What could you tell him to do? Dr. Brennan can charge the beneficiary the same cost-sharing as Original Medicare as long as she sends the claim to Medicare and not the plan. Preview 6 out of 55 pages. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state for Medicaid assistance.
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). Ms. Adams, a healthy early retiree who has just begun to collect Social Security at age 62. He has tried two but had an allergic reaction to them. Purchase of equipment$415, 000. Marketing representatives may only use internet pop-up ads providing plan-specific information that have been approved by CMS when soliciting prospects through electronic means of communication. AHIP Final Exam Test Review Questions and Answers (2022/2023) Latest Update. It means that he will be able to purchase continued drug coverage from the insurer that had provided it to the company retirees, but that he will not have to pay the entire premium himself. 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. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? 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. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. As long as his employer offers coverage that is equivalent to Medicare's, he cannot enroll in Part B. Mr. Roberts must return to Original Medicare within two months of discharge, but he may continue to enroll and disenroll in Part D for 12 months following discharge.
Mr. Roberts is enrolled in an MA plan. Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. It is mid-September, and Mrs. Young is going on vacation. Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. University Of Arizona. Medigap plans that cover costs not paid for by an MA plan are available only in Massachusetts, Minnesota, and Wisconsin. He gains the Part D low-income subsidy. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. Medicare inpatient psychiatric coverage is limited to the same number of days covered for typical inpatient stays. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. Question 17. Who is most likely to be eligible to enroll in a Part D prescription drug plan? Now is my chance to help others. AHIP Exam Flashcards. 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. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision.
Part D plans may use varying co-payments for brand name and generic drugs, but they may not restrict access through prior authorization. You may correct the information since it was a simple mistake. Purchase of available-for-sale debt securities$59, 000. He has chronic bronchitis, putting him at severe risk for pneumonia. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. After 90 days he would pay the full amount of all costs. Docmerit is super useful, because you study and make money at the same time! Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. You do not need to do anything further to the application form. AHIP questions.odt - Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through massage therapy. She is | Course Hero. Medicaid will select a Part D plan and enroll for her. His entitlement to Part A makes him eligible to enroll in any Medicare Advantage plan. SNPs only serve individuals eligible for both Medicaid and Medicare, so he cannot enroll.
If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. 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. This is a good idea. He became eligible for Medicare when his disability eligibility determination was first made.
To obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. 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. Tell her that the Medicare agency does not endorse or recommend any plan. Ms. Davis who is entitled to Part A and has just enrolled in Part B. Mr. Charles, an undocumented immigrant, entered the country illegally. Because her husband paid Medicare taxes, and she rarely did, she will have to pay Part A premiums but will do so at a reduced rate. What should you say? Medicare does not cover hospice services.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. Ms. Bradley is currently living abroad for a multi-year job assignment. You must send it to the plan for immediate processing, although the enrollment will not become effective until January 1. Mrs. Tanner can go to non-plan doctors without receiving prior approval for all services.
Agents are generally prohibited from soliciting or accepting an enrollment form before the start of the AEP. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. Part A, which covers long-term custodial care services, is covered under Original Medicare. He can apply the subsidy amount to his existing plan immediately, but he cannot enroll in a different plan. Mrs. Wu was primarily a homemaker and employed in jobs that provided taxable income only sporadically. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. Mrs. Tanner can go to non-plan doctors knowing that cost sharing will generally be the same as with network providers. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? The Honda Civic GX is the only car offered to consumers in the United States that runs on natural gas and uses no gasoline.
Yoo contacted you to find out more about what this means. Medicare covers hospice services and they will be available for her. He recently suffered complications following hip replacement surgery. Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it likely won't offer coverage that is equivalent to that provided under Part D. Mrs. Gonzalez should purchase a K or L Medigap plan. For Part D plans to receive the full government payment, they must offer the standard model, however, they can take a risk and revise their benefit structure to attract more beneficiaries. Medicare does not cover massage therapy, or, in general, glasses or dentures. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). Mr. Zachow has a condition for which three drugs are available. All plans must cover at least the standard Part D coverage or its actuarial equivalent. You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request. If she doesn't select a plan, Medicare will select a plan for her. Mrs. Tanner can go to non-plan doctors for certain services without receiving prior approval.