When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals? Plan sponsors and their marketing representatives may not willfully structure pre-enrollment activities with the intent to give people more than $75 per year. Enrollment via the internet: CMS offers an on-line enrollment center through • Individuals can also enroll through: • CMS on-line enrollment is disabled for MA and Part D plans with a low performer icon (LPI), which means the plan received less than 3 stars for three consecutive years.
He asks you to explain it to him since he is interested in enrolling in a plan that is newly available in his area. What should you tell her about obtaining drug coverage? Which of the following is a correct statement about state laws as they pertain to marketing representatives? Regional PPOs are PPOs that serve an entire region, made up of one or more states. You would like to market an MA plan at a neighborhood pharmacy. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. Annual election period (October 15 - December 7) Medicare Advantage Disenrollment Period (January 1 - February 14) Beneficiaries may only enroll in or change plans at certain fixed times each year or under certain limited special circumstances. PACE plan may only receive Part D benefits through that plan. 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. Several agents you work with are planning sales events in your area. What should you tell her about coverage of emergency care? Mrs. paterson is concerned about the deductibles drummer ronnie. ▪ (Name of plan) is the best Medicare plan you can buy. She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves.
Group 1: January 1 - March 31 Group 2: Begins the month beneficiaries are notified and continues for two months. You may correct this information as long as you add your initials and date next to the correction. Mrs. paterson is concerned about the deductibles music live. • When withholding begins, it will be for the 2-3 months of premiums owed. MA and Part D plans may offer CMS-approved online enrollment on the plan sponsor's website. • Typically it takes 2-3 months for SSA withholding to begin or end.
What can you do in this situation? You work for a company that has marketed Medigap products for many years. 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. She decides she would rather be enrolled in another PDP or an MA-PD plan and submits a request in November. Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Enrollees may be enrolled in a stand-alone PDP only if they are enrolled in: Original fee-for-service Medicare; Private Fee-for-Service (PFFS) plan without Part D drug coverage; Medical Savings Account (MSA) plan; or 1876 Cost plan. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. 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. Marketing representatives should contact plan sponsor regarding the appropriateness of the food products provided and must ensure that items provided could not be reasonably considered a meal and/or that multiple items are not being "bundled" and provided as if a meal. Social media posts are subject to marketing requirements, such as those related to testimonials. ▪ If you don't like this plan, you can stop paying your premium and return to original Medicare anytime. Dual eligible beneficiaries may enroll in any type of MA plan except an MA MSA.
Marketing representatives may offer gifts to potential enrollees if they attend a marketing presentation as long as the gifts are of nominal value and provided regardless of enrollment and without discrimination. She does so using this SEP and her enrollment is effective December 1st. Who is eligible for a SEP based on change of residence? Beneficiaries who have moved into a plan service area from a location where there was no Part D plan available (e. overseas) qualify for an SEP just for Part D election purposes MA eligible and Part D eligible beneficiaries who experience certain qualifying events are allowed an SEP Timeframes for SEPs are variable, however, most begin on the first day of the month in which the qualifying event occurs and last for a total of three months. Medicare Savings Program: help paying for the Medicare Part B premium and, in some cases, deductibles and coinsurance. What steps may it take to inform residents of the Medicare options available to them? 2) Beneficiaries who lose their LIS eligibility during the year outside of the annual redetermination does the SEP take place? 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? ▪ Provide educational information. Example: Ms. Perry is awarded LIS. Do not delay even if you do not take any prescription drugs regularly right now. ▪ Provide and collect enrollment forms. When a new generic drug for the same condition becomes available or when the FDA or manufacturer withdraws the drug from the market, a brand name drug can be replaced. Some cost plans transitioning to MA contracts will have "deemed" or facilitated enrollment.
What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? 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. Skilled nursing and rehabilitative care only after a three day hospital stay, up to 100 days in a benefit period (as defined by Medicare). 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.
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. What do you need to do with your materials before using them for marketing purposes? If the PFFS plan does not offer Part D coverage, the beneficiary may enroll in a standalone PDP. Persons interested in Part D help only may call the Social Security Administration (SSA) at 1-800-772-1213 or apply online at. They may not enroll in a standalone PDP. Cost plan may obtain Part D benefit through their plan (if offered) or through a standalone PDP. ▪ Market non-health care related products. Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. You are doing a sales presentation for Mrs. Pearson.
If you wait until later to sign up, you will be charged extra on your premium for every month that you waited. How will Agent Chan be compensated under CMS rules? 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. What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans?
What action(s) should BestCare take in response? ▪ Ask for referrals. 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. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable.