However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. -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). However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell her? Mr. Denton is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. d. 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. What should you tell him? Below we countdown to Simmi Singh upcoming birthday. Demand for this particular make of car is exploding, and the manufacturer cannot produce enough to satisfy demand. -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. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. c. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D to a MA or MA-PD plan. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields long-term care costs. -She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. You are visiting with Mr. Tully and his daughter at her request. Authorization can be obtained by directing a beneficiary to a website to provided consent as long as the website contains a mechanism for an electronic signature that is valid under applicable law. What could you tell her to address her concern? a. TTY: 1-877-486-2048. c. If the SEP is for Part D coverage, he may only drop, but not add or change, his Part D coverage one time before the SEP expires. Where might he turn for help with his prescription drug costs? 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. a. 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. 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. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. c. SNPs limit enrollment to certain subpopulations of beneficiaries. She can enroll in the PPO and purchase drug coverage through a Medigap plan. You work for a company that has marketed Medigap products for many years. -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. What should you tell her? because the content does not contain any plan-specific information about benefits, premiums, cost-sharing, or Star Ratings. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. 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. d. She must wait until the next MA Open Enrollment Period (OEP) during which she can elect to return to Original Medicare. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. b. An individual is eligible to enroll in Part D if the individual is entitled to Part A or enrolled in Part B. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. 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. What could you tell him? b. 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. If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. 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. b. Can his daughter fill out the enrollment form and sign it for him? What could you tell her about the implications of such a decision? Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. -Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. What should you tell her about obtaining drug coverage? d. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. Juan Perez, who 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. One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. Mr. Wu is eligible for Medicare. b. Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. a. He wants to know if Medicare covers cancer screening. a. WebGet the right Medicare drug plan for you. a. d. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. (An individual enrolled in a MA PFFS plan that does not include a Part D benefit may enroll in a stand-alone Part D prescription drug plan. Alternatively, Agent Miller can suggest that Jerry drop his Medigap coverage and enroll in a MA-PD plan.). a. 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. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. Mr. Wu is eligible for Medicare. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. She is in excellent health and will have considerable income when she retires. What could you tell Mrs. Park that might be of assistance? d. There is no limitation on meals. At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the companies John represents offer more comprehensive coverage for a lower price. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. c. Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they have changed. d. This could be considered discriminatory activity and a prohibited practice. Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90-day transition period. Agent John Miller is meeting with Jerry Smith, a new prospect. Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is opened marketing representatives may also follow-up with unsolicited telephone calls. Singh would like drug coverage, but does not want to be enrolled into a health plan. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. a. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. c. I only This is a social security program. a. sole proprietorships d. Yes. Part B primarily covers physician services. What you should tell him is: He can enroll in a stand-alone prescription Her recent videos also seem like the same old recycled jokes over and over again. b. As long as he has any sort of employer coverage, regardless of the level of coverage, he will incur no penalty if he does not enroll in a Part D plan when first eligible. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. d. "How are you this morning, Mrs. 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. The mechanism must advise each individual at the beginning of the process that he or she is completing an actual enrollment request. What should you tell him? The approval process requires that the plan you represent submit the materials.). Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Becky Knauer recently resigned from her position as controller for Shamalay Automotive, a small, struggling foreign car dealer in Upper Saddle River, New Jersey. What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? 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. In a retail pharmacy, this would be areas away from the pharmacy counter where patients receive services from the pharmacist.). c. 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