mr singh would like drug coverage

Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. He has tried two but had an allergic reaction to them. Call me direct to learn more." a. Part D plans may use varying co-payments for brand name and generic drugs, but they may not restrict access through prior authorization. b. d. Original Medicare covers ambulance services. b. Identify the three ways to write a topic sentence. What should you tell her about obtaining drug coverage? Mary Rodgers sees Dr. Brennan for treatment. What could you tell her? What enrollment rules would apply in this case? Dixie State University. a. -He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. Mrs. Pea is 66 years old, has coverage under an employer plan and will retire next year. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. c. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. Part B primarily covers physician services. What should you tell him? -You are sorry to disappoint Anita but a Medigap Part F plan is no longer available to those who turn age 65 after January 1,2020. d. Tell her that, because you represent a Medicare health plan, you therefore work for Medicare, and the information you offer her is a good basis of any decision she makes. Correct. The hospital administration expresses some hesitation about allowing marketing in a health care facility. -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. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. c. In general, Mrs. Ramos will need a referral to see specialists. Correct. You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. -He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. d. No. -TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances drug manufacturer discounts. c. SNPs limit enrollment to certain subpopulations of beneficiaries. You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. Agent Jennings makes a presentation on Medicare advertised as an educational event. voodoo. c. You should plan to answer questions and accept enrollment forms. ), You are doing a sales presentation for Mrs. Pearson. d. nonprofit organizations. What should you tell her? Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? 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. 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%. Melissa Meadows is a marketing representative for Best Care which has recently introduced a Medicare Advantage plan offering comprehensive dental benefits for $15 per month. b. Mr. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. She asks you to explain it. You may not market in a pharmacy if you are not a pharmacist. b. a. b. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. There is no disadvantage in doing so. d. Plans may not participate in advertising such an event. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. 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. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. d. You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area. 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. What could you tell her? 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. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. Nutlins: Nutlins act by sterically inhibiting MDM2 at its p53 binding pocket. c. Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving health care services. Mr. Zachow has a condition for which three drugs are available. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. 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. What should you tell him?. Beneficiaries who qualify for the low-income subsidy, however, are not subject to the late enrollment penalty.). -After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. You are sorry to disappoint Anita but a Medigap Part F plan is no longer available to those who turn age 65 after January 1,2020. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. Otherwise, he has no problems functioning. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. If he does not, he must enroll in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty.). (Part D plans must cover at least the Part D standard benefits or its actuarial equivalent. what should you tell him? Correct. Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. b. In a retail pharmacy, this would be areas away from the pharmacy counter where patients receive services from the pharmacist.). He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. d. You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area. The hospital administration expresses some hesitation about allowing marketing in a health care facility. -She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? She would also like to enroll in a Medicare Supplement (Medigap) plan. She currently does not have creditable coverage. Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D? d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. On the other hand, during the annual open enrollment period, an individual may make as many changes to his MA enrollment as he wants but the last choice before the end of the period will be the effective one.). Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. a. II, III, and IV only c. During the MA Open Enrollment Period, from January 1 - March 31, she may drop a MA or MA-PD plan and go back to Original Medicare, but she may only enroll in a stand-alone prescription drug plan if she also purchases a Medigap policy. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell him? Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. What questions would you need to ask to determine his eligibility? 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. Mr. Kelly has substantial financial means. What should you tell her? d. As long as Mrs. Mulcahy is 65, eligibility for a Medicare prescription drug plan is not dependent on entitlement to Part A or enrollment under Part B, so she should not be concerned. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? What should you tell him? 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 her? a. TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include only expenses paid directly by a Medicare Part D beneficiary. What you should tell him is: He can enroll in a stand-alone prescription drug plan. State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. b. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. 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 If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage. She will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location. c. corporations d. Yes. a. (Mr. Kelly does not need to be enrolled in Part A to be eligible to enroll in a Medicare Advantage PFFS plan. Beneficiaries enrolled in a Cost plan may obtain Part D benefits through their plan (if offered) or alternatively through a stand-alone Prescription Drug Plan (PDP).). Webd. She is concerned that her income will make it impossible for her to qualify for Medicare. a. Medicare health plans must cover all benefits available under Medicare Part A and Part B. b. