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Mrs. Paterson is concerned about the deductibles and co-payments associat- ed with Original Medicare. What can you tell her about Medigap as an option to address this concern?
Anita Magri will turn age 65 in August
- Anita intends to enroll in Origi- nal Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's old- er neighbor Mel has told her about the Medigap Plan F in which he is en- rolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her?
What impact, if any, have recent regula- tory changes had on Medigap plans?
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychi- atric hospital stay that Medicare will cov- er?
Medigap plans help beneficiaries cover Original Medicare benefits, but they co- ordinate with Original Medicare cover- age.
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who turn age 65 after January 1,
- Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B de- ductible.
b. The Part B deductible is no longer cov- ered for individuals newly eligible for Medicare starting January 1, 2020.
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physi- cians feel that after her lengthy hos- pital stay, she will need a month or two of nursing and rehabilitative care. What should you tell them about Original
Medicare's coverage of care in a skilled nursing facility?
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through massage therapy. She is concerned about whether or not Medicare will cover these items and ser- vices. What should you tell her?
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. What should you tell her about obtaining drug cover- age?
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?
Mr. Barker enjoys a comfortable retire- ment income. He recently had surgery and expected that he would have cer- tain services and items covered by the plan with minimal out-of-pocket costs be- cause his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him?
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?
Medicare does not cover massage ther- apy, or, in general, glasses or dentures.
She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan.
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
You can offer to review the plans appeal process to help him ask the plan to re- view the coverage decision.
He will have to enroll in Part B.
Mr. Carlini has heard that Medicare pre- scription drug plans are only offered through private companies under a pro- gram known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him?
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. She asks you to explain it. What do you say?
Mr. Rice is 68, actively working, and has coverage for medical services and med- ications through his employer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B and switching to an MA-PD be- cause he is paying a very large part of his group coverage premium, and it does not provide coverage for a number of his medications. Which of the following is NOT a consideration when making the change?
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has re- cently lost creditable coverage previous- ly available through her husband's em- ployer. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her?
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until
Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficia- ries.
TrOOP stands for true out-of-pocket ex- penses that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances drug manufactur- er discounts.
it is exhausted, and then have his pre- miums withheld from his Social Security check. What should you tell him?
Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do?
Next week you will be participating in your first "educational event" for prospec- tive enrollees. To be sure that you do not violate any of the applicable guidelines, in what activities should you plan to en- gage?
You plan to participate in an education- al event sponsored by a large region- al health care system. One of your col- leagues suggests that you do a presen- tation on one of the Medicare Health plans you market and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion?
You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situa- tion?
A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do?
In general, he must select a single Part D premium payment mechanism that will be used throughout the year. Mr. Zachow has a right to request a for- mulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan.
Gift cards or gift certificates of $15 or less that can be readily converted to cash.
You must have her sign a scope of ap- pointment form, indicating which prod- ucts she wishes to discuss. You may then proceed with the discussion.
riod. What are his options during the MA OEP?
Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his first Medicare eligibility date will be June 1. Mr. Liu's ICEP and Part D IEP begin on March 1 and end on September
- He wants prescription drug coverage with his Part A and Part B benefits. What advice can you provide him?
Agent Chan is conducting a sales pre- sentation on senior issues where he hopes to enroll some attendees in the Medicare Advantage (MA) plans he rep- resents. What action(s) may Agent Chan take during the event?
Mr. Landry is approaching his 65th birth- day. He has signed up for Medicare Part A, but he did not enroll in Part B be- cause he has employer-sponsored cov- erage and intends to keep working for several more years. But he is consider- ing enrolling in Part D prescription drug coverage because he believes it is supe- rior to his employer plan. How would you advise him?
Discuss plan specific information such as premiums and benefits.
Mr. Landry is eligible for Part D since he has Part A, and his initial enrollment period (IEP) for Part D will continue for three months after his 65th birthday.
