Original Medicare covers ambulance services. Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). b. Enrollment in Cost plans offering Part D coverage is generally available only 30 days per year, because of the more generous benefits of these plans. b. The MA PPO plan does not include drug coverage, but the other two plans do. The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. The MA PPO plan does not include drug coverage, but the other two plans do. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. c. "A Private Fee-for-Service plan is not the same as a Medigap supplemental policy." A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. c. corporations Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. Mr. Shapiro gets by on a very small amount of fixed income. Beneficiary income may not exceed 150 percent of the Federal Poverty Level (FPL). (Under a Medicare Advantage (MA) SEP, beneficiaries generally have one opportunity to change their MA coverage. b. What should you say? c. What are the possible consequences. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. a. She sustained a hip fracture and is being successfully treated for that condition. 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. -SNPs limit enrollment to certain subpopulations of beneficiaries. What could you tell him to do? d. The government bases its payments to Part D plans on the standard benefit model. Official Medicare site. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? d. nonprofit organizations. b. 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. In what activity can you review reports about the patient's status, Drivers under the influence of alcohol and other drugs tend to. She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. She may remain in her ABC MA plan, enroll in another MA plan in her service area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. d. Marketing in health care facilities is an acceptable practice, regardless of where it takes place. What should you tell her? Medicare beneficiaries should choose either Original Medicare or a MA plan based on their particular needs and circumstances.). b. Mention THREE benefits of properly planning your responses when answering examination questions.. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. c. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. a. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. c. In general, he must select a single Part D premium payment mechanism that will be used throughout the year. On a separate sheet of paper, explain the following term by using it correctly in a sentence. c. He is not eligible to enroll in a Medicare Advantage as a naturalized citizen. "If you're not in very good health, you will probably do better with a different product." (Because Daniel's bronchitis is a chronic condition, a Chronic condition SNP would be most appropriate for him to enroll in.). 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. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? What should you tell him? c. Authorization may be obtained by directing a beneficiary to a website to provide consent as long as the website includes a mechanism for an electronic signature that is valid under applicable law. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. During the MA-OEP Miguel can make unsolicited calls to former enrollees who have selected a new plan during the Annual Enrollment Period (AEP). C. The House of Representatives must approve the treaty by a two-thirds vote, but it can be vetoed by the president or found unconstitutional by the Supreme Court. Mr. Vaughn takes a prescription for helping to regrow his hair. b. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What can you do in this situation? c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. What advice would you give her? 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. What should you tell him? Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its formulary. Ralph disenrolls on February 12th because he discovers that the plan does not cover services furnished by several of his longtime providers. 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. d. You should plan to ensure that the educational event is an informative event and must not conduct a sales presentation or distribute or accept enrollment forms at the event. b. TrOOP refers to true out-of-pocket expenses paid by a Part D beneficiary for non-prescription over-the-counter (OTC) drugs and vitamins that are not covered by his or her plan. PCs are also able to function as phones. Marketing representatives may not accept enrollment forms and hold them before October 15th for enrollment under the AEP.). If he does not, he must enroll in Medicare Part D during his initial eligibility period to avoid a late enrollment penalty.). Therefore he should enroll for a stand-alone prescription drug plan. Correct, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese, Fundamentals of Financial Management, Concise Edition, Daniel F Viele, David H Marshall, Wayne W McManus. a. 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. c. She may fill both prescriptions and they will be fully covered at in-network pricing due to the fact that she is traveling. Nutlins: Nutlins act by sterically inhibiting MDM2 at its p53 binding pocket. She wants to understand what this means. d. Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. 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. Best Care has not submitted any potential posts to CMS for approval. Beneficiaries should consult the government's list prior to deciding whether they wish to enroll in a Part D plan during that year. However, enrollees are typically responsible for higher cost-sharing payments if their provider is out-of-network.). Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's service area next month. Her husband worked for many years and contributed into the Medicare system. Correct. 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 tell Mr. Moy? 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. She may continue to keep her existing plan, because all Medicare health plans are required to provide coverage to anyone, no matter where they live. . Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. b. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? Mrs. Burton is a retiree with substantial income. Standard Part D coverage would require payment of only fixed per-prescription co-payments. 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