualify for either a MA or Part D SEP because he has moved within his existing plan's service area. You work for a company that has marketed Medigap products for many years. She could enroll in the PFFS plan and a Medigap plan that offers drug coverage, but not in a stand-alone Medicare prescription drug plan. What could you tell her about the implications of such a decision? d. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, she will be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. a. I and II only Premiums, plan formularies, and cost-sharing, among other factors, may change from one plan year to another.). How would you advise Agent John Miller to proceed? a. (October 10th is prior to the start of the Annual Election Period (AEP) which begins October 15th and ends December 7th. WebMr. In order to obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. (Marketing representatives may engage in marketing activities in a retail pharmacy in common areas. What should you tell him? a. c. What are the possible consequences. (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. There is no requirement for a time and date stamp at the time the applicant enters the online site. Correct. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. (MA-PPO enrollees may seek care from any provider who accepts Medicare. b. In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so he will need to transfer the funds prior to beginning such withdrawals. What should you tell her? Dixie State University. Mr. Shapiro gets by on a very small amount of fixed income. b. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a prescription drug plan. What could you tell her? When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. WebMr. a. c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services. None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary. 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? c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. However, use of electronic media must provide an opt-out process.). Original Medicare covers cosmetic surgery. Since Ms. Gonzales chose to remain in Original Medicare, she cannot change plans during the MA OEP. What should you tell him? Mr. Shultz was still working when he first qualified for Medicare. b. c. 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. 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. c. He is not eligible to enroll in a Medicare Advantage as a naturalized citizen. b. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. What should you tell him? (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.). 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. a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. a. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. What should you tell her? a. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because eligibility to use the OEP is available only to MA enrollees. A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Marketing representatives may respond to beneficiary requests for one-on-one meetings.). 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. You are working with a number of plans and community organizations to sponsor an educational event. d. This could be considered discriminatory activity and a prohibited practice. d. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Mr. Wu is eligible for Medicare. d. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan. What is the difference between a sign and a symptom? b. Aaditiananta Answer: Handing out enrollment forms, on the other hand, would not be permissible. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. a. Medicare Advantage is a new name for the Original Medicare program. What would be the correct description? Ralph's effective enrollment date is January 1st. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Call me to find out more!". The cost of all medications bought within the United States not covered by his plan would count toward TrOOP. Because of high demand for these cars, dealerships all want to receive as many cars as they can from the regional sales manager. You can specify conditions of storing and accessing cookies in your browser. (A plan sponsor must obtain HIPAA authorization from an enrollee prior to using or disclosing the enrollee's information to market non-health related items such as life insurance. Total views 20. 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. b. Under what circumstances can she do this? 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. d. Mrs. Lopez must first seek COBRA benefits under her husband's plan before she can apply for Part D coverage. c. If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. (Agent John Miller can help prospect Jerry select a standalone Part D prescription drug plan that complements his current Original Medicare and Medigap coverage. Ms. Claggett is sixty-six (66) years old. This provides her with options as to how she secures Part D benefits. 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. Web39 ANMs successfully completed 12-days induction training at ANMTC Chandausi. b. FIDE-SNP Gift cards or gift certificates of $15 or less that can be readily converted to cash. a. Mr. Hutchinson has drug coverage through his former employer's retiree plan. d. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. PCs are also able to function as phones. How would you respond? What is t At that time, he had employer group coverage that was creditable. c. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. a. 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. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? With the certificate of deposit, you make an initial investment at the beginning of the first year. 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