What costs would a beneficiary incur for prescription drugs in 2013 under the standard coverage? You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Gonzalez can purchase a Medigap plan that covers drugs, but it likel to that provided under Part D. Gonzalez should purchase a K or L Medigap plan. Question3 You would like to market an MA plan at a neighborhood pharmacy. She will need to complete a disenrollment form the month before she wants to submit her application for the new plan to ensure she does not end up with two plans. Question7 Mr. Mrs. roberts has original medicare coverage. As long as his employer offers coverage that is equivalent to Medicare b. As long as his employer offers coverage that is equivalent to Medicare's, he cannot enroll in Part B.
She has heard about a technique called "step therapy" and is wondering if you can explain what that is. D. You must set an appointment for another time, at least 48 hours from the point w Source: Required Practices: Marketing Activities, cont'd. D. Market non-health related products, such a life insurance, to current m HIPAA Privacy Rules. Mrs. roberts has original medicare plan. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out-of-pocket limit that qualifies her for catastrophic coverage. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. Klasen 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. A large physician group in your area contracts with the plans you represent.
Carlini can obtain drug coverage through the Federal government's fallback p an alternative to privately sponsored Medicare Advantage plans. She may do it only during the MA Disenrollment Period, which runs from January 1 to February 14 of each year. All individuals who are citizens and over age 65 will be covered under Part A. 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. Yes, because their cost to the plan was under $15. 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. D. State Medicaid programs do not coordinate any of their coverage with Medic Source: MA Plans and Dual Eligible Beneficiaries. Hall's home to ensure that the discussion of the prescription drug plan can take place. B. Medicare Supplemental Insurance would cover his dental, vision and hearing s. c. Medicare Supplemental Insurance would help cover his Part A and Part B cost (FFS) Medicare as well as possibly some services that Medicare does not cover. The extra help is available only to Medicare beneficiaries who are enrolled in M coverage under his state's Medicaid program to access the extra help with his dru. Standards of Conduct are the same for every Medicare Parts C and D sponsor. He can enroll in or disenroll from a Part D plan at any time and the subsidy will apply to the plan he chooses. D. AHIP Exam Test Review Unit 1 to 5 - Question and Answe - Study-Guide. Cost plans do not offer optional supplemental benefits, but they also do not m obtain services from any provider he wishes to see and the cost-sharing will be Source: Other Health Plans: Medicare 1876 Cost Plans. Long-Term Care policies for Medicare beneficiaries c. Medigap plans d. Medicare Advantage (MA) and Prescription Drug (PDP) plans Source: Medicare Marketing Rules.
D. The government bases its payments to Part D plans on the standard benefit model. Tavenner could charge the beneficiary the same cost sharing as Original Medicare as long as she sends the claim to Medicare and not the plan. Mrs. roberts has original medicare cover. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. He is suspicious about how plans establish these formularies.
Question6 Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next year. You may request names and mailing addresses. Mr. Any MA plan he joins will assign him to a primary care physician and he can request a change if he has a valid reason that the plan will approve. At the time you arrive for the appointment, let her know which products you will be going over.
He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Antonio should include on the invitation a statement that a salesperson will be present with information and applications. Mrs. She is concerned that her expenses have reached the maximum out-of-pocket costs and now her special needs plan (SNP) will disenroll her. 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. Can they use these items as promotional prizes? Mr. How can you explain this to him? Generally, Dr. Brennan can charge the beneficiary more than the cost sharing long as she treats all beneficiaries the same. Share with Email, opens mail client. You may not provide any gift or prize as an inducement to enroll. The Part D low income subsidy is designed for Medicare beneficiaries who also qualify for Medicaid. Source: Educational Events; Educational Events cont'd. C. In general, Mrs. Ramos can obtain care from any provider who participates in O difference between the plan's allowed amount and the provider's usual and custom d. AHIP Module 5 Continued... Flashcards. Ramos will need a referral to see specialists. Source: Promotional Activities: Referral Programs Question4 Several agents you work with are planning sales events in your area.
Question4 Mrs. Austin just signed up for a Medicare Advantage plan on the second of the month. He should not be concerned because Medicare health plans must cover all IRS-approved health care expenses, which means that all of them provide substantially greater benefits than are available under Medicare Part A and Part B. Medicare health plans must cover all benefits available under Medicare Part A and Part B. You must set up your table and make marketing presentations only in common areas, but you may accept enrollment applications anywhere in the pharmacy. He has a right to select or change his primary care provider from within the plan's ne b.
B. Diaz will pay a penalty, which will be a flat amount each year, paid during. Mr. Zigmund is turning 65 next month and has asked you what he can do, and when he must do it, with respect to enrolling in Part D. He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD plan. Medicaid will cover all of her PFFS out-of-pocket costs and Medicaid providers will accept amounts paid by the PFFS plan as payment in full. You may leave an enrollment kit and discuss a new life insurance product she might like. 1 Mrs. She may enroll in an MA plan beginning three months immediately before he A and Part B. c. She must have previously been enrolled in Original Fee-for-Service Medicar enroll in an MA plan. You notice a certain diagnostic provider ("Doe Diagnostics") requested a substantial payment for a large number of members. They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs. Question3 You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees. Question2 If you are to be in compliance with Medicare's guidance regarding educational events, which of the following would be acceptable activities? As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before such withholding should begin, he can change his method of Part D premium payment and withholding will begin the month after his savings account is exhausted. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. She has heard that to qualify for Medicare Part A she has to have worked and paid Medicare taxes for a sufficient time. If he sends the form directly to the plan, the plan will process the enrollment on the day the Annual Election Period begins.
What should you tell her about how the Part D Initial Enrollment Period applies to her situation? Question2 Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was offered to company retirees. You could tell her she is right and ask if you could get a contract with the TMO too. With Mr. Schmidt to avoid influencing his answers. She is concerned that it is a forgery since it does not have her Social Security number on it. Cotter must convert his current coverage to employer-sponsored retiree coverage and wait one year before enrolling in an MA or Part D plan. You spoke to your supervisor who said don't worry about it. Under ACA Section 1557, a health plan. Mrs. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? Denise is an independent agent who markets to different types of groups.
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