An individual is eligible to enroll in Part D if the individual is entitled to Part A or enrolled in Part B. (Mrs. Walters is a dual-eligible. c. Mr. Vaughn's hair growth medication would only be covered under Part D if his balding resulted from an illness or was a side effect of a treatment such as chemotherapy. b. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. Dixie State University. Beneficiary income may not exceed 150 percent of the Federal Poverty Level (FPL). When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. 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. (This statement may discourage Mrs. Pearson from enrollment due to her health status. Mrs. Schneider has Original Medicare Parts A and B and has just qualified for her state's Medicaid program, so the state is now paying her Part B premium and she is considered a dual eligible. 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. However, this SEP is not an opportunity to select another MA plan.). b. I, II, III, and IV It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs she needs. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell her? 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. On a separate sheet of paper, explain the following term by using it correctly in a sentence. However, the plan does not provide drug benefits. a. b. a. -She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. d. She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. 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. What should you tell him? (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.). What would be the correct description? 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. Correct. b. What should you tell him? d. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. 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. How would you advise Agent John Miller to proceed? This action is permissible. Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D? I. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. Correct. -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. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. Answer: Mr. Singh can enroll in a stand-alone The MA PPO plan does not include drug coverage, but the other two plans do. 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. 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. No. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. -Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. d. 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. a. II, III, and IV only Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. 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. Write out the probability distribution of xxx. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. A pobreza da alma causa pena qual substantivo e? Mrs. Shields is covered by Original Medicare. He should apply for coverage under his state's Medicaid program to access the extra help with his drug costs. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. What questions would you need to ask to determine his eligibility? You will have to attend one of several remedial training events sponsored by the Medicare agency before being allowed to retake the test. d. He should wait for at least six months into the plan year to be sure that he really wants to make the change. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. Official Medicare site. 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. d. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location. What can you do in this situation? -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. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. One might be right for you. a. Better CE - Prop & Casualty Continuing Educat, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese. 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. She is in excellent health and will have considerable income when she retires. a. Fresenius ~ CCHT Certification Preparation Te. b. a. 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 him? He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. -He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. b. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. 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. She wants to enroll in a Part D plan. Next week you will be participating in your first "educational event" for prospective enrollees. d. Part D plans do not have to cover all medications. Mrs. Schneider must wait until the Annual Election Period to make any changes in her enrollment in an MA or Part D plan. a. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. a. d. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage. (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.). How would you respond? b. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. He has tried two but had an allergic reaction to them. He is wondering if he can obtain coverage under Medicare. What could you tell her? What should you tell her? Anita Magri will turn age 65 in August 2020. 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. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. "Are you interested in a Medicare supplement plan or a Medicare health plan?" Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. b. During the MA Open Enrollment Period, from January 1 - March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. 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. What should you tell him?. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. c. Yes. Singh would like drug coverage, but does not want to be enrolled into a health plan. b. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. She comes to you for advice. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. b. Mrs. Shields is covered by Original Medicare. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan., Mr. Alonso receives some help The president must sign an executive agreement without the Senate, but must have approval of the House and the Supreme Court. Some terms may apply to more than one category. c. SNPs are essentially the same as Original Medicare and are not likely to have a noticeable impact on how Mr. Sinclair receives his care. d. Part D plans do not have to cover all medications. b. She is traveling and wishes to fill two of the prescriptions that she has lost. What should you tell Mrs. Quinn? There is no testing requirement for agents/brokers that only market employer/union group plans.). 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). Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. what should you tell Okjaanu504 d. Original Medicare covers ambulance services. 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. What should you tell her? If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out and signing the form. c. During the MA Open Enrollment Period, from January 1 - March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy. 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. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? Whether or not an event has been advertised as "educational" or a "sales presentation," discussing plan-specific information is impermissible. 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. You must set up your table, make marketing presentations, and accept enrollment applications only in common areas outside of where the patient waits for services from the pharmacist. 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. Additionally, beneficiaries enrolled in an MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP.). b. b. Consequently, Shamalay was not very profitable. c. C-SNP Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan. He has chronic bronchitis, putting him at severe risk for pneumonia. a. c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. b. Call the plan. Original Medicare covers ambulance services. All advertising must be done by community organizations. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. c. I only 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 Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. If he missed this opportunity, he will not be able to apply for the extra help again until the next annual enrollment period. II. What should you tell him? 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. Webc. b. 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. Her husband worked for many years and contributed into the Medicare system. a. Enrollment in Cost plans offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. 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. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. In a retail pharmacy, this would be areas away from the pharmacy counter where patients receive services from the pharmacist.). Web(4) Some prior distributions used in DisMod-MR, the Bayesian meta-regression tool used to simultaneously estimate incidence, prevalence, remission, excess mortality, and cause-specific mortality, were revised on the basis of simulation studies showing that less informative priors helped to improve the coverage of uncertainty intervals. -Part D plans do not have to cover all medications. She is traveling and wishes to fill two of the prescriptions that she has lost. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. During the appointment, what are you permitted to do? a. What should you tell him? There are also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and Special Needs Plans (SNPs).). Alternatively, Agent Miller can suggest that Jerry drop his Medigap coverage and enroll in a MA-PD plan.). -They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Cell phones in Japan are becoming more versatile than ever. d. Mrs. Lopez must first seek COBRA benefits under her husband's plan before she can apply for Part D coverage. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. 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. If an individual already had one of the plans before January 1, 2020, they will be able to keep their plan. What could you tell him? Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. (Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. Mr. Wu is eligible for Medicare. -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. (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. c. SNPs limit enrollment to certain subpopulations of beneficiaries. (Discussion or distribution of plan-specific information is prohibited at any educational event.). Has been advertised as `` educational event the Part B deductible will no longer under... Is so she can immediately enroll and have prescription drug ( PDP coverage! 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A MA-PD plan. ). ). ). ). ). ). ) ). No longer be covered for individuals newly eligible for Medicare starting January 1,.... Discourage mrs. Pearson from enrollment due to her health status the appointment, what are you permitted to?... Original Medicare and if he will be able to enroll in a Medicare Advantage plan that includes drug...