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Wed, 03 Jul 2024 01:33:33 +0000The government bases its payments to Part D plans on the standard benefit model. Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as to whether this is possible. The government allows Part D plans to adopt any benefit structure as long as the list of covered drugs meets their approval. AHIP questions.odt - Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through massage therapy. She is | Course Hero. 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 can enroll in a Medicare Advantage plan but it will pay only the benefits associated with Medicare Part A.
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Sets found in the same folder. Part D plans do not have to cover all medications. It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part D prescription drug plan. As a dual eligible beneficiary, her Part D drugs will be covered by Medicare once she is enrolled in a Part D plan. Ms. Adams, a healthy early retiree who has just begun to collect Social Security at age 62. Medicine, published 02. You should plan to ensure that the educational event is an informative event and must not conduct a sales presentation or distribute or accept enrollment forms at the event. Mr. Zachow has a condition for which three drugs are available. You may correct the information since it was a simple mistake. AHIP Exam Flashcards. Generally, employers prefer retirees to have both the retiree group plan and the MA-PD plan to fill in the gaps, but he would be better off with just the MA-PD plan. This is not a possibility. What should you say?
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She is very concerned about how this will affect her prescription drug coverage. You should plan to conduct sales presentations but must not accept enrollment forms. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. 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. Because of the severity of his condition, Mr. Wendt must remain enrolled in Original Medicare and also enroll in a Medigap plan to supplement his additional medical needs. Most individuals who are citizens and age 65 or over and wish to be covered under Part A must enroll in a Medicare Advantage Plan. The percentage increases after 60 days and again after 90 days. This allows Mrs. Tanner to do which of the following? 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. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through - Brainly.com. Berkowitz can do this. You must state in the advertisement that it will be an educational event and that the education will consist of specific information about the participating plans. Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. Mrs. Berkowitz can apply for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her service area. If Mrs. Berkowitz wants health coverage and drug coverage through a plan, she must purchase an MA-PD plan.
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The plan will retain Mrs. Young's application and process it when the AEP begins. SNPs do not provide Part D prescription drug coverage, so if he does enroll, he should be aware that he will not have coverage for any medications he may need now or in the future. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. Students also viewed. He has tried two but had an allergic reaction to them. Standard Part D coverage would require payment of only fixed per-prescription co-payments. To qualify for enrollment into a Medicare prescription drug plan, Mrs. Mulcahy must be entitled to Part A and enrolled under Part B. As long as his employer offers coverage that is equivalent to Medicare's, he cannot enroll in Part B. It means that he will have a one time opportunity to enroll in a Medigap policy with drug coverage. Northwestern University. He called you to ask what he could do? He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Mr. Mrs west wears glasses and dentures and has enjoyed. Zachow will have to wait until the Annual Election Period when he can switch Part D plans. You even benefit from summaries made a couple of years ago.
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C. Generally, employers prefer retirees to enroll in a stand-alone PDP, so he should consider that instead of the MA-PD. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary's stay. Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. They collected the following data: Line Speed (ft/min) 20 20 40 30 60 40 Number of Defective Parts Found 21 19 15 16 14 17. You appreciate the opportunity and would ask the facility to provide enrollment applications for the MA-PD plans you represent. If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals with diabetes, he may enroll in the SNP during the MA Open Enrollment Period which takes place between January 1 and March 31. Preview 6 out of 55 pages. Tell her that if a plan obtains permission from CMS for a marketing event in a provider facility, the event may go forward, regardless of where it occurs in the facility. Mrs. Tanner can go to non-plan doctors without receiving prior approval for all services. Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug coverage, and enroll in any stand-alone Medicare prescription drug plan. You have approached a hospital administrator about marketing in her facility. You appreciate the opportunity and your friend would just need to complete scope of appointment forms on behalf of all the residents who would like to attend.
The plan will cover his Part A and Part B services, as well as provide him with the desired prescription drug coverage. Mary Rodgers sees Dr. Brennan for treatment. His open enrollment period as an institutionalized individual will continue for 12 months following his date of discharge. 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. He should compare the benefits in his employer-sponsored retiree group health plan with the benefits in his neighbor's MA-PD plan to determine which one will provide sufficient coverage for his prescription needs. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working with Agent Neil Adams in the selection of a Medicare Advantage (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. His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. Mr. Ziegler 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. What could you tell him? You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. She will have to pay the monthly Part A premium in order to obtain the coverage. You notice that her handwriting is illegible and as a result, the spelling of her street looks incorrect.
After day 60 the amount gradually increases until day 90. Part C, which always covers dental and vision services, is covered under Original Medicare. Standard Part D coverage would require payment of an annual deductible, and once past the catastrophic coverage threshold, the beneficiary pays whichever is greater of either the co-pays for generic and brand name drugs or coinsurance of 5%. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. Part D plans may use varying co-payments for brand name and generic drugs, but they may not restrict access through prior authorization. Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. He may change or drop MA plans, but may not drop drug coverage. A borrower is faced with choosing between two loans. You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.
During a sales presentation, your client asks you whether the Medicare agency recommends that she sign up for your plan or stay in Original Medicare.
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