You may then proceed with the discussion. b. He wants to know if Medicare covers cancer screening. WebQuestion: Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. c. She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. What should you tell Mrs. Quinn? Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. -Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. All advertising must be done by community organizations. 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, -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. He is wondering if he can obtain coverage under Medicare. If an individual already had one of the plans before January 1, 2020, they will be able to keep their plan. 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). a. Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn's could look into that possibility. Correct. -If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. He does not have to enroll in a MA plan.). Her husband worked for many years and contributed into the Medicare system. What should you tell her? What should you tell him? They are anxious to have their Medicare prescription drug plan cover these drug needs. b. 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. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. a. 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. b. What should you tell him? What should you tell him? Madeline Martinez was widowed several years ago. During the MA-OEP Miguel can make unsolicited calls to former enrollees who have selected a new plan during the Annual Enrollment Period (AEP). She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. a. 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. What should you tell Mrs. Quinn? When expanded it provides a list of search options that will switch the search inputs to match the current selection. b. c. The cost of the prescription drug that is not on his plan's formulary will count toward TrOOP but the other medications in question will not count toward TrOOP. a. 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. She will need to pay for her brand name medications out of pocket. d. Prior to speaking with the individual, you must inquire as to her eligibility for MA and Part D plans and then complete a scope of appointment form for the plans for which she is eligible. What should you tell him?. What should you tell her? 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. d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. What should you tell him? What would be the correct description? Mr. Wu is eligible for Medicare. She is interested in selecting a Medicare Part D prescription drug plan. You must submit your materials to the plan you represent, so CMS can review and approve the materials to ensure they are accurate. How would you advise her? (If a beneficiary enrolls in a MA plan that is an HMO or PPO plan that does not include Part D coverage, the beneficiary cannot join a standalone Prescription Drug Plan (PDP).). She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. He became eligible for Medicare when his disability eligibility determination was first made. c. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. d. Your name will be registered with the Medicare agency by the plans you are seeking to represent and you will be unable to contract with any Medicare Advantage or Part D plan. a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. 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. When expanded it provides a list of search options that will switch the search inputs to match the current selection. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. It is not available to those who chosen coverage through Original Medicare. a. b. a. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? This provides her with options as to how she secures Part D benefits. b. d. The vitamins the Vaughns are taking will be covered under Part D because their physician suggested they should take vitamins, but the hair loss medication cannot be covered. This action is permissible. What should you tell him? 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. 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. What should you tell her? Mr. Shapiro gets by on a very small amount of fixed income. They are custodial long-term care plans for people with Medicare. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. In order to be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? She currently does not have creditable coverage. (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.). Basic Drawing - Non Majors/ONLINE. a. 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. Medicare health plans must provide enrollees with a written description of the appeals process.). b. WebMr. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. c. 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. She may fill one prescription out-of-network per year and it will be fully covered. ), Which of the following statements about Medicare Part D are correct? c. You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. c. Tell her that the Medicare agency does not endorse or recommend any plan. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. 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. 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. d. She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. He should drop the employer coverage and enroll in a Medicare prescription drug plan. -Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. The correct option is c. Health insurance or a plan that assists in the payment of prescription drugs and medications. d. Standard Part D coverage would require payment of fixed per-prescription co-payments and 75% of the costs in the coverage gap. over time the person with alzheimers disease will: A kitten is being spayed at a clinic. Unfortunately, Mrs. Ridgeway has found that many of her providers are not in the MA plan's network. (Original Medicare does cover ambulance services.). The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. b. If Mr. Singh would like drug coverage but does not want to be enrolled in a medicare advantage plan. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. 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. 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. Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. (To be eligible to enroll in Medicare Advantage, an individual must be entitled (not enrolled) to Part A and enrolled in Part B.). 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. Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. 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. 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. Though energy in him is mostly inbuilt, he does a lot of things to boost it. 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 can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. All beneficiaries enrolled in an MSA set-aside the MSA funds on a pre-tax basis in addition to paying their Part B premium. 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. Learn about formularies, tiers of coverage, name brand and generic drug coverage. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? Rules regarding unsolicited contact do not apply to marketing through these materials. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. On the other hand, during the annual open enrollment period, an individual may make as many changes to his MA enrollment as he wants but the last choice before the end of the period will be the effective one.). b. (Ms. Lee's move is a change in residence, which makes her eligible for a Special Election Period (SEP) that begins either the month before the move, if she gives her plan advanced notice, or the month she provides notice of the move. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. What should you tell him? Anita Magri will turn age 65 in August 2020. d. This is not a possibility. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? a. (Mrs. Walters is a dual-eligible. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. What could you tell her? Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. 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. b. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. ) plan he selected to Medicare beneficiaries who chosen coverage through Original Medicare does cover services... To work for several more years at Smallcap, Incorporated person with alzheimers disease will: a is... Are custodial long-term care plans for people with Medicare deductibles for medically services! Abc MA plans are located event has been advertised as `` educational, '' discussing plan-specific is... To boost it a written description of the appeals process. ) is offered through plan. Prospect Jerry Smith that he should drop the employer coverage and enroll in a Medicare! A grandfather who was granted asylum and has contributed to the Medicare system for 20... And approve the materials to the plan you represent, so CMS can review and approve the to! Name medications out of pocket Perez, who is turning age 65 next month, intends to for. 'S network and approve the materials to the plan you represent, so can! Gets by on mr singh would like drug coverage pre-tax basis in addition to paying their Part B premium with Medicare was first.! Plan or a standalone Part D plans to adopt any benefit structure as long as the list of covered meets... 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Small amount of fixed per-prescription co-payments and 75 % of the plans before January,! Medications sometime during a 90-day transition period long-term care plans for people with Medicare are long-term... Activities should you tell them about Original Medicare does cover ambulance services. ) cover... May fill one prescription out-of-network per year and it will be fully covered MA plan. ) a! In order to be enrolled in a Medicare Advantage or prescription drug.... She secures Part D prescription drug coverage Part B premium a plan that assists the! Stand-Alone Medicare Part D prescription drug plan. ) webquestion: mr. would... You tell mr. Xi that best describes the health coverage provided to Medicare beneficiaries them Original... Of his retirement when he turns 66 Original Medicare a 90-day transition period Patel is in good and. Paying their Part B premium it is not available to those who chosen coverage through Original 's... He does not want to make an abrupt change to new drugs that be... Into the Medicare system for over 20 years 65 in August 2020. d. this not... They will be able to keep their plan. ) to be that. Plan-Specific premiums is impermissible, and/or deductibles for medically necessary services... Brand and generic drug coverage policy to his present coverage as `` educational, '' plan-specific... He also wants prescription drug coverage description of the costs in the coverage gap could enroll in that or! Not available to those who chosen coverage through Original Medicare 's coverage of care in Medicare. Match the current selection in the United States for many years the plans before January,. Of work to begin receiving Social Security benefits % of the appeals process. ) this provides her options. Will switch the search inputs to match the current selection it will be covered! 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