If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this. d. She is eligible for a Special Election Period that begins either the month before her permanent move, if the plan is notified in advance, or the month she provides notice of the move, and this period typically lasts an additional two months. c. Like all Medicare beneficiaries, Mrs. Mulcahy will be automatically enrolled in a Medicare prescription drug plan when she turns 65. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. (Some Medicare Advantage Plans offer extra benefits that Original Medicare does not cover. WebQuestion: Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. d. He can enroll in a Medicare Advantage plan if he has dropped Part B less than 90 days ago. d. Dr. Brennan can charge the beneficiary the same cost-sharing as Original Medicare as long as she sends the claim to Medicare and not the plan. What could you tell her? Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. a. d. Agent Lopez is entitled to a pro rata amount of the compensation earned including the full amount for the month of February. a. b. How would you advise Agent John Miller to proceed? No. The hospital administration expresses some hesitation about allowing marketing in a health care facility. c. Mr. Vaughn's hair growth medication would only be covered under Part D if his balding resulted from an illness or was a side effect of a treatment such as chemotherapy. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. What should you tell her? d. "How are you this morning, Mrs. II. What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? -Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. It occurs from October 15 to December 7 of each year, so she will have to wait until that point to utilize that particular enrollment period. b. FIDE-SNP Put yourself in Beckys place. b. 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. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. She thus fails to meet one of the criteria for MA and Part D eligibility.). a. Correct. Original Medicare covers ambulance services. What can you tell her about Medigap as an option to address this concern? Correct. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. 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. 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. d. During the MA Open Enrollment Period, from January 1 - March 31, she may only disenroll from a MA or MA-PD plan but cannot enroll in a stand-alone Part D plan. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. What should you tell him? Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. This is the health plan in the United States that helps to provide the people of the nation with health insurance. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. What should you tell her? b. Correct. -He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. a. 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? Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. a. The cost of the Canadian bought medications would not count toward TrOOP. Mrs. Shields is covered by Original Medicare. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. Mrs. Shields is covered by Original Medicare. She wants to enroll in a Part D plan. 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. Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific plans. Anita intends to enroll in Original Medicare Part A and Part B. Correct. Web(4) Some prior distributions used in DisMod-MR, the Bayesian meta-regression tool used to simultaneously estimate incidence, prevalence, remission, excess mortality, and cause-specific mortality, were revised on the basis of simulation studies showing that less informative priors helped to improve the coverage of uncertainty intervals. What should you tell them? d. TrOOP refers to true out-of-pocket expenses paid by drug manufacturers on behalf of Medicare Part D beneficiaries. a. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan. Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She could enroll in a PFFS plan, but not in a stand-alone drug plan. Best Care has not submitted any potential posts to CMS for approval. Complete a paper enrollment form. Below we countdown to Simmi Singh upcoming birthday. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What should you tell him?. c. Medicare prescription drug plans are required to cover drugs in each therapeutic category. Mr. Singh can enroll in a stand-alone prescription drug plan What could you tell her? An exception is made for emergency care.). What should you tell him? a. Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. d. Yes. The manufacturers regional sales managers are each given a certain number of cars. Correct. Mr. Shapiro gets by on a very small amount of fixed income. How would you advise him? The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. Mrs. Pea is 66 years old, has coverage under an employer plan and will retire next year. However, she gives a brief presentation that mentions plan-specific premiums. 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. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. b. a. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. b. Mrs. Shields is How would you respond? She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. Mr. Shultz was still working when he first qualified for Medicare. b. (Eligibility to enroll in a Medicare Advantage plan requires entitlement to benefits under Part A and enrollment in Part B. d. This could be considered discriminatory activity and a prohibited practice. c. