Medicare Module 1 questions and answers 2022

What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020.The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will make changes to Medigap plans effective 2020. Specifically, for individuals newly eligible to Medicare, the Part B deductible cannot be covered. Therefore, Plans C and F will no longer be an option for newly eligible individuals starting January 1, 2020. 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 Mrs. Lenard is enrolled in a Medicare Cost plan. Recently the cost plan has transitioned to a Medicare Advantage (MA) contract, and Mrs. Lenard has been told that she has been subject to "deemed enrollment." What does this mean? Some cost plans transitioning to MA contracts will have "deemed" or facilitated enrollment. That is, unless a cost plan enrollee opts out, he/she will be automatically enrolled in an MA plan offered by the same organization.Individuals subject to deemed enrollment will be notified by CMS and the plan and given the opportunity to choose another option. Mr. Carter, who is enrolled in a stand-alone Part D plan, receives the Part D low-income subsidy and just received a letter from the Social Security Administration informing him that he will no longer qualify for the subsidy? He is wondering if he can switch to a lower cost Part D plan. What should you tell him? Medicaid: help with health care costs. Medicare Savings Program: help paying for the Medicare Part B premium and, in some cases, deductibles and coinsurance. Part D low-income subsidy: help paying for prescription drug coverage. The State Medicaid office will check eligibility for this and other programs such as the Medicare Savings Program. Persons interested in Part D help only may call the Social Security Administration (SSA) at or apply online at Supplemental Security Income (SSI) benefits: help with cash for basic needs. You also may apply through SSA. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital 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? Skilled nursing and rehabilitative care only after a three day hospital stay, up to 100 days in a benefit period (as defined by Medicare). In 2017, beneficiaries pay $164.50 coinsurance for days 21-100 each benefit period.Inpatient psychiatric care (up to 190 lifetime days) Part A does not cover custodial or long-term care Cost-sharing may differ for enrollees of Medicare 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. What action(s) should BestCare take in response? Agent Armstrong is an independent agent under contract with MarketCo, a third party marketing organization. MarketCo has a contract with BestChoice health plan, a Medicare Advantage organization, to offer marketing services through its contracted agents and agencies. Agent Armstrong returns calls to individuals who call MarketCo in response to its mailers promoting BestChoice health plan. Agent Armstrong is a marketing representative of BestChoice. Thus, he is obligated to comply with all marketing requirements, including those regarding using only approved call scripts. Agent Mark Andrews would like to employ technology to facilitate the growth of his Medicare Advantage (MA) practice. What step(s) would you recommend that Mark take? Plans/Part D Sponsors must submit to CMS social media (e.g.,Facebook, Twitter, YouTube, LinkedIn, Scan Code, or QR Code)posts that meet the definition of marketing materials, specifically those that contain plan-specific benefits, premiums, cost-sharing,or Star Ratings. Social media posts are subject to marketing requirements, such as those related to testimonials. Generally disclaimers are not required unless a communication written for social media has the potential to be disseminated via other mediums, such as youtube.Plans/Part 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. Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. 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 should you tell her? 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. If the application does not include information supporting a permissible election period, plans must contact the beneficiary to decide if enrollment is permissible.MA 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) Mrs. Reynolds just signed up for a Medicare Advantage plan on the second of the month. She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves. What should you tell her? Initial Coverage Election Period (ICEP) The ICEP begins three months immediately before the individual's first entitlement to both Medicare Part A and Part B and ends on the later of: The last day of the month preceding entitlement to both Part A and Part B, or;The last day of the individual's Part B initial enrollment period.The initial enrollment period for Part B is the seven (7)month period that begins 3 months before the month an individual meets the eligibility requirements for Part B, and ends 3 months after the month of eligibility. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan's service area. What should you tell her about coverage of emergency care? Cover the following services even when provided by non-network providers: • emergency services; • out-of-area urgently needed services; and • out-of-area renal dialysis. Have access to doctors, specialists and hospitals: Get emergency care when and where they need it. CMS may offer services through non-network providers at the in-network enrollee cost-sharing level. Mr. Rivera has QMB-Plus eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) plan. Later in the year, Mr. Rivera needs dentures, a service only covered under Medicaid. What action would you recommend he take in order to have this cost covered? has QMB-Plus eligibility. She has decided to enroll in a Medicare Advantage plan. Ms. Jones can receive all Medicare covered services through her Medicare Advantage plan cost sharing. However, in order to receive coverage of services that are only covered under Medicaid, for example, dentures, she must go to a Medicaid provider or obtain the services through a Medicaid managed care plan if she is enrolled in one Categories of dual eligible beneficiaries and out-of pocket costs that must be paid by Medicaid: QMB Plus - Medicare Part A and Part B premiums; cost sharing for Part A & Part B benefits; Full Medicaid benefits.When a dual eligible individual enrolls in an MA plan, if the individual has coverage for Part A and B cost sharing, they will not have to pay more than the cost sharing that would apply under Medicaid. This rule applies to all types of Medicare Advantage plans, including dual eligible SNPs. Dual eligible beneficiaries may enroll in any type of MA plan except an MA MSA. 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. 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 coverage? Medicare Advantage HMO or PPO may only obtain Part D benefits through their plan. They may not enroll in a standalone PDP. (Employer group plan enrollees may have additional choices.) Several agents you work with are planning sales events in your area. One plans on giving door prizes worth $5, refreshments valued at $8 per anticipated attendee, and coupon books with discounts worth $10. Since no gift or prize exceeds the $15 limit he believes his plan is acceptable. What should you tell them He can give away more than one gift during a single event, but the aggregate retail value cannot exceed $15.