Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. She is traveling and wishes to fill two of the prescriptions that she has lost. b. Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available January 1 next year. c. You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges. b. You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. If an individual already had one of the plans before January 1, 2020, they will be able to keep their plan. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. d. The vitamins the Vaughns are taking will be covered under Part D because their physician suggested they should take vitamins, but the hair loss medication cannot be covered. This is true even if the organization offers another PFFS plan under the same MA contract that includes a Part D benefit.). What should you tell him? 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. Cell phones in Japan are becoming more versatile than ever. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? As long as the marketing activities are conducted in a way that does not target healthy beneficiaries, it does not matter where in the hospital these activities are carried out. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. Singh would like drug coverage, but does not want to be enrolled into a health plan. II. What advice would you give her? What should you tell her? Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. She should use an existing prescription drug coverage to get as large a supply of her existing drugs as possible, and then pick new drugs that are covered under her Medicare plan's formulary. (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. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? Which of the following individuals is most likely to be eligible to enroll in a Medicare Advantage (MA) or Part D Plan? 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. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. b. WebAHIP 3 - question 9 Mr. Singh would like drug coverage but Doc Preview. Choose one answer. How would you advise him? To do so it must obtain authorization from the enrollees. Mr. Prentice has many clients who are Medicare beneficiaries. 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. b. The SEP continues for two months either after it begins or the month of the move, whichever is later.). 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. (Mrs. Roswell is a new enrollee. Anita comes to you for advice. c. Medicare prescription drug plans are required to cover drugs in each therapeutic category. Mr. He is wondering whether he can obtain coverage under Medicare. (There are some circumstances that allow for enrollees to utilize a non-network pharmacy. (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. When putting together advertisements for this event, what should you do? All advertising must be done by community organizations. What should you keep in mind to comply with the marketing requirements for MA plans? Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. 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. b. Mr. Singh can enroll in a stand-alone prescription drug plan What should you tell him? He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. -The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. (To avoid a late enrollment penalty, Mr. Hutchinson must have "creditable" coverage. 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 could you tell her about the implications of such a decision? She wants to enroll in a Part D plan. a. How should you respond? Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. c. They are major medical policies but are only for low-income beneficiaries with Medicare. What should you tell her? d. Part D plans do not have to cover all medications. ), You are doing a sales presentation for Mrs. Pearson. -Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. b. Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements several years ago. 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. b. Fresenius ~ CCHT Certification Preparation Te. What could you tell her to address her concern? WebWe need to reduce the cost of Hospitalization in India and that will require a multi-pronged approach that addresses the underlying factors that contribute to She should disenroll if she does not want to pay the monthly premiums. d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. a. D-SNP a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). a. -In order to join a Medicare Advantage plan, she also must enroll in Part B. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. How would you advise Agent John Miller to proceed? d. Yes. Correct. He does not have to enroll in a MA plan.). Agent John Miller is meeting with Jerry Smith, a new prospect. 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. 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. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. b. II and III only c. Enrollment in Cost plans offering Part D prescription drug coverage is not necessary because Cost plans offer more generous Part B benefits. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. What could you tell her? CMO Sambhal has given certificate to the 39 newly recruited ANM. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? d. Gift cards or gift certificates of $15 or less that can be readily converted to cash. Mrs. Burton is a retiree with substantial income. 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. b. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. What should you tell him? 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. Beneficiary income may not exceed 150 percent of the Federal Poverty Level (FPL). She comes to you for advice. What should you tell him? Two or more gifts whose combined value does not exceed $15. Assets may not exceed a limited amount also specified by the government.). d. Part D plans do not have to cover all medications. c. You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. What could you tell him? What should you do? (Marketing representatives may engage in marketing activities in common areas in a health care setting.). a. 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. Mobile phone makers in Japan have gone beyond the imagining phase. 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. What you should tell him is: He can enroll in a stand-alone prescription a. What should you tell him? -Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. -The extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government. 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