(CMS must review and approve the materials in order for you to use them. Madeline Martinez was widowed several years ago. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. 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.). I. c. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. a. a. -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. Otherwise, he has no problems functioning. Choose one answer. 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. a. -Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. c. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. 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. You would like to market a MA plan at a neighborhood pharmacy. Correct. c. Yes. 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 traveling and wishes to fill two of the prescriptions that she has lost. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. c. Tell her that the Medicare agency does not endorse or recommend any plan. d. The government bases its payments to Part D plans on the standard benefit model. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. II. As a dual eligible, her SEP takes place during the first 9 months of the year.). a. Enrollment in Cost plans offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage. What is medicare advantage plan? He wants to know if Medicare covers cancer screening. She would also like to enroll in a Medicare Supplement (Medigap) plan. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. Gifts of nominal retail value ($15 or less) 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. 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. What should you tell her? 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. c. Gifts worth more than $15 but based on anticipated attendance will not exceed $15 per attendee. Section 1332 waiver plans. She comes to you for advice about when she can enroll in a plan you have previously discussed. As long as the meal is paid for by another person or entity, you are permitted to invite your clients and their friends to partake of the meal at your sales presentation. In addition to drugs on his plan's formulary he takes several other medications. However, she gives a brief presentation that mentions plan-specific premiums. Describe G. Stanley Halls theory of adolescence. c. Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. A legal representative need only attest that he or she is legally authorized to complete the electronic enrollment request. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. What can you tell her about Medigap as an option to address this concern? Phiona is placed in charge of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. Original Medicare covers cosmetic surgery. Ralph's effective enrollment date is January 1st. d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage. 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. , ches of government? In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare? Daniel is a middle-income Medicare beneficiary. Mrs. Park is an elderly retiree. (Mrs. Lopez is enrolled in a Cost plan. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. ), Fresenius ~ CCHT Certification Preparation Te. 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. He has limited financial resources but failed to qualify for the Part D low-income subsidy. IV. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. c. Yes. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. She would also like to enroll in a Medicare Supplement (Medigap) plan. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. b. What should you tell him? (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.). What should you tell him? d. There is no limitation on meals. Mr. Castillo is still covered by Part A. Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. a. Choose one answer. d. I-SNP, c. C-SNP -They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. She is traveling and wishes to fill two of the prescriptions that she has lost. In addition, in order to enroll in a specific PFFS plan, the individual must permanently reside in the plan's service area - not whether his doctor will accept the terms and conditions of the PFFS plan.). (Sales presentations and distribution or acceptance of enrollment forms are prohibited when an event is advertised as educational.). a. Agent Jennings distributes materials that are solely educational in nature. c. Medicare prescription drug plans are required to cover drugs in each therapeutic category. 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 a. SNPs only serve individuals in long-term care facilities, so he cannot enroll. d. Plans may not participate in advertising such an event. Her husband worked for many years and contributed into the Medicare system. C. upward sloping at low wage rates but becomes downward sloping at Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. (Mr.Greco's circumstances would not meet the eligibility criteria to qualify him for any of the SNPs.). Mr. Shapiro gets by on a very small amount of fixed income. What should you keep in mind to comply with the marketing requirements for MA plans? 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. 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. But they have various methods to manage costs including formularies, cost-sharing tiers, step therapy, prior authorization and substitution.). c. During the MA-OEP Miguel can send unsolicited print materials to seniors in his area advertising the opportunity to change from one MA plan to another. . She can enroll in the PPO and purchase drug coverage through a Medigap plan. d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. Mr. Shapiro gets by on a very small amount of fixed income. d. You would be happy to help Anita enroll in a Medigap Part F plan will provide foreign travel benefits as a well as cover her Part B deductible. Yes. a. Mr. Zachow will need to enroll in a Special Needs Plan to obtain coverage for his medication. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. She is considering enrollment in a Medicare health plan (Part C). Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. (Mrs. Walters is eligible to enroll in Part D because she is entitled to Part A. Alternatively, Agent Miller can suggest that Jerry drop his Medigap coverage and enroll in a MA-PD plan.). What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? d. She must remain enrolled in her ABC MA plan unless the plan terminates. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. b. How would you advise him? You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. (Mrs. Roswell is a new enrollee. a. (In order to enroll in a Medicare Advantage (MA) plan, an individual must be entitled to Part A and enrolled in Part B. 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