mr singh would like drug coverage

He will incur a late enrollment penalty. c. All Medicare Advantage Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original 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. 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. I. c. MSA enrollees may only receive covered health care services from a limited panel of network providers because otherwise, some providers may charge more than Original Medicare rates. -Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. a. (Mr. Kelly does not need to be enrolled in Part A to be eligible to enroll in a Medicare Advantage PFFS plan. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? -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 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. I. WebMr. (Discussion or distribution of plan-specific information is prohibited at any educational event.). (Some pharmaceutical manufacturers operate programs that assist low-income individuals. You must set up your table, make marketing presentations, and accept enrollment applications near the pharmacy counter where people wait for their prescriptions. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? 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. Which type of SNP is likely to be most appropriate for him? (There are coordinated care Medicare Advantage plans that include HMOs and PPOs. In setting up the enrollment site, which of the following must Phiona consider? -Original Medicare covers ambulance services. He has limited financial resources but failed to qualify for the Part D low-income subsidy. (Mrs. Walters is a dual-eligible. -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. The Part D Initial Enrollment Period occurs only when a beneficiary turns 62 so it cannot be used as the justification for allowing her to enroll at this point. He is wondering if he can obtain coverage under Medicare. d. I, II, and III only, d. I, II, and III only 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. The cost of all medications bought within the United States not covered by his plan would count toward TrOOP. b. In addition to drugs on his plan's formulary he takes several other medications. She will have a six-month window during which she can select a plan other than the one into which she has been automatically enrolled. However, use of electronic media must provide an opt-out process.). If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. Also, Original Medicare does not have a maximum out-of-pocket limit.). a. d. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage. a. You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? 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. d. She should wait to fill her prescriptions until she is back home since only her local pharmacy is likely to be in her plan's network. -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%. II. c. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy." Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. 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. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). Choose one answer. I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing plan's service area. To do so it must obtain authorization from the enrollees. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this. What should you tell him? What should you do? 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? (Educational events must be explicitly advertised as educational). a. Daniel is a middle-income Medicare beneficiary. However, she gives a brief presentation that mentions plan-specific premiums. 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. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. WebThis button displays the currently selected search type. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. What should you tell her? c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. a. What Medicare Part D drug plans cover Overview of what Medicare drug plans cover. Only the third drug works for him and it is not on his Part D plan's formulary. Weba. (Presentations may include light snacks, but marketing representatives must not provide full meals even if another entity provides or subsidizes the meal.). While unsolicited contacts may be made through print media such as direct mail, marketing representatives may not initiate electronic contact. What could you tell her? Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. Mr. Prentice has many clients who are Medicare beneficiaries. a. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. She has a low, fixed income. The mechanism must advise each individual at the beginning of the process that he or she is completing an actual enrollment request. c. You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans. -In general, he must select a single Part D premium payment mechanism that will be used throughout the year. -She may remain in her ABC MA plan, enroll in another MA plan in her service area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Anita intends to enroll in Original Medicare Part A and Part B. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? b. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. 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. (Eligibility to enroll in a Medicare Advantage plan requires entitlement to benefits under Part A and enrollment in Part B. She must write to the plan and wait for a response and then, if she is still dissatisfied, she could file an appeal with her state Medicaid office requesting transfer to one of its managed care plans. 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. 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. b. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. 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. a. 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. (Starting January 1, 2020, Medigap plans sold to individuals who are newly eligible to Medicare will not be allowed to cover the Part B deductible. d. nonprofit organizations. d. He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium penalty. what should you tell Okjaanu504 She is considering enrollment in a Medicare Advantage plan (Part C). Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program. c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. III. b. 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. -Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. b. a. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. There is no disadvantage in doing so. WebNo. ABC is a Medicare Advantage (MA) plan sponsor. Rules regarding unsolicited contact do not apply to marketing through these materials. b. partnerships What should you tell him . His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. Mrs. Shields is Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a 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). They are anxious to have their Medicare prescription drug plan cover these drug needs. Qualifying for this state program gives Mrs. Schneider access to a Special Enrollment Period that allows her to make changes to her MA and/or Part D enrollment during the first 9 months of each calendar year. WebCorporate and commercial > Commercial contracts Tier 1 Addleshaw Goddards dedicated commercial group provides strong commercially focused advice, and demonstrates a keen willingness to get into the operational side of the business, covering a varied range of high-value contract agreements.Leveraging its expertise across the retail, financial services, Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. Becky has just started a new job as controller for Mueller Imports, a much larger dealer for the same car manufacturer. How would you advise Agent John Miller to proceed? Section 1332 waiver plans. (Mr. Schultz should enroll in a Part D plan, or otherwise obtain creditable drug coverage, before he has a 63-day break in order to avoid a premium penalty.). You may then proceed with the discussion. What should you tell him?. b. -Medicare prescription drug plans are required to cover drugs in each therapeutic category. Choose one answer. a. The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. Correct. a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. What could you tell him? -An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. 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. a. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. At that time, he had employer group coverage that was creditable. b. When putting together advertisements for this event, what should you do? c. In general, Mrs. Ramos will need a referral to see specialists. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. You will have to attend one of several remedial training events sponsored by the Medicare agency before being allowed to retake the test. He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? Why do you think Seamus Heaney might have chosen this rhyme scheme for a poem about a couples relationship He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. 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. She is 4 pounds 4 ounces. 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. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage. (Betsy is not a United States citizen nor is she legally present in the country having overstayed her visa. 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. 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. Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. What should you tell her? 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. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. All SNPs include prescription drug coverage.). a. c. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. d. Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. Correct. 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.). Assets may not exceed a limited amount also specified by the government.). Next week you will be participating in your first "educational event" for prospective enrollees. 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. She wants to enroll in a Part D plan. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields long-term care costs. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. a. ), Which of the following statements about Medicare Part D are correct? a. Mrs. Burton is a retiree with substantial income. He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? It is not available to those who chosen coverage through Original Medicare. What would be the correct description? Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. ing. The techniques he uses to control those around him. His relationships with Ariel, Miranda, and Caliban. What all this tells you about his character. Webc. a. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. d. The government bases its payments to Part D plans on the standard benefit model. What should you tell him? c. You may provide her with the required enrollment materials and take her completed enrollment application. b. Some terms may not be used. How should you respond? 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. Where might he turn for help with his prescription drug costs? Where might he turn for help with his prescription drug costs? Ms. Moore plans to retire when she turns 65 in a few months. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. Also, private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. Agent John Miller is meeting with Jerry Smith, a new prospect. d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP), but he lost the paper that explains what he could do during the SEP. What can you tell him? b. Enrollment in Cost plans offering Part D coverage is generally available only 30 days per year, because of the more generous benefits of these plans. 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. a. If permitted under the terms of her contract, Agent Meadows could post a tweet stating that "Best Care offers an array of Medicare Advantage benefit packages. Gift cards or gift certificates of $15 or less that can be readily converted to cash.

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