Be a U. citizen or lawfully present in the United States on or before the enrollment effective date. Continues as long as he or she is eligible for LIS. Agent Armstrong is a marketing representative of BestChoice. Agents/brokers must be licensed in the State in which they do business, annually complete training and pass a test on their knowledge of Medicare and health and prescription drug plans, and follow all Medicare marketing rules. If enrollment is completed during a face-to-face interview, the plan representative should use the individual's Medicare card to verify the spelling of the name, sex, Medicare number; and Part A and Part B effective dates. Mrs. paterson is concerned about the deductible des impots. ▪ If your doctor accepts Medicare, she accepts this plan. Part D enrollees have three options for paying their Part D premium.
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Mrs. Paterson Is Concerned About The Deductibles
The Medicare Managed Care Manual Chapter 2 has a full description of the relevant special enrollment periods. Medicare Module 1 – Flashcards. Employer group plan enrollees may have additional choices. What statement best describes the marketing and compliance rules that apply to Agent Armstrong?
Enrollees do not need a referral to see an out-of-network provider, but may be encouraged to contact the plan to be sure the service is medically necessary and will be covered. How would you advise him? Non-dual beneficiaries who qualify for LIS but do not receive Medicaid benefits When does the SEP take place? Can obtain care from any provider who participates in Original Medicare, but generally will be charged a lower co-payment if she goes to one of the plan's preferred providers. Which of the following is a correct statement about state laws as they pertain to marketing representatives? Mrs. paterson is concerned about the deductibles are usually. Ms. Lee is enrolled in an MA-PD plan, but will be moving out of the plan's service area next month. What action(s) should BestCare take in response? What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? Who is eligible for a SEP based on gaining eligibility for Part D LIS? Mrs. Quinn has just turned 65, is in excellent health, and has a relatively high income.
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Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. General audience materials such as brochures, direct mail, newspapers, magazines, television, radio, billboards, yellow pages or the Internet. Mr. Albert has heard about something called the Star Rating system for Medicare Advantage plans. Apply those guidelines to the following statements and identify which would be prohibited. Persons interested in Part D help only may call the Social Security Administration (SSA) at 1-800-772-1213 or apply online at. Medicare Savings Program: help paying for the Medicare Part B premium and, in some cases, deductibles and coinsurance. 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. You have had a good meeting with Mr. Claggett and he has selected a Medicare Advantage plan. XYZ Agency maintains a website marketing the MA plans with which it has contracts. ▪ Promotional materials such as brochures or leaflets, including materials for circulation by physicians, other providers, or third parties. You will NOT be able to represent any MA or Part D plan until you compete the training and achieve an adequate score, although you will NOT have to take a test if you exclusively market employer/union group plans and the companies do not require testing. CMS facilitates her enrollment into a PDP, effective October 1st. You need to get Mr. Mrs. paterson is concerned about the deductibles for 2022. Schmidt's phone number and include it on the enrollment form because the plan must call him after you leave to ensure that he understood the nature of the PFFS plan he selected and to verify his intent to enroll. MA and Part D enrollees who move out of their existing plan's service area, or who have new options available to them as a result of a permanent move.
The amount of the premium penalty changes every year. Dual eligible beneficiaries may enroll in any type of MA plan except an MA MSA. For example, the SEP for calendar year 2018 can be used from December 8, 2017 through November 30, 2018. 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. Example: Ms. Perry is awarded LIS. If Mr. Block enrolls in the stand-alone Medicare Rx plan, he will be dis-enrolled from the MA plan. Phiona works in the IT Department of BestCare Health Plan. 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. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan's service area. 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. Skilled nursing and rehabilitative care only after a three day hospital stay, up to 100 days in a benefit period (as defined by Medicare). This rule applies to all types of Medicare Advantage plans, including dual eligible SNPs.
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What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presentation? Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. Later in the year, Mr. Rivera needs dentures, a service only covered under Medicaid. MarketCo has a contract with BestChoice health plan, a Medicare Advantage organization, to offer marketing services through its contracted agents and agencies. ▪ Marketing representative scripts or outlines for telemarketing, enrollment or other presentations. PPOs must have a maximum limit on member out-of pocket costs for network providers of not greater than $6, 700 per year and an aggregate limit on network and non-network costs of $10, 000. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. Cash gifts include charitable contributions on behalf of an attendee and those gift certificates or gift cards that can be readily converted to cash. You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. For MA and Part D plans the individual must Permanently reside in the service area of the plan. ABC is a long-term care facility provider. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan.
What do you need to do with your materials before using them for marketing purposes? 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. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. She asks you to fill in the corrected street name. 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). In setting up the enrollment site, which of the following must Phiona consider?
Mrs. Paterson Is Concerned About The Deductibles For 2022
You should sign up for Medicare Part D at the same time that you enroll in Part B. 1) Beneficiaries who lose their LIS eligibility because they are no longer deemed eligible for the following calendar year. Begins on the month the individual becomes eligible for LIS. Some cost plans transitioning to MA contracts will have "deemed" or facilitated enrollment. She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves.
Mr. Landry is approaching his 65th birthday. BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. 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. Specifically, for individuals newly eligible to Medicare, the Part B deductible cannot be covered. ▪ It is better to choose a different company if you are sick. He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15.
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