What advice would you give her? However, this SEP is not an opportunity to select another MA plan.). (Educational events must be explicitly advertised as educational). How would you respond? c. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. b. 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%. b. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? Suppose that xxx has a hypergeometric distribution with N=10N =10N=10, r=4r = 4r=4, and n=3.n = 3.n=3. Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare. a. a. 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. Before engaging in such a discussion, what should you do? 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. 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. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. a. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. (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.). Most individuals who are citizens and age 65 or over and wish to be covered under Part A must enroll in a Medicare Advantage Plan. What should you tell him? What could you tell her? Agent Jennings makes a presentation on Medicare advertised as an educational event. Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. WebMr. b. a. c. Tell Mr. Anderson that you cannot accept an enrollment form for coverage to begin on January 1 of next year prior to December 15. What could you tell Mrs. Park that might be of assistance? During the MA-OEP Miguel can make unsolicited calls to former enrollees who have selected a new plan during the Annual Enrollment Period (AEP). Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. You may offer meals to existing enrollees of the plan(s) you represent, but potential enrollees may not have a meal. What should you tell him? Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). He wants to know if he must use doctors in a network as his current HMO plan requires him to do. WebDownloaded from mr.vathorstcollege.nl on by @guest them. (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. She would also like to enroll in a Medicare Supplement (Medigap) plan. d. Tell her that, because you represent a Medicare health plan, you therefore work for Medicare, and the information you offer her is a good basis of any decision she makes. Madeline Martinez was widowed several years ago. Ranveer Singh is known as the energy powerhouse in Bollywood. 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. a. SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. c. Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. Explain. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Call me direct to learn more." 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. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. How would you respond? -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. 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. If an individual was eligible for Medicare before January 1, 2020, but not yet enrolled, his or she may be able to purchase one of these plans.). c. She may continue to keep her existing plan, because all Medicare health plans are required to provide coverage to anyone, no matter where they live. -SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. Also, Original Medicare does not have a maximum out-of-pocket limit.). Choose one answer. Marketing representatives may not offer gifts in the form of cash or that can easily be converted to cash.). 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. -Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. a. SNPs only serve individuals in long-term care facilities, so he cannot enroll. She wants to understand what this means. (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.). You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participation in the Medicare system. Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements several years ago. b. She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. -Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. -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. 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. 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. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. WebIf Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. She is concerned that her income will make it impossible for her to qualify for Medicare. a. Correct. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. d. There is no limitation on meals. What can you tell her about Medigap as an option to address this concern? Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare. What should you tell him? Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. She comes to you for advice about when she can enroll in a plan you have previously discussed. (Mr.Greco's circumstances would not meet the eligibility criteria to qualify him for any of the SNPs.). -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. Gifts of nominal retail value ($15 or less) The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. d. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. c. The Medicare Part D drug plan is required to offer her coverage of the exact same drugs that she is currently stabilized on, so she does not need to be concerned about transitioning to any new medications. She can enroll in the PPO and purchase drug coverage through a Medigap 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. 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. IV. In order to obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. IV. (The Medicare Advantage Open Enrollment Period (MA OEP) is only available to those who have enrolled in Medicare Advantage. -They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. 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. To do so it must obtain authorization from the enrollees. Mr. Castillo is still covered by Part A. In addition to drugs on his plan's formulary he takes several other medications. She has recently lost creditable coverage previously available through her husband's employer. What should you tell him? II. What could you tell him? You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. What could you tell him? Which type of SNP is likely to be most appropriate for him? If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. During the appointment, what are you permitted to do? When expanded it provides a list of search options that will switch the search inputs to match the current selection. Nutlins: Nutlins act by sterically inhibiting MDM2 at its p53 binding pocket. b. WebMakenna Name Puns, I gotta admit lol I loved kolhatkars first comedy show, but the jokes I liked were the ones not necessarily related to his Indian heritage. b. You are working with a number of plans and community organizations to sponsor an educational event. You would be happy to help Anita enroll in a Medigap plan but before she can do so, she must also enroll in a Medicare Part D prescription drug plan. She is concerned about whether or not Medicare will cover these items and services. b. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Pearson? b. d. As long as Mrs. Mulcahy is 65, eligibility for a Medicare prescription drug plan is not dependent on entitlement to Part A or enrollment under Part B, so she should not be concerned. Will she be able to? a. She currently does not have creditable coverage. The Supreme Court must decide whether the treaty is constitutional, but Congress can override the court with approval of the president. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. What could you tell her to address her concern? . Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. Newer models of cell phones contain a myriad of applications and can do many of the things that a personal computer (PC) can do. -Original Medicare covers ambulance services. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. c. Tell prospect Jerry Smith that he should drop his Medigap coverage and put those premium dollars toward the purchase of a standalone Part D prescription drug plan because he can always reactivate his Medigap policy on a guaranteed issue basis. Medicare health plans must provide enrollees with a written description of the appeals process.). You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. He wants to know whether he might qualify. , Which scenario best illustrates how the power to make treaties in the United States Consituttion provides for checks and balances among the three bran (Part D formularies must include at least two drugs in each therapeutic category whether or not generic versions are available. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. All plans must cover at least the standard Part D coverage or its actuarial equivalent. (An individual may enroll in a stand-alone Medicare Part D prescription drug plan (PDP) if they are enrolled in a PFFS plan that does not include Part D drug coverage or a MSA plan. 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