d. TrOOP refers to true out-of-pocket expenses paid by drug manufacturers on behalf of Medicare Part D beneficiaries. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. Her husband worked for many years and contributed into the Medicare system. It occurs from October 15 to December 7 of each year, so she will have to wait until that point to utilize that particular enrollment period. 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. a. a. Aaditiananta Answer: -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. b. 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. Match the terms with the definition. 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. -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. ART. Gilbert is likely to qualify for a Part D SEP because he has gained the opportunity to enroll in Part D prescription drug coverage. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. She is interested in selecting a Medicare Part D prescription drug plan. c. She cannot enroll in an MA Medical Savings Account (MSA) plan. Add your answer and earn points. In setting up the enrollment site, which of the following must Phiona consider? However, the plan does not provide drug benefits. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. WebGet the right Medicare drug plan for you. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. The approval process requires that the plan you represent submit the materials.). 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 specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? WebA: 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 can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. No. 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. (Generally, a Part D beneficiary must stay with a premium payment option for the entire plan year.). Alternatively, Agent Miller can suggest that Jerry drop his Medigap coverage and enroll in a MA-PD plan.). Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. II. What should you keep in mind to comply with the marketing requirements for MA plans? Mr. singh would like drug coverage, but does not want to be enrolled into a health plan. You may leave an enrollment kit and discuss a new life insurance product she might like. He is wondering whether he can obtain coverage under Medicare. Her husband worked for many years and contributed into the Medicare system. Using evidence from Document 2, explain why the Great War was not the last world war. c. Mr. Carlini can obtain drug coverage through the Federal government's fallback plans, which are designed to provide an alternative to privately sponsored Medicare Advantage plans. There are also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and Special Needs Plans (SNPs).). b. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. 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? b. Correct. 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. A legal representative need only attest that he or she is legally authorized to complete the electronic enrollment request. a. What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. a. I and II only What should you tell him? In addition, they can use cost containment techniques such as tiered co-payments and prior authorization. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Ms. Moore plans to retire when she turns 65 in a few months. In order to join a Medicare Advantage plan, she must be enrolled in Parts A, B, and D. In addition, some states have assistance programs specifically for their residents. When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. However, this SEP is not an opportunity to select another MA plan.). She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. What questions would you need to ask to determine his eligibility? c. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? No. -They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. What should you tell her? 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. 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. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. 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. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. She has recently lost creditable coverage previously available through her husband's employer. Her husband worked for many years and contributed into the Medicare system. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. b. ABC is a Medicare Advantage (MA) plan sponsor. At that time, he had employer group coverage that was creditable. 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. b. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. WebMr. 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. c. 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 have to pay a one-time penalty equal to 10% of the annual premium amount. She is concerned that her income will make it impossible for her to qualify for Medicare. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. (To avoid a late enrollment penalty, Mr. Hutchinson must have "creditable" coverage. Question 4 Mr. Wu 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. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. What should you tell her? Correct. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. Correct. Total views 20. -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). Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. b. Mr. Schultz should immediately enroll in a Part D plan but he can expect to pay a premium penalty because he failed to enroll when first eligible. 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. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. a. 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. Singh would like drug coverage, but does not want to be enrolled into a health plan. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? What could you tell Mrs. Park that might be of assistance? However, the plan does not provide drug benefits. (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. 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 uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. Call me to find out more!". 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. 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. Mrs. Burton is a retiree with substantial income. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. She wants to understand what this means. The DVM orders the following medication Acepromazine(1mg/mL) at 0.025 mg/kg. 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. She wants to understand what this means. What should you tell him?. Is this a prohibited activity at an event that has been advertised as educational? Mrs. Claggett is now 66 years old and her Part D IEP based on attaining age 65 has now expired so she will not be able to use it to enroll in Part D.). He does not have to enroll in a MA plan.). b. 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.
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