Cell phones in Japan are becoming more versatile than ever. B. What should you tell him? a. He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. TTY: 1-877-486-2048. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What could you tell her? What should you tell her about obtaining drug coverage? Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. b. 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).). What enrollment rules would apply in this case? Ms. Claggett is sixty-six (66) years old. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. A legal representative need only attest that he or she is legally authorized to complete the electronic enrollment request. (Under a Medicare Advantage (MA) SEP, beneficiaries generally have one opportunity to change their MA coverage. d. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. You have been providing a pre-Thanksgiving meal during sales presentations in November for many years and your clients look forward to attending this annual event. Mrs. Burton is a retiree with substantial income. (Because Dr. Brennan accepts the plan's terms and conditions for payment, she is permitted to charge this amount.). Correct. There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31 and Ms. Gonzales can use it to change from Original Medicare and Part D only to a MA plan that includes prescription drug coverage. 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. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. 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. d. Jose, a grandfather who was granted asylum and has worked in the United States for many years. Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. Mr. Castillo is still covered by Part A. She has recently lost creditable coverage previously available through her husband's employer. The mechanism must capture an accurate time and date stamp at the time the applicant enters the online site. One might be right for you. c. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan's terms and conditions as long as she treats all beneficiaries the same. c. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. b. Mrs. Shields is covered by Original Medicare. WebMr. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What should you tell her? a. -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. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. On December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-PD plan. What should you tell him? The DVM orders the following medication Acepromazine(1mg/mL) at 0.025 mg/kg. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. (An individual enrolled in a MA PFFS plan that does not include a Part D benefit may enroll in a stand-alone Part D prescription drug plan. 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. 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. 12. What could you tell her? d. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. -Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Before talking to anyone about this, Becky decides to work through her ethical dilemma. b. partnerships Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. She would also like to enroll in a Medicare Supplement (Medigap) plan. Which of the following statements best describes some of the costs a beneficiary would incur for prescription drugs under the standard coverage? Her husband worked for many years and contributed into the Medicare system. What can you tell her about Medigap as an option to address this concern? All plans must cover at least the standard Part D coverage or its actuarial equivalent. a. D-SNP b. What should you tell her? Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. 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. Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available January 1 next year. What should you keep in mind to comply with the marketing requirements for MA plans? 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. He has chronic bronchitis, putting him at severe risk for pneumonia. She will need to have her physician help her select a new drug that is covered. Medicare health plans must provide enrollees with a written description of the appeals process.). Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. what should you tell him? An individual is eligible to enroll in Part D if the individual is entitled to Part A or enrolled in Part B. Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. During the appointment, what are you permitted to do? All SNPs include prescription drug coverage.). You would need to ask Mr. Kelly if he is enrolled in Part A and Part B, if he is healthy, and how often he expects to visit a doctor. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. 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. Which statement best describes the authorization process? She will have to wait until the next Annual Election Period to be able to enroll in a plan available in her new location. a. What should you tell her? c. She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. (Presentations may include light snacks, but marketing representatives must not provide full meals even if another entity provides or subsidizes the meal.). 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. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. He can make as many enrollment changes as he likes during the Annual Election Period and the last choice made prior to the end of the period will be the effective one as of January 1. b. b. Fresenius ~ CCHT Certification Preparation Te. Call me to find out more!". 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. There are also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and Special Needs Plans (SNPs).). Web39 ANMs successfully completed 12-days induction training at ANMTC Chandausi. 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. c. What are the possible consequences. Yes. Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. b. This site is using cookies under cookie policy . d. There is no possibility of obtaining coverage for her existing medications once coverage under the Medicare Part D plan begins. -He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. 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. c. Tell her that the Medicare agency does not endorse or recommend any plan. You are visiting with Mr. Tully and his daughter at her request. a. Grimsby doctor Reeta Singh, pictured, will now await a decision on whether her fitness to practice is currently impaired. What should you tell him?. d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage. d. Mrs. Lopez must first seek COBRA benefits under her husband's plan before she can apply for Part D coverage. Agent Armstrong needs to be licensed and appointed only in the state where ABC Health Plan is headquartered. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income. 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? b. Medicare Advantage (MA) and Prescription Drug (PDP) plans. 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. 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. Standard Part D coverage would require payment of only fixed per-prescription co-payments. 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. Correct: 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. d. Part D plans do not have to cover all medications. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. Describe G. Stanley Halls theory of adolescence. c. Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. b. a. d. I and II only. a. 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. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan? -She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. What should you tell him? What should you tell him? What you should tell him is: He can enroll in a stand-alone prescription 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 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. a. What could you tell him? 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. c. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. Which of the following statements best describes some of the costs a beneficiary would incur for prescription drugs under the standard coverage? You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. She should contact her local Social Security office and make arrangements to enroll in Part B prior to selecting a prescription drug plan. (Mr. Kelly does not need to be enrolled in Part A to be eligible to enroll in a Medicare Advantage PFFS plan. d. Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. b. Mr. Singh must leave Original Medicare to receive drug coverage. WebIn this review, we will focus our discussions on nutlin-based and spirooxindole class compounds given that they are the most widely used classes among the MDM2-p53 interaction inhibitors in breast cancer studies and display drug-like properties. What would be the correct description? 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. d. Private long-term care policies for Medicare beneficiaries. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). WebMakenna Name Puns, I gotta admit lol I loved kolhatkars first comedy show, but the jokes I liked were the ones not necessarily related to his Indian heritage. c. SNPs limit enrollment to certain subpopulations of beneficiaries. Correct. What should you tell her? What should you tell her? The goal is to ensure and make health care more accessible to the people of the nation. What should you tell her? Is this a prohibited activity at an event that has been advertised as educational? Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? What should you tell Mrs. Quinn? b. Medicare prescription drug plans are permitted to cover vitamins, but not drugs for cosmetic purposes. One might be right for you. You would be happy to help Anita enroll in a Medigap plan but before she can do so, she must also enroll in a Medicare Part D prescription drug plan. d. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. 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. He has tried two but had an allergic reaction to them. If she does not sign up for a Medicare prescription drug plan, she will incur no penalty, as long as she can demonstrate that she was in good health and did not take any medications. d. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan. If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. Mr. Shapiro gets by on a very small amount of fixed income. Mrs. Shields is covered by Original Medicare. b. An exception is made for emergency care.). What could you tell her to address her concern? b. 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. b. Medicare Advantage Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services but must include a maximum out-of-pocket limit. In addition to drugs on his plan's formulary he takes several other medications. "Are you interested in a Medicare supplement plan or a Medicare health plan?" 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