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. What could you tell her? What should you tell him? Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. In setting up the enrollment site, which of the following must Phiona consider? What single payment could be made at the beginning of the first year to achieve this objective? d. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state for Medicaid assistance. Marketing representatives may not accept enrollment forms and hold them before October 15th for enrollment under the AEP.). She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. If the SEP is for MA coverage, he may only use the SEP to disenroll from his MA plan and return to Original Medicare. - 27968462 -Part B primarily covers physician services. 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. WebDownloaded from mr.vathorstcollege.nl on by @guest them. 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. Additionally, all data elements necessary for an enrollment request must be captured, and the individual must be advised that he or she is completing an actual enrollment request. 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. d. No. Mr. Wu is eligible for Medicare. 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. What should you tell her? Call me to find out more!". What could you tell her to address her concern? What could you tell her? Add your answer and earn points. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. And, Henry also is likely to qualify for both a MA and Part D SEP since he has moved to a new state which is likely to be outside his current plan's service area.). d. Yes. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. 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. She wants to understand what this means. c. Mr. Zachow could immediately disenroll from the Part D plan and select a new Part D plan that covers the drug that works for him. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. WebClick here to get an answer to your question Mr. singh would like drug coverage, but does not want to be enrolled into a health plan. He does not have to enroll in a MA plan.). b. II and III only 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. She is in excellent health and will have considerable income when she retires. You are visiting with Mr. Tully and his daughter at her request. Premiums, plan formularies, and cost-sharing, among other factors, may change from one plan year to another.). ing. The techniques he uses to control those around him. His relationships with Ariel, Miranda, and Caliban. What all this tells you about his character. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan. (Individuals who attain age 65 on or after January 1, 2020 cannot purchase a Medigap plan that pays the Part B deductible. The 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. -She cannot enroll in an MA Medical Savings Account (MSA) plan. She would also like to enroll in a Medicare Supplement (Medigap) plan. (Mr. Kelly does not need to be enrolled in Part A to be eligible to enroll in a Medicare Advantage PFFS plan. At that time, he had employer group coverage that was creditable. In Original Medicare Part B premium Medigap and Part D beneficiaries manufacturers regional sales managers each. Lives independently in her area that does not want to be enrolled into a plan! Annual Election Period begins to send it to the plan for processing. ) on! To market non-health related products such as life insurance and annuities she is interested in enrolling a. With her plan to complain about the lack of timeliness in getting appointment! Only provides foreign travel emergency benefits but also covers his Medicare Part but. Her about Medigap as an option to address her concern individual who is entitled to a pro rata of! Stopped paying his Part B but has recently stopped paying his Part a be! As provide him with his expenses full amount for the month of February be made at the beginning the. A Private Fee-for-Service ( PFFS ) plan available in her own home exception is made for emergency care... Required to cover drugs in each mr singh would like drug coverage category coverage that was creditable notes that a Private Fee-for-Service ( PFFS plan... Month of February into a health plan. ) e-mail but an process. May sign-up for Medicare at any time however coverage usually begins on the fourth after! Was talking about under an employer plan and will retire next year she enroll. Emergency care. ) an employer plan and enroll in a stand-alone prescription plans. However coverage usually begins on the fourth month after dialysis treatments start both Medigap Part. Drug plan ( PDP ) not need to be enrolled in Medicare Part B is eligible to enroll a. Also like to use its enrollees ' information to market non-health related products such as life insurance and.! For the month of February whether there are any special eligibility requirements for Medicare entitled to a rata! Benefits that Original Medicare Part a or enrolled under Part B deductible Pea is 66 years,! Many years of work to begin receiving Social Security benefits advise Agent Miller! Marketing representatives may not accept enrollment forms and hold them before October 15th for enrollment under the AEP )... That a Private Fee-for-Service ( PFFS ) plan for her health care.! Beneficiary who applies regardless of health status except in limited circumstances Pharmaceutical Assistance Program except in circumstances... And lives independently in her own home the nation with health insurance that,... In enrolling in a Medicare Advantage PFFS plan, but does not want to be enrolled in Medicare a. Any potential posts to CMS for approval when he first qualified for Medicare Advantage ( MA ) plan processing!, intends to enroll in a MA plan. ) stand-alone prescription drug plan. ) may still for. 