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. d. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. Beneficiaries may make more than one enrollment choice during the AEP, but the last one made prior to the end of the AEP, as determined by the date the plan or marketing representative receives the completed enrollment form, will be the election that takes effect. b. Madeline Martinez was widowed several years ago. Daniel is a middle-income Medicare beneficiary. III. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Advantage plan. You should plan to conduct sales presentations and accept enrollment forms. WebMr. 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. c. 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. b. Mrs. Burton is a retiree with substantial income. c. Yes. Demand for this particular make of car is exploding, and the manufacturer cannot produce enough to satisfy demand. a. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Put yourself in Beckys place. (To avoid a late enrollment penalty, Mr. Hutchinson must have "creditable" coverage. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Handing out enrollment forms, on the other hand, would not be permissible. No. 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. d. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? a. Madeline Martinez was widowed several years ago. She could enroll in a PFFS plan, but not in a stand-alone drug plan. Madeline Martinez was widowed several years ago. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? (Sales presentations and distribution or acceptance of enrollment forms are prohibited when an event is advertised as educational.). (The CMS Communication and Marketing Guidelines apply to MA and PDP plans.). Singh would like drug coverage, but does not want to be enrolled into a health plan. 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. -If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty. What should you tell him? -She cannot enroll in an MA Medical Savings Account (MSA) plan. -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. 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. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Most individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. IV. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. 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. There is no testing requirement for agents/brokers that only market employer/union group plans.). Premiums, plan formularies, and cost-sharing, among other factors, may change from one plan year to another.). One might be right for you. b. II, III, and IV only c. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. An individual is eligible to enroll in Part D if the individual is entitled to Part A or enrolled in Part B. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. All SNPs include prescription drug coverage.). She wants to understand what this means. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. On a separate sheet of paper, classify each of the numbered terms below into the following categories. 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. All beneficiaries enrolled in an MSA set-aside the MSA funds on a pre-tax basis in addition to paying their Part B premium. 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. -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. "Are you interested in a Medicare supplement plan or a Medicare health plan?" She comes to you for advice. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. 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? Whether or not an event has been advertised as "educational" or a "sales presentation," discussing plan-specific information is impermissible. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. b. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare. In general, Mrs. Ramos can obtain care from any provider who participates in Original Medicare but will have to pay the difference between the plan's allowed amount and the provider's usual and customary charge. What could you tell her? Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. Becky has just started a new job as controller for Mueller Imports, a much larger dealer for the same car manufacturer. (Mr. Gomez may receive health care services from any doctor allowed to bill Medicare, provided he shows the doctor the plan's identification card, and the doctor accepts the PFFS's payment terms and conditions. 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. a. Mr. Torres has a small savings account. Correct. b. -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. 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? 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. She is traveling and wishes to fill two of the prescriptions that she has lost. 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. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. b. She is considering enrollment in a Medicare Advantage plan (Part C). However, the plan does not provide drug benefits. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Pearson? These terms may include balance billing up to 15%of the Medicare rate. 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. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Mr. Prentice has many clients who are Medicare beneficiaries. What should you tell her? 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. What could you tell Mr. Moy? Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. 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. d. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. What should you tell him? What should you tell him? Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP. WebThe answer that you can give to Mr. Singh would be that he can enroll in a stand-alone prescription drug plan and be receiving Part A and B services. 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. c. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan's terms and conditions as long as she treats all beneficiaries the same. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. You can specify conditions of storing and accessing cookies in your browser. c. You will have to repeat the tests in three months, but may begin enrolling beneficiaries while you are waiting. (During the MA-OEP, those enrolled in a Medicare Advantage plan have the opportunity to change plans or enroll in Original Medicare.

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