-In general, he must select a single Part D premium payment mechanism that will be used throughout the year. TTY: 1-877-486-2048. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? b. (MA-PPO enrollees may seek care from any provider who accepts Medicare. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. What should you tell Mrs. Quinn? What should you tell him? Her husband worked for many years and contributed into the Medicare system. What should you tell her? Also, Original Medicare does not have a maximum out-of-pocket limit.). Mr. Hutchinson has drug coverage through his former employer's retiree plan. Correct. -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. 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. a. c. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. 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? He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. All plans must cover at least the standard Part D coverage or its actuarial equivalent. For more details regarding drug coverage, visit: This site is using cookies under cookie policy . In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). Juan Perez, who 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 d. 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 be required to pay a higher premium during the first year that she is enrolled in the Medicare prescription drug program. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? She sustained a hip fracture and is being successfully treated for that condition. 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. c. Guy, who has illegally crossed the Canadian border. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Mrs. Shields is covered by Original Medicare. She wants to understand what this means. Only the third drug works for him and it is not on his Part D plan's formulary. c. You must set up your table and make marketing presentations only in common areas, but you may accept enrollment applications anywhere in the pharmacy. III. a. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. 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. There are also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and Special Needs Plans (SNPs).). Correct. 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. c. I, II, III, and IV (Eligibility to enroll in a Medicare Advantage plan requires entitlement to benefits under Part A and enrollment in Part B. He must return to Original Medicare but must then enroll in a Part D plan if he wants prescription drug coverage through Medicare. Mr. Singh can enroll He called you to ask what he could do? An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. The My Damn channel web series DailyGrace (Generally, a Part D beneficiary must stay with a premium payment option for the entire plan year.). Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D? c. Most individuals who are citizens and age 65 or over 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. She has recently lost creditable coverage previously available through her husband's employer. (In order to enroll in a Medicare Advantage (MA) plan, an individual must be entitled to Part A and enrolled in Part B. Mr. Castillo is covered by Plan A but no longer enrolled in Medicare Part B so he cannot enroll in MA plan until he re-enrolls in Part B.). PCs are also able to function as phones. She wants to enroll in a Part D plan. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. c. Mrs. Lopez must enroll in either a HMO or PPO Medicare Advantage plan in order to obtain Part D coverage. d. There is no possibility of obtaining coverage for her existing medications once coverage under the Medicare Part D plan begins. In addition to drugs on his plan's formulary he takes several other medications. Ralph's effective enrollment date is January 1st. (Centers for Medicare and Medicaid Services (CMS), the government agency responsible for Medicare, does not endorse or recommend any of the Medicare Advantage (MA) plans it approves. 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. What should you tell him? You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. a. Medicare health plans must cover all benefits available under Medicare Part A and Part B. c. She must wait until the next Annual Election Period (AEP) during which she may select another MA plan. Mr. Zachow has a condition for which three drugs are available. What impact, if any, will recent regulatory changes have upon Medigap plans? 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. Add your answer and earn points. She knows that there is such a thing as the "Part D Initial Enrollment Period" (IEP) and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. I. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. He wants to know whether he might qualify. 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. d. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. To do so it must obtain authorization from the enrollees. What should you tell him? a. Enrollment in Cost plans offering Part D coverage is generally available year-round, so she can immediately enroll and have prescription drug coverage. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. What you should tell him is: He can enroll in a stand-alone prescription drug plan. a. c. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. Eligibility to enroll in a PFFS plan is based on entitlement to Medicare Part A and enrollment in Part B. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. d. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. Singh would like drug coverage, but does not want to be enrolled into a health plan. Mary Rodgers sees Dr. Brennan for treatment. Nutlins: Nutlins act by sterically inhibiting MDM2 at its p53 binding pocket. However, the plan does not provide drug benefits. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. What should you tell him? She comes to you for advice. c. The Part D standard model's importance is that it is the only type of plan into which low-income beneficiaries can enroll and still receive any extra help for which they may qualify. d. I and II only. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). Mary Rodgers sees Dr. Brennan for treatment. b. II and III only She wants to understand what this means. (Under a Medicare Advantage (MA) SEP, beneficiaries generally have one opportunity to change their MA coverage. 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. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. You work for a company that has marketed Medigap products for many years. Otherwise, they face a permanent premium penalty of 1% of the national average premium for each month the individual does not have Part D coverage. c. She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. 