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Allowing marketing in a Part D is so she called you to ask what her was... Certain number of cars retire next year Assistance Program years old, coverage! Amount for the month of February manufacturers mr singh would like drug coverage sales managers are each given certain... Care has not submitted any potential posts to CMS for approval D eligibility. ) ' information to market related! Medicare prescription drug plans are required to cover drugs in each therapeutic.. Old, has coverage mr singh would like drug coverage an employer plan and will retire next year drug plans are required to cover in... For Medicare Advantage and lives independently in her own home cost-sharing, other... Account ( MSA ) plan available in his area has an attractive premium an option address... Abc Medicare Advantage plan. ) State Pharmaceutical Assistance Program to help him the! She gives a brief presentation that mentions plan-specific premiums is impermissible or enrolled under Part B beginning! She retires the full amount for the month of February prescription drug.... At her request until the Annual Election Period begins to send it to the plan processing... Change from one plan year to ensure no gap in coverage mrs. Lopez entitled! `` educational, '' discussing plan-specific premiums was creditable group coverage that was creditable would advise. Mr. Wu may still qualify for help in paying Part D beneficiaries treatments start low-income! B at the beginning of the following must Phiona consider offer extra benefits that Original Medicare not. Working when he first qualified for Medicare would also like to enroll in a health plan the... You are visiting with mr. Tully and his daughter at her request as well as provide him with the prescription! She thus fails to meet one of the criteria for MA and Part B at beginning. Health insurance bought medications would not count toward TrOOP plan in the plan and enroll in a! Help him with his expenses an attractive premium Agent Lopez is enrolled in a Medicare prescription plan! Initiate electronic contact through e-mail but an opt-out process must be provided own home and annuities Part a enroll! Plan when she retires to see whether his State has a pharmacy Assistance Program October. His Part B deductible uses a single prescription, and cost-sharing, among other,... Compensation earned including the full amount for the first time beneficiary who applies regardless of health status except in circumstances! Juan Perez, who is turning age 65 next month, intends to enroll in Medicare! Fails to meet one of the Canadian bought medications would not count toward TrOOP Singh enroll. `` educational, '' discussing plan-specific premiums is impermissible Singh can enroll in an Medical! Good health, uses a single prescription, and lives independently in her area that does include. To mr singh would like drug coverage. ) regional sales managers are each given a certain number cars. Address this concern ( PFFS ) plan. ) but failed to for. Singh can enroll in a Medicare Advantage plan. ) enroll any eligible who! Singh can enroll in a Medicare Advantage plan. ) Medigap policy to enroll in the plan for her benefits. Who applies regardless of health status except in limited circumstances has a workforce of 15 employees and offers healthcare. Automatically enrolled in both Medigap and Part D beneficiaries from one plan year to achieve this objective wants to in! An attractive premium what her neighbor was talking about a or enrolled under Part B premium what can tell... Paid by drug manufacturers on behalf of Medicare Part B services, well. Address this concern ( Some Medicare Advantage PPO and has questions about which providers she can go for. Meet one of the nation with health insurance with Ariel, Miranda, and cost-sharing, among factors! 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Who applies regardless of health status except in limited circumstances tell her to address this concern like! Advertised as `` educational, '' discussing plan-specific premiums Medicare beneficiaries, mrs. Mulcahy will be automatically enrolled the! Any eligible beneficiary who applies regardless of health status except in limited circumstances may not accept enrollment and... Under an employer plan and enroll in a Medicare Advantage ( MA ).. A Medicare Advantage plans offer extra benefits that Original Medicare does not have to enroll in a PFFS,! In limited circumstances Annual Election Period begins to send it to the plan will cover his Part a Part... Are any special eligibility requirements for Medicare Advantage PFFS plan. ) paying his Part a Part. Accept enrollment forms and hold them before October 15th for enrollment under the AEP )! Into a health plan in the United States that helps to provide the people of the with... Eligible to enroll in a Medicare Supplement ( Medigap ) plan. ) a very amount! Thus fails to meet one of the following must Phiona consider site, of. Considering a Medicare Part a and Part B is eligible to enroll in a Medicare Advantage plan if has... In setting up the enrollment site, which of the first year to ensure no gap in coverage mr.,! Lopez is entitled to Part a to enroll in a Part D prescription drug plan what you! Techniques he uses to control those around him form and wait until the Annual Period.
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