mr singh would like drug coverage

d. You must set up your table, make marketing presentations, and accept enrollment applications only in common areas outside of where the patient waits for services from the pharmacist. c. Yes. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. a. SNPs only serve individuals in long-term care facilities, so he cannot enroll. Melissa would like to use the power of social media to reach potential prospects. What should you advise her to do before she will be able to enroll into a Medicare health plan? She is considering enrollment in a Medicare Advantage plan (Part C). c. Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions. She would like to keep the coverage she has, but replace her existing Medigap plan with one that provides drug coverage. b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. d. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. How would you respond? How would you advise Agent John Miller to proceed? b. 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 her? 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. ", b. Agent Jennings makes a presentation on Medicare advertised as an educational event. b. What should you tell her? The goal is to ensure and make health care more accessible to the people of the nation. b. c. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. (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.). Demand for this particular make of car is exploding, and the manufacturer cannot produce enough to satisfy demand. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. b. This action is permissible. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. Correct. (Edward is not likely to qualify for either a MA or Part D SEP because he has moved within his existing plan's service area. A. 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. Correct. However, this SEP is not an opportunity to select another MA plan.). Correct. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. Becky has just started a new job as controller for Mueller Imports, a much larger dealer for the same car manufacturer. b. b. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? a. He has tried two but had an allergic reaction to them. high wage rates, D. vertical at the standard number of hours a person works per day, Find dy/dxd y / d xdy/dx for the functions. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. c. Standard Part D coverage would require payment of an annual deductible, fixed per-prescription co-payments, and once catastrophic coverage begins, the plan covers 100% of all costs. b. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). What Medicare Part D drug plans cover Overview of what Medicare drug plans cover. 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. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. 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). Consequently, Shamalay was not very profitable. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. She agreed to sign a scope of appointment form and meet with you on October 15. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Correct. (Marketing representatives may engage in marketing activities in common areas in a health care setting.). What should you keep in mind to comply with the marketing requirements for MA plans? 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. 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. a. d. It occurs from January 1 to February 14 of each year, so she will have to wait until that point to utilize that particular enrollment period. Becky is surprised to learn that her new employer, Mueller Imports, receives over 200 cars a month. All SNPs include prescription drug coverage.). 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. 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 further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. Tell her that Medicare recommends that beneficiaries enroll in a Medicare Advantage plan because it will serve her better than Original Medicare. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? She should use an existing prescription drug coverage to get as large a supply of her existing drugs as possible, and then pick new drugs that are covered under her Medicare plan's formulary. 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). (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. 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). b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. Mr. Singh can enroll in a stand-alone prescription drug plan ), Fresenius ~ CCHT Certification Preparation Te. (Because Dr. Brennan accepts the plan's terms and conditions for payment, she is permitted to charge this amount.). Choose one answer. a. Helena, an overseas college student who has overstayed her visa. a. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. Agent Lopez's entire compensation must be recouped because Ralph disenrolled within 3 months of enrollment. What should you tell him? Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. b. Mr. Singh must leave Original Medicare to receive drug coverage. (To be eligible to enroll in Medicare Advantage, an individual must be entitled (not enrolled) to Part A and enrolled in Part B.). Marketing representatives may initiate electronic contact through e-mail and as long as an e-mail is opened marketing representatives may also follow-up with unsolicited telephone calls. Accept the form and wait until the Annual Election Period begins to send it to the plan for processing. As long as the meal is paid for by another person or entity, you are permitted to invite your clients and their friends to partake of the meal at your sales presentation. If he still wants to do so, he can make any sort of change he likes at that point. Write out the probability distribution of xxx. Before talking to anyone about this, Becky decides to work through her ethical dilemma. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. d. Yes. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. 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. Gilbert is likely to qualify for a Part D SEP because he has gained the opportunity to enroll in Part D prescription drug coverage. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products. a. Ralph's effective enrollment date is January 1st. He has chronic bronchitis, putting him at severe risk for pneumonia. c. Medigap plans. b. Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. (An individual may enroll in a stand-alone Medicare Part D prescription drug plan (PDP) if they are enrolled in a PFFS plan that does not include Part D drug coverage or a MSA plan. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. b. What should you tell her? a. What can you do in this situation? 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. Mr. Shapiro gets by on a very small amount of fixed income. d. I and II only. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Is this a prohibited activity at an event that has been advertised as educational? Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. What could you tell him? a. What should you tell him? Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. 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. 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. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. c. He is not eligible to enroll in a Medicare Advantage as a naturalized citizen. 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. d. This is not a possibility. b. (Mr. Schultz should enroll in a Part D plan, or otherwise obtain creditable drug coverage, before he has a 63-day break in order to avoid a premium penalty.). Which type of SNP is likely to be most appropriate for him? d. 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. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. The manufacturers regional sales managers are each given a certain number of cars. III. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? b. What should you tell her? (During the MA OEP, as an MA-PD enrollee Mrs. Goodman may disenroll from her plan, return to Original Medicare and enroll in a stand-alone Part D prescription drug plan. c. Agent Lopez's compensation is not impacted because Ralph's disenrollment occurred more than 30 days after the effective date of coverage. c. You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if his doctor will accept the terms and conditions of payment of the PFFS plan. What should you tell her?

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