Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. After that point, her premium will return to the normal amount. However, the plan does not provide drug benefits. What should you tell him? a. 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. 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. She would also like to enroll in a Medicare Supplement (Medigap) plan. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. d. Mr. Singh She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. c. You may provide her with the required enrollment materials and take her completed enrollment application. What could you tell her? b. c. Mr. Schultz can wait up to 180 days after the loss of his creditable employer group coverage before enrolling in a Part D plan without worrying payment a premium penalty. If he receives an exception under which the plan covers the drug, it could count toward TrOOP. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. a. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. What should you tell him?. OEPI-eligible individuals can make unlimited MA enrollment requests, enroll in a Part D plan, as well as return to Original Medicare.). (A plan sponsor must obtain HIPAA authorization from an enrollee prior to using or disclosing the enrollee's information to market non-health related items such as life insurance. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. Singh has sat as the member of Parliament (MP) for Burnaby South since 2019. What should you tell them? -She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%, but those of specialists are covered at 80%. d. Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. Mr. Denton is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. If he missed this opportunity, he will not be able to apply for the extra help again until the next annual enrollment period. 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. What impact, if any, will recent regulatory changes have upon Medigap plans? She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she may enroll in an MA plan. a. Medicare health plans must cover all benefits available under Medicare Part A and Part B. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? (A signed scope of appointment form describing the types of products she wishes to discuss must be completed before you begin your discussion.). All plans must cover at least the standard Part D coverage or its actuarial equivalent. 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. (Because Daniel's bronchitis is a chronic condition, a Chronic condition SNP would be most appropriate for him to enroll in.). a. III. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? Part D prescription drug coverage can only be obtained by enrollment into a Medicare Health Plan that also covers Part A and Part B services. WebMr. WebMr. Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare. You may not market in a pharmacy if you are not a pharmacist. b. It is not necessary for ABC to obtain an authorization to simply explain pending state or federal legislation since there is no anticipation of selling a non-health related product in these 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. Correct. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advantage (MA) plan. (This statement may discourage Mrs. Pearson from enrollment due to her health status. d. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. c. Part B will cover her dental and vision needs. WebMr. Original Medicare covers ambulance services. Mr. Kelly has substantial financial means. Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? 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. In addition, some states have assistance programs specifically for their residents. In what activity can you review reports about the patient's status, Drivers under the influence of alcohol and other drugs tend to. Cell phones in Japan are becoming more versatile than ever. At that time, he had employer group coverage that was creditable. -Part D plans do not have to cover all medications. a. What could you tell him to do? Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. b. What should you tell them? Correct. If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. Yes. d. Agent Armstrong needs to be licensed and appointed only in the state where XYZ Agency is headquartered. Web-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. Mrs. Park is an elderly retiree. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. What should you tell him? What should you tell her? PCs are also able to function as phones. 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. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. What could you One might be right for you. -SNPs limit enrollment to certain subpopulations of beneficiaries. 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. Correct. d. If he enrolls in the PFFS plan and shows his card to a doctor who participates in Original Medicare, then that doctor is required to accept the plan's terms and conditions, which could include balance billing. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where no Part D plan was available. 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. d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. d. Private long-term care policies for Medicare 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. d. 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. Henry makes a permanent move to a new state providing him with new MA and Part D options. a. What could you tell him? d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. Demand for this particular make of car is exploding, and the manufacturer cannot produce enough to satisfy demand. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. WebOnce you choose a Medicare drug plan, here's how to get prescription drug coverage: Enroll on the Medicare Plan Finder or on the plan's website. He has tried two but had an allergic reaction to them. What do you say? She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. (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.). b. (Mrs. Shields has experienced a long hospital stay, over the 3-day time period to qualify for skilled nursing and rehabilitative care benefits under Medicare.). Mrs. Schneider has Original Medicare Parts A and B and has just qualified for her state's Medicaid program, so the state is now paying her Part B premium and she is considered a dual eligible. a. Choose one answer. (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. d. Accept the form and immediately send it into the plan for processing. -Original Medicare covers ambulance services. b. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. Part D covers hospital and home health services and the cost sharing has changed this year. Ranveer Singh is known as the energy powerhouse in Bollywood. If an individual already had one of the plans before January 1, 2020, they will be able to keep their plan. Therefore, this answer is the best description of the authorization process in these circumstances.). d. SNPs offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will always be lower than in Original Medicare. What should you tell him? Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. 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. a. Assets may not exceed a limited amount also specified by the government.). b. Is this a prohibited activity at an event that has been advertised as educational? a. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. c. Like all Medicare beneficiaries, Mrs. Mulcahy will be automatically enrolled in a Medicare prescription drug plan when she turns 65. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. If the enrollment form is countersigned by one of Mr. Tully's treating physicians, she can sign it for him. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. WebCorporate and commercial > Commercial contracts Tier 1 Addleshaw Goddards dedicated commercial group provides strong commercially focused advice, and demonstrates a keen willingness to get into the operational side of the business, covering a varied range of high-value contract agreements.Leveraging its expertise across the retail, financial services, Correct. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. Correct. What should you tell him? 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. 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 currently does not have creditable coverage. 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. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. (Mrs. Kendrick will soon enter her MA Initial Coverage Election Period (ICEP) which begins three months immediately before the individual's first entitlement to both Medicare Part A and Part B. Mrs. Kendrick will become eligible for Part A and Part B upon turning age 65. 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. What could you tell her? c. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income. 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. What should you tell her? d. Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. 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. What should you tell him? Mr. Hutchinson has drug coverage through his former employer's retiree plan. Singh would like drug coverage, but does not want to be enrolled into a health plan. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). 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. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell him? Standard Part D coverage would require payment of only fixed per-prescription co-payments. She could enroll in the PFFS plan and a Medigap plan that offers drug coverage, but not in a stand-alone Medicare prescription drug plan. c. Despite the terms of her contract forbidding the use of social media, Agent Meadows could send out a tweet stating that "Best Care offers a Medicare Advantage benefit package offering the lowest cost comprehensive dental benefit package available. a. 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. This is used as a supplement to Medicare. -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. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. c. You should plan to answer questions and accept enrollment forms. Madeline Martinez was widowed several years ago. b. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. d. The request for authorization may include a brief synopsis of non-health related content. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). (To avoid a late enrollment penalty, Mr. Hutchinson must have "creditable" coverage. a. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. The Federal government establishes a set formulary, or list of covered drugs, each year that the Part D plans must use. What could you tell her? c. The Part B deductible will be covered for some newly eligible individuals depending on their financial status. Answer: Mr. Singh can enroll in a stand-alone d. He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium penalty. c. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. 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. c. During the MA-OEP Miguel can send unsolicited print materials to seniors in his area advertising the opportunity to change from one MA plan to another. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. How would you respond? So, she should be sure to notify the Postal Service immediately. 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). Mr. Wu is eligible for Medicare. To qualify for enrollment into a Medicare prescription drug plan, Mrs. Mulcahy must be entitled to Part A and enrolled under Part B. 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. 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. -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. 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. b. You must only ensure that the advertisement is factually accurate. d. This could be considered discriminatory activity and a prohibited practice. d. During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meetings. She has recently lost creditable coverage previously available through her husband's employer. All SNPs include prescription drug coverage.). All advertising must be done by community organizations. Match the terms with the definition. d. This is not a possibility. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare. She is considering enrollment in a Medicare Advantage plan (Part C). -You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? Best Care has not submitted any potential posts to CMS for approval. -Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. Suppose that xxx has a hypergeometric distribution with N=10N =10N=10, r=4r = 4r=4, and n=3.n = 3.n=3. What should you tell him?. Gifts of nominal retail value ($15 or less) One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. She takes a number of medications and is concerned that she has not been able to identify a plan that covers all of her medications. b. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-sponsored coverage would continue to be the primary payor while Medicare would be considered a secondary payor of his healthcare claims. He wants to know if Medicare covers cancer screening. What should you tell him? (Formulary exception requests can be used to request coverage of a drug not on a Part D plan's formulary or to cover a formulary drug at a lower cost formulary.). No uploaded proof is necessary. What should you tell him? He has limited financial resources but failed to qualify for the Part D low-income subsidy. d. The cost of the prescription drugs that are not on his plan's formulary as well as the cost of the drug(s) to reduce joint swelling from the Canadian pharmacy will count toward TrOOP but the other medications in question will not count toward TrOOP. The manufacturers regional sales managers are each given a certain number of cars. a. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. 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. She should disenroll if she does not want to pay the monthly premiums. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. Mrs. Kendrick is in good health, has worked for many years and is six months away from turning 65. 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. (Marketing representatives must not engage in any activity that would be considered discriminatory such as attempting to recruit Medicare beneficiaries from higher-income areas without making comparable efforts to recruit Medicare beneficiaries from lower-income areas.). Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. Brief synopsis of non-health related content available under Medicare Part a and Part D coverage would payment... In Original Fee-for-Service ( FFS ) Medicare cover a single one-month fill of her existing medications sometime a! And n=3.n = 3.n=3 that she will not qualify for coverage under the Medicare Agency, what you! Health, lives in his own home, and has enjoyed considerable pain relief from through. Had one of the applicable guidelines, in what activity can you review reports about the Part! 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