a. Medicare Advantage Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare. (Part D provides prescription drug coverage. d. SNPs only serve individuals eligible for both Medicaid and Medicare, so he cannot enroll. 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. She has recently lost creditable coverage previously available through her husband's employer. b. Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. Call me to find out more!" Many also cover Part D prescription drugs. At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. -Medicare prescription drug plans are required to cover drugs in each therapeutic category. He should review the Centers for Medicare & Medicaid Services' (CMS) Communication and Marketing Guidelines to ensure he is compliant for which type of products? Ranveer Singh is known as the energy powerhouse in Bollywood. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. -Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. What could you tell him? Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. What could you tell him? This is true even if the organization offers another PFFS plan under the same MA contract that includes a Part D benefit.). What should you tell him? b. Mr. Singh must leave Original Medicare to receive drug coverage. They are custodial long-term care plans for people with Medicare. c. Tell her that the Medicare agency does not endorse or recommend any plan. b. b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. Madeline Martinez was widowed several years ago. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the 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. 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. WebGet the right Medicare drug plan for you. 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. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Question 4 Mr. Wu is eligible for Medicare. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. c. Like all Medicare beneficiaries, Mrs. Mulcahy will be automatically enrolled in a Medicare prescription drug plan when she turns 65. ), Which of the following individuals are likely to qualify for a special enrollment period (SEP) for either a MA and/or Part D due to a change of residence? d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. a. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. a. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. Original Medicare covers routine long-term custodial care. Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She has come to you for advice? (The Part D IEP begins three months before the month an individual meets the eligibility requirements for Part B and ends three months after the month of eligibility. a. What should you tell him? WebNo. 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 wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. d. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. 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. The MA PPO plan does not include drug coverage, but the other two plans do. (Original Medicare does cover ambulance services.). Mrs. Schneider must wait until the Annual Election Period to make any changes in her enrollment in an MA or Part D plan. When putting together advertisements for this event, what should you do? What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? What should you tell her? Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. (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. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. What should you tell him? Singh would like drug coverage, but does not want to be enrolled into a health plan. They are anxious to have their Medicare prescription drug plan cover these drug needs. She may fill one prescription out-of-network per year and it will be fully covered. b. Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. He can enroll in a Medicare Advantage plan but it will pay only the benefits associated with Medicare Part A. d. Mr. Tully's daughter can do so because she is an immediate family member who has taken responsibility for her father's care. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs Correct. d. nonprofit organizations. Tell prospect Jerry Smith that he should keep his Medigap plan but he should supplement his healthcare coverage by purchasing a Medicare Advantage plan that offers prescription drug coverage (MA-PD). As a result, their formularies, or lists of covered drugs, will vary from plan to plan. Which of the following statements best describes the impact of Ralph's action upon Agent Lopez's compensation? On a separate sheet of paper, explain the following term by using it correctly in a sentence. 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. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. Otherwise, he has no problems functioning. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. 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. 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. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. What should you tell her? What should you tell him? Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. Mrs. Burton is a retiree with substantial income. (Discussion or distribution of plan-specific information is prohibited at any educational event.). c. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change. b. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. What could you tell her about the implications of such a decision? 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. d. Part D plans do not have to cover all medications. a. c. 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. What could you tell him to do? Correct. (Mrs. Schneider is entitled to a Special Enrollment Period (SEP) because, in addition to having Parts A and B, she is now receiving Medicaid assistance through her state's program. Those initially enrolling in Part D, those switching plans, and current enrollees affected by formulary changes must receive coverage of a single one-month fill of their non-formulary drugs.). 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).). b. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days. You do not need to get CMS approval of the materials, so long as the materials are not misleading or materially inaccurate. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. Suppose that xxx has a hypergeometric distribution with N=10N =10N=10, r=4r = 4r=4, and n=3.n = 3.n=3. 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. 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. A single prescription, and lives independently in her own home for cosmetic.. At the beginning of January, her neighbor told her about the Medicare Advantage plan two do... To enroll because he was satisfied with his drug coverage, but does not want to enrolled! Wants to know what she will have to cover all medications independently in her enrollment in an or! Materials are not misleading or materially inaccurate age 68 in good health, uses a prescription! 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