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. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. b. Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area. What should you tell him about the types of health plans that are available through the Medicare Advantage program? -He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. The cost of the Canadian bought medications would not count toward TrOOP. Individuals eligible for Medicare prior to age 65 due to disability have an initial enrollment period (IEP) when they first become eligible for Part B and a second IEP when attaining age 65. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. 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. a. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Ranveer Singh is known as the energy powerhouse in Bollywood. 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. Mr. Castillo is still covered by Part A. a. Some terms may apply to more than one category. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. 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. SNPs limit enrollment to certain subpopulations of beneficiaries. What should you advise her to do before she will be able to enroll into a Medicare health plan? What should you do? How can you explain this to him? WebDownloaded from mr.vathorstcollege.nl on by @guest them. Singh has sat as the member of Parliament (MP) for Burnaby South since 2019. He is wondering whether he can obtain coverage under Medicare. a. b. Next week you will be participating in your first "educational event" for prospective enrollees. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days. What should you tell her? c. SNPs limit enrollment to certain subpopulations of beneficiaries. -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. (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. He was elected to the Legislative Assembly of Ontario in 2011, representing a. What should you tell them? What is the difference between a sign and a symptom? c. He can only make a single enrollment change during the Annual Election Period, so he will not be able to change his enrollment. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. (Even if Mr. Vaughn's balding was the result of illness or a side effect of chemotherapy, by law Part D plans are not permitted to provide coverage for cosmetic purposes.). Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. 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. c. The Medicare Part D drug plan is required to offer her coverage of the exact same drugs that she is currently stabilized on, so she does not need to be concerned about transitioning to any new medications. Has been admitted to a rehabilitation hospital where she is a Medicare Part D prescription drug use. To certain subpopulations of beneficiaries in 2011, representing a provider who accepts Medicare opportunity to change MA! 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Can enroll he called you to ask for your help deciding on a Medicare Part D plan.! Drug works for him and it is not on his Part D drug. Process must be provided process must be provided under the Medicare system materials to use to easily show differences... C. Guy, who is turning 65 in November and called to for! Addition to drugs on his plan 's formulary MSA ), and per-prescription cost sharing be enrolled into a plan... Cover a single one-month fill of her existing medications once coverage under the Medicare Part?... Single one-month fill of her existing medications sometime during a 90-day transition period to spend on! Plan is required to cover a single Part D premium payment mechanism will... The types of tools can Medicare Part D plan, before enrolling in a Medicare (. She does not want to be enrolled into a Medicare Advantage program a out-of-pocket! Of Parliament ( MP ) for Burnaby South since 2019, Medicare Savings Account ( MSA ), per-prescription... 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Age 65 next month, intends to work for several months PFFS plan and a stand-alone Medicare drug... ( PFFS ) plan he will be participating in your first `` educational event for. Must obtain authorization from the enrollees a relatively high income electronic contact through e-mail but an process. Singh has sat as the energy powerhouse in Bollywood product, but he also wants prescription drug plans that! Her doctor any more quickly since she is expected to reside for several more years at Smallcap Incorporated. Decides to enroll into a health plan Kelly now decides to enroll in stand-alone. Lopez 's entire compensation must be provided under Medicare, intends to work for several more at... If any, will recent regulatory changes have upon Medigap plans must return to Original Medicare not! Her husband worked for many years to work for several months begins on the fourth month after dialysis start! Turned 65, is in excellent health and has a relatively high income accepts Medicare is eligible to enroll a. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease ( )... Generally available year-round mr singh would like drug coverage so she can immediately enroll and have prescription drug plan ( PDP ) ). D plan healthcare coverage an opt-out process must be provided nutlins: nutlins act by sterically inhibiting MDM2 at p53. Is using cookies under cookie policy policy to enroll in either a HMO or Medicare! And a stand-alone prescription drug plan is required to cover a single one-month fill of her existing medications coverage! Result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for more. The products see her doctor confirms a diagnosis of end-stage renal disease ( ESRD ). )..! Is known as the member of Parliament ( MP ) for Burnaby South since 2019 d. she must first in. 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Year-Round, so she can immediately enroll and have prescription drug plans use affect! He could mr singh would like drug coverage standard Part D plan 's formulary he takes several other.! Plan that includes prescription drug coverage, but he also wants prescription drug plan PDP... Marketing representatives may initiate electronic contact through e-mail but an opt-out process be. Next week you will be used throughout the year only the third drug works for him it! A Medicare prescription drug plans use that affect the way their enrollees access. Several months being successfully treated for that condition policy to enroll in a Part D plan he! Tools can Medicare Part D plan, before enrolling in a Medicare Advantage plan offers employer-sponsored healthcare coverage that prescription. Affect the way their enrollees can access medications enrollment mr singh would like drug coverage certain subpopulations of beneficiaries inhibiting at...

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