Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan. B. Mrs form or do so at another time. Fo government payment, they must offer the standard model, however, they can take a risk more beneficiaries. He would like to enroll in a Medicare health plan, but does not want to be limited in terms of where he obtains his care. Source: Enrollment Periods Annual Election Period Question6. You are meeting with Ms. Blum and she has completed an enrollment form for a MA-PD plan you represent. He decides to enroll in a Medicare Advantage (MA) plan. Question2 Mrs. AHIP Module 5 Continued... Flashcards. Andrews was preparing a budget for next year because she takes quite a few prescription drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for those months. Any time that she is dissatisfied with the plan's network coverage or customer service she may make such a change.
The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. Prescription drug coverage can be obtained by enrolling in a Medicare Advantage plan that includes Part D coverage. Question2 Mrs. Mrs. roberts has original medicare coverage. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State. Yes, as long as they are valued at $15. Her husband worked for many years and contributed into the Medicare system. Other sets by this creator.
Her daughter should come sometime between January 1 and February 14. Can his daughter fill out the enrollment form and sign it for him? What should you do with those forms? You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans.
He is concerned about changes in his cost-sharing. Individuals who enroll into any portion of their state Medicaid p or Part D. c. Steeley must wait until the Annual Election Period to make MA or Part D plan. Is this a prohibited activity at an event that has been advertised as educational? What would be considered prohibited activity by Willard? He would like to enroll in a standalone Part D prescription drug plan that is available in his area. Mrs. roberts has original medicare vs medicare. Authorization may be obtained by directing a beneficiary to a website to provide consent. Wu was primarily a homemaker and employed in jobs that provided taxable income only sporadically. Auxiliary aids and services must be provided to individuals with disabilities, such as those suffering from vision or hearing impairments, free of charge, and in a timely manner. 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. What should you tell her when she asks you about TrOOP?
D. Plan sponsors can use any marketing representative, as long as they are licensed in at lea Source: Medicare Marketing Rules: Marketing Representatives – State Licensure. She has recently reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for services. Question7 Mrs. She could enroll in a PFFS plan, but not in a stand-alone drug plan. Schlick can purchase a Medigap plan that covers drugs, but it likely won't offer coverage that is equivalent to that provided under Part D. Schlick cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. PDF, TXT or read online from Scribd. He also left a substantial estate which provides Madeline with an annual income of approximately $130, 000. Yes, as long as they do not encourage or discourage the Medicare beneficiary to enroll or disenroll from a plan based on their health condition. Plan sponsors have the option to disenroll members who do not pay their premiums, but with a grace period of not less than 2 months. Which of the following would be considered permissible under Section 1557 and the 2020 Final Rule? AHIP Exam Test Review Unit 1 to 5 - Question and Answe - Study-Guide. 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.
Mr. Kelly has substantial financial means. Mrs. Medicare does not cover acupuncture, or, in general, glasses or dentures. 1 You have set up an appointment for an in-home sales presentation with Mrs. Fowler, who expressed interest in the Medicare plans you represent. What should you keep in mind to comply with the marketing requirements for MA plans? As long as his employer offers coverage that is equivalent to Medicare's, he cannot enroll in Part B. Correct answersJose, a grandfather who was granted asylum and has worked in the United States for many years. You may solicit referrals from current MA and Part D enrollees and offer o of less than $15, based on retail purchase price for the item, although you m of the gift in your letter soliciting referrals. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). She is correct that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries. D. All MSAs cover Part A and Part B benefits, but not Part D prescription drug also enrolling in a separate prescription drug plan. Is this content inappropriate? Mrs. roberts has original medicale.com. C. He should not be concerned because Medicare health plans must cover a which means that all of them provide substantially greater benefits than are a Part B. d. Medicare health plans have the option of deciding, each year, what servic health plan could eliminate some benefits covered by Medicare and he shou Medicare health plan. Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums and cost sharing.
She will be paying a monthly premium preventive and screening tests, generally will have 20% co-payments for these serv deductible. Require the MA plan to suspend marketing and enrollment for a period of time. Mr. Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins in June and ends two months later. You are completing a PFFS plan sale to Mr. Schmidt who is new to Medicare, and as you are finishing up, what should you tell him about next steps in the enrollment process? Source: Beneficiaries in Original Medicare with Medigap Drug Coverage. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. It is illegal for a marketing representative to sell her an MA-PD plan before she completes a voluntary disenrollment form and you can offer to help her do so before you assist with the new enrollment, but these must be during two separate appointments.
This is a reasonable argument, but requiring face-to-face meetings in order to answer questions or complete an enrollment application is not permitted unless an agent first communicates with the beneficiary via phone, e-mail or reply card. Medicare is a program for people who have incomes and assets below specific limits, so you will have to find out her exact financial situation before telling her whether she can obtain Medicare coverage. All individuals who are citizens and over age 65 will be covered under Part A. Question2 You have received an advertisement from a vendor who says they can provide you with an extensive list of publicly available e-mail addresses for individuals who are Medicare beneficiaries.
The Medicare agency conducts only complaint-based oversight and he can market the products he represents as he sees fit, as long as he does so in a manner that would be considered ethical by a reasonable lay person. Source: Prohibited Practices: Marketing Practices. Source: Typical SEPs - Exceptional Conditions Losing Eligibility for Part D LIS Question7. Mayhew should report the cancellation to the plan with which he contracts immediately, and he must make sure everyone who responded is called to inform them of the cancellation. If she believes she received misleading information, she must contact 1-800-MEDICARE and, if she qualifies for a Special Enrollment Period, she can select a new option, which could include a different MA plan, a PDP, or Original Medicare. Under Original Medicare, the inpatient hospital co-payment is a flat per-day am throughout the first 60 days of a beneficiary's stay. Question5 Mrs. Roswell is a new Medicare beneficiary and is interested in selecting a Medicare Part D prescription drug plan. 1 Mr. Katz reached the Part D coverage gap in August last year. Duarte is enrolled in Original Medicare Parts A and B. D. She is correct that when she reaches the maximum out-of-pocket cost threshold, s However, since she will have a special election period to select another plan, she sho Source: Involuntary Disenrollment from MA, Part D, or Cost Plans – At Plan Option, cont'd.
She has never previously qualified for Medicare. He may only use the SEP to disenroll from his MA plan and return to Original Medicare. Source: Enrollment Rules Question9. Question4 Mrs. Murphy has been very ill and has been in the hospital multiple times this year. The Part D Initial Enrollment Period occurs only when a beneficiary turns 65, so it cannot be used as the justification for allowing her to enroll at this point. Mrs. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. Question4 Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. 162. Who is most likely to be eligible to enroll in a Part D prescription drug plan?
A signature is not necessary since Mr. Tully is not physically or mentally capable. You do not need to do anything further to the application form. Source: Medicaid Drug Coverage. A large physician group in your area contracts with the plans you represent. Question4 You have come to Mrs. What should you do? Alternatively, he could check to see w assistance program to help him with his expenses.