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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. Mrs. paterson is concerned about the deductibles drummer ronnie. ▪ Provide and collect enrollment forms. 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 beneficiaries.

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CMS makes this determination. If he wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he have to do? ▪ If you don't like this plan, you can stop paying your premium and return to original Medicare anytime. Be a U. citizen or lawfully present in the United States on or before the enrollment effective date. You should tell your colleague no because participation in an educational event may not include a sales presentation. Posts that meet the definition of marketing materials, specifically those that contain plan-specific benefits, premiums, cost-sharing, or Star Ratings. 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. Mrs. paterson is concerned about the deductibles for 2022. You are completing a PFFS plan sale to Mr. West who is new to Medicare, and as you are finishing up, what should you tell him about next steps in the enrollment process?

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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. Next week you will be participating in your first "educational event" for prospective enrollees. The company has added Medicare Advantage and Part D plans and you will begin marketing those plans this fall. 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. What should you tell her about coverage of emergency care? 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. ▪ I am certified by Medicare to sell this plan. • If a beneficiary is considering this option, he/she should call the plan first.

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▪ We cover all drugs without restrictions. However, individuals who already have Plans C and F will be able to keep their current versions of the plans and individuals eligible for Medicare prior to January 1, 2020, can purchase the current version of Plans C and F on or after January 1, 2020. ▪ There is an exception where state law requires that the gift certificate or gift card must be convertible to cash and the cash value is no more than $2. You would like to market an MA plan at a neighborhood pharmacy. • Typically it takes 2-3 months for SSA withholding to begin or end.

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Ms. O'Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent. If you wait until later to sign up, you will be charged extra on your premium for every month that you waited. 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. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan's service area. She has decided to enroll in a Medicare Advantage plan. What does this mean? In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What do you need to do with your materials before using them for marketing purposes? If Mr. Block enrolls in the stand-alone Medicare Rx plan, he will be dis-enrolled from the MA plan. For MA and Part D plans the individual must Permanently reside in the service area of the plan. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. Examples of foods that may be considered "light snacks" include: ▪ Fruit and raw vegetables ▪ Pastries and muffins ▪ Cookies or other small bite-size dessert items ▪ Crackers ▪ Cheese ▪ Chips ▪ Yogurt ▪ Nuts.

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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. Medicaid: help with health care costs. 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. Generally the beneficiary must stay with the premium payment option for the entire year. AHIP Exam Practice with 100% Correct Answers. ▪ There are no limits on services. PFFS is not a Medicare supplement, Medigap, or a Medicare Select policy. An institutionalized beneficiary has a continuous open enrollment period (OEPI) for purposes of changing enrollment in Medicare Advantage plans; this period does not end until two months after the month the beneficiary moves out of the institution. 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 State Medicaid office will check eligibility for this and other programs such as the Medicare Savings Program.

He has signed up for Medicare Part A, but he did not enroll in Part B because he has employer-sponsored coverage and intends to keep working for several more years. 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. Continues as long as he or she is eligible for LIS. 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. He found a stand-alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA-PD plan and in addition has a low premium.

▪ Provide educational information. Generally disclaimers are not required unless a communication written for social media has the potential to be disseminated via other mediums, such as D Sponsors must not include content on social/electronic media that discusses plan-specific benefits, premiums, cost-sharing, or Star Ratings for products offered in the next contract year prior to October 1. What can you tell her about Medigap as an option to address this concern? She plans to switch from her old MA HMO plan to the new MA-PD plan during the Annual Election Period. ▪ 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. He would like you to help him complete the enrollment application because he wants to make sure he gets into the right plan. Supplemental Security Income (SSI) benefits: help with cash for basic needs. ▪ Promotional materials such as brochures or leaflets, including materials for circulation by physicians, other providers, or third parties.

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. Skilled nursing and rehabilitative care only after a three day hospital stay, up to 100 days in a benefit period (as defined by Medicare). MA and Part D plans may offer CMS-approved online enrollment on the plan sponsor's website. 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.

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? How should you respond to your colleague's suggestion? Do not delay even if you do not take any prescription drugs regularly right now. 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. MA organizations may develop and offer electronic enrollment mechanisms made available via an electronic device or secure internet website. She does so using this SEP and her enrollment is effective December 1st.