c. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan. "If you're not in very good health, you will probably do better with a different product." -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. a. 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 keep in mind to comply with the marketing requirements for MA plans? Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? b. Mr. Vaughn takes a prescription for helping to regrow his hair. d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. 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. What should you say? 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 them? Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. a. Medicare health plans must cover all benefits available under Medicare Part A and Part B. -She cannot enroll in an MA Medical Savings Account (MSA) plan. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. b. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. With the certificate of deposit, you make an initial investment at the beginning of the first year. b. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. b. b. 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. 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. What can you tell her? Determine the rhyme scheme in scaffolding. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. Correct. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. Correct. 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. b. a. d. 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. a. Medicare Health 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. d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. I. What could you tell her? Part D plans are permitted to offer supplemental benefits that cover certain drugs not covered under Part D. Some Part D plans may offer these supplemental benefits for an additional monthly premium.). 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). He became eligible for Medicare when his disability eligibility determination was first made. -He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. Therefore, this answer is the best description of the authorization process in these circumstances.). How should you respond? Madeline Martinez was widowed several years ago. -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. He is wondering if he can obtain coverage under Medicare. 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. She is considering enrollment in a Medicare health plan (Part C). d. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state for Medicaid assistance. What should you tell her? Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D? Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. What should you tell him? - 27968462 The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. 1 See answer Advertisement MrsCA Answer: She could enroll in a PFFS plan and a stand-alone Medicare prescription Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. a. What should you tell him? d. Mr. Singh He wants to know if he must use doctors in a network as his current HMO plan requires him to do. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. She may need to pay for this particular medication out of pocket. He has limited financial resources but failed to qualify for the Part D low-income subsidy. d. 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. II. 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. 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. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. 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. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. b. There is no requirement for a time and date stamp at the time the applicant enters the online site. d. Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. Her husband worked for many years and contributed into the Medicare system. She asks you to explain it. 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. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. a. 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.). 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. 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 only to a MA plan that includes prescription drug coverage. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. Part D plans may use varying co-payments for brand name and generic drugs, but they may not restrict access through prior authorization. What should you tell him? (There are coordinated care Medicare Advantage plans that include HMOs and PPOs. What should you tell him? In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? 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. What could you tell him? c. In general, Mrs. Ramos will need a referral to see specialists. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. 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. c. Standard Part D coverage would require payment of an annual deductible, fixed per-prescription co-payments, and once catastrophic coverage begins, the plan covers 100% of all costs. b. 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. If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications. Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. What could you What questions would you need to ask to determine his eligibility? c. Part B will cover her dental and vision needs. c. Mr. Zachow could immediately disenroll from the Part D plan and select a new Part D plan that covers the drug that works for him. -Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least as good as the standard model established by the government. WebMr. What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? a. Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least as good as the standard model established by the government. What could you tell Mr. Moy? She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. d. Yes. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What could you tell her to address her concern? She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. b. She is concerned that her income will make it impossible for her to qualify for Medicare. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B, if he is healthy, and how often he expects to visit a doctor. "Are you interested in a Medicare supplement plan or a Medicare health plan?" Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's service area next month. Is this a prohibited activity at an event that has been advertised as educational? Cell phones in Japan are becoming more versatile than ever. Correct. The correct option is c. Health insurance or a plan that assists in the payment of prescription drugs and medications. 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. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. In the meantime, he will have to pay for his drug out of pocket. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. No. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. Beneficiary income may not exceed 150 percent of the Federal Poverty Level (FPL). Mr. Hutchinson has drug coverage through his former employer's retiree plan. c. C-SNP How would you respond? 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. Using evidence from Document 2, explain why the Great War was not the last world war. Coverage under the Medicare prescription drug plan in these circumstances. ) enrolled under Part B Medicare drug... To address her concern cell phones in Japan are becoming more versatile than ever begins on the month... Which of the first year coverage under Medicare Part D prescription drug plan is required to cover a one-month... 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