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She decides she would rather be enrolled in another PDP or an MA-PD plan and submits a request in November. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with Original Medicare coverage.... [Show more].

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Do not delay even if you do not take any prescription drugs regularly right now. What steps may it take to inform residents of the Medicare options available to them? What should you tell her about obtaining drug coverage? Mrs. paterson is concerned about the deductibles the rose. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? If enrolled in a Medicare coordinated care plan (HMO/PPO) or a PFFS plan that includes Part D drug coverage, the beneficiary may not be enrolled in a stand-alone PDP.

You offer to help, but you tell him that you cannot do which of the following? One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period.

Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. Preferred Provider Organizations (PPOs), local and regional; PPO enrollees generally may get care from any provider in the U. S. who accepts Medicare, but will pay less if they go to one of the "preferred" providers in the PPO's network. CMS may offer services through non-network providers at the in-network enrollee cost-sharing level. You plan to participate in an educational event sponsored by a large regional health care system. Mrs. paterson is concerned about the deductibles. Enroll in or disenroll from a PDP or MA-PD plan at any time Who is eligible for a SEP based on loss of eligibility for Part D LIS? He could look at plan designs to see if one of the enhanced plans would serve his needs better than a plan based on the standard design. All individual appointments ▪ Are considered sales/marketing events; ▪ Must meet sales/marketing event requirements; ▪ Must follow scope of appointment requirements (See following slides). Preventive & screening services. Therefore, Plans C and F will no longer be an option for newly eligible individuals starting January 1, 2020. 50 coinsurance for days 21-100 each benefit patient psychiatric care (up to 190 lifetime days) Part A does not cover custodial or long-term care Cost-sharing may differ for enrollees of Medicare. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period.

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▪ Provide educational information. • If a beneficiary is considering this option, he/she should call the plan first. He thought that all the drug plans were required to offer the same standard benefits and would like you to explain why there is such a range in premiums. She contacted you to ask what a Special Election Period is. You should tell your colleague no because participation in an educational event may not include a sales presentation. ▪ Gifts are of nominal value if an individual item is worth $15 or less (based on retail purchase price of the item); ▪ When more than one gift is offered, the combined value of all items must not exceed $15; ▪ Gifts must not be in the form of cash or other monetary reward, even if their worth is less than $15. You are completing a PFFS plan sale to Mr. Mrs. paterson is concerned about the deductible des impots. West who is new to Medicare, and as you are finishing up, what should you tell him about next steps in the enrollment process?

▪ If your doctor accepts Medicare, she accepts this plan. She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. Continues as long as he or she is eligible for LIS. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. That is, unless a cost plan enrollee opts out, he/she will be automatically enrolled in an MA plan offered by the same dividuals subject to deemed enrollment will be notified by CMS and the plan and given the opportunity to choose another option. However, she wants to make sure she does not end up paying premiums for two plans. What could you tell her? MA organizations may develop and offer electronic enrollment mechanisms made available via an electronic device or secure internet website. Persons interested in Part D help only may call the Social Security Administration (SSA) at 1-800-772-1213 or apply online at. Plan sponsors must include a disclaimer on all marketing materials promoting a prize or drawing or any promise of a free gift that there is no obligation to enroll in the sponsors must track and document promotional activities and items given to current enrollees during the year. MA and Part D plans may offer CMS-approved online enrollment on the plan sponsor's website.

A meal CAN'T be provided, but light snacks would be permitted. He would like you to help him complete the enrollment application because he wants to make sure he gets into the right plan. Recently the cost plan has transitioned to a Medicare Advantage (MA) contract, and Mrs. Lenard has been told that she has been subject to "deemed enrollment. " It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan. Ms. Jones can receive all Medicare covered services through her Medicare Advantage plan cost sharing. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will make changes to Medigap plans effective 2020. You should sign up for Medicare Part D at the same time that you enroll in Part B. Where appropriate, SEPs allowing changes to MA coverage are coordinated with those allowing changes in Part D coverage. Medicare Module 1 – Flashcards. Marketing representatives cannot say: ▪ The government wants you to join a Medicare health plan because it helps them. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. MA MSA may only obtain Part D benefits through a standalone PFFS plan that offers Part D coverage may only obtain Part D benefits through that plan.

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▪ Promotional materials such as brochures or leaflets, including materials for circulation by physicians, other providers, or third parties. Regional PPOs are PPOs that serve an entire region, made up of one or more states. Most individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. In setting up the enrollment site, which of the following must Phiona consider? If you wait until later to sign up, you will be charged extra on your premium for every month that you waited. Cash gifts include charitable contributions on behalf of an attendee and those gift certificates or gift cards that can be readily converted to cash. The amount of the premium penalty changes every year. You are planning what materials to use to easily show the differences in benefits, premiums and cost sharing for each of the products.

Social media posts are subject to marketing requirements, such as those related to testimonials. You are meeting with Ms. Berlin and she has completed an enrollment form for a MA-PD plan you represent. Medicaid: help with health care costs. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market, and modify it to include information about preventive screening tests showcased at the event. Submit a complete enrollment request (a legal representative may complete the enrollment request for the individual) Be fully informed of and agree to abide by the plan rules provided during the enrollment request. ▪ There are no limits on services. PFFS is not the same as Original Medicare. If the PFFS plan does not offer Part D coverage, the beneficiary may enroll in a standalone PDP. Disenroll from an MA plan, PDP or Cost plan or leave Original Medicare Enroll in a 5-star MA plan, PDP or Cost plan Eligible individuals may enroll in a 5-star plan through 1-800-MEDICARE,, or directly through the 5-star plan. Mrs. Shields is covered by Original Medicare. AHIP Exam Practice with 100% Correct Answers. Begins on the month the individual becomes eligible for LIS. Medicare-Medicaid beneficiaries have a continuous special enrollment period that permits them to enroll in a MA, MAPD, PDP, or MMP (in applicable states and subject to state-specific eligibility rules) during any month. PFFS options available to beneficiaries may include: Enrolling in a PFFS plan offering only Medicare A/B benefits and not obtaining Part D coverage; Enrolling in a PFFS plan that combines Medicare A/B and Part D prescription drug benefits (MAPD plan); or Enrolling in a PFFS plan offering Medicare A/B benefits and enrolling in a stand-alone Part D prescription drug plan (PDP).

Some MA plans, known as dual eligible Special Needs Plans, are tailored to dual eligible individuals, depending on the category (see prior slide) to which they belong. This rule applies to all types of Medicare Advantage plans, including dual eligible SNPs. General audience materials such as brochures, direct mail, newspapers, magazines, television, radio, billboards, yellow pages or the Internet.

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