Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. Mr. Mrs. paterson is concerned about the deductibles drummer ronnie. Albert has heard about something called the Star Rating system for Medicare Advantage plans. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. General audience materials such as brochures, direct mail, newspapers, magazines, television, radio, billboards, yellow pages or the Internet.
In setting up the enrollment site, which of the following must Phiona consider? Agents/brokers are subject to rigorous oversight by their contracted health or drug plans and face the risk of loss of licensure with their State and termination with their contracted health or drug plans if they don't comply with strict rules related to selling to and enrolling Medicare beneficiaries in Medicare plans. 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. Mrs. paterson is concerned about the deductibles balances. 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. What should you tell her about obtaining drug coverage? 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. Medicare Advantage HMO or PPO may only obtain Part D benefits through their plan. )
If he wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he have to do? Mrs. paterson is concerned about the deductibles the rose. He is wondering if he can switch to a lower cost Part D plan. ABC is a long-term care facility provider. Thus, he is obligated to comply with all marketing requirements, including those regarding using only approved call scripts. You notice that her handwriting is illegible and as a result, the spelling of her street looks incorrect.
▪ Presentation materials such as slides and charts. They may not enroll in a standalone PDP. 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. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered If you do not have a Medicare Advantage plan that includes Part D drug coverage, you must sign up for it separately. 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? Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. Employed or independent agents/brokers must be state-licensed and follow all state appointment regulations in order to sell Medicare Advantage plans.
What do you need to do with your materials before using them for marketing purposes? Mrs. Quinn has just turned 65, is in excellent health, and has a relatively high income. Mrs. Schmidt is moving and a friend told her she might qualify for a "Special Election Period" to enroll in a new Medicare Advantage plan. Agent Armstrong is a marketing representative of BestChoice. She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves. In 2017, beneficiaries pay $164. If the PFFS plan does not offer Part D coverage, the beneficiary may enroll in a standalone PDP. If Mr. Block enrolls in the stand-alone Medicare Rx plan, he will be dis-enrolled from the MA plan. Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. 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.
What action(s) should BestCare take in response? Posts that meet the definition of marketing materials, specifically those that contain plan-specific benefits, premiums, cost-sharing, or Star Ratings. Later in the year, Mr. Rivera needs dentures, a service only covered under Medicaid. Medicare Savings Program: help paying for the Medicare Part B premium and, in some cases, deductibles and coinsurance. Do not delay even if you do not take any prescription drugs regularly right now. ▪ Market non-health care related products. 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. A number of requirements apply to electronic enrollment mechanisms, including, but not limited to: Plan Sponsors must submit all materials, web pages, and images (e. g. screen shots) related to the electronic enrollment process for CMS dividuals must be provided with all required pre-enrollment information (see module 4) mechanism must comply with CMS' data security policies. 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. Has QMB-Plus eligibility. During individual appointments, marketing representatives may not: ▪ Discuss plan options that were not agreed to in the Scope of Appointment.
If you wait until later to sign up, you will be charged extra on your premium for every month that you waited. If the application does not include information supporting a permissible election period, plans must contact the beneficiary to decide if enrollment is and Part D Enrollment periods are:MA Initial Coverage Election Period (ICEP)Part D Initial Enrollment Period (IEP)MA and Part D Annual Election Period (AEP)MA and Part D Special Enrollment Periods (SEP)Open Enrollment Period for Institutionalized Individuals (OEPI)MA 45-Day Disenrollment Period (MADP). Cost plan may obtain Part D benefit through their plan (if offered) or through a standalone PDP. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? The Medicare Managed Care Manual Chapter 2 has a full description of the relevant special enrollment periods. You know that the Medicare marketing guidelines prohibit certain types of statements.
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