Study guides, Class notes & Summaries

Q 1: Mr. ,Davis ,is ,52 ,years ,old ,and ,has ,recently ,been ,diagnosed ,with ,end-stage ,renal ,disease,(ESRD) ,and ,will ,soon ,begin ,dialysis. ,He ,is ,wondering ,if ,he ,can ,obtain ,coverage ,under Medicare. ,What ,should ,you ,tell ,him? correct answers: He ,may ,sign-up ,for ,Medicare ,at any ,time ,however ,coverage ,usually ,begins ,on ,the ,fourth ,month ,after ,dialysis ,treatments start.

This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected. What should you do? - Answer You may go ahead and call them. Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: "We offer Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if you would like to l...

Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? - Answer He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of15 employees a...

Medicare Advantage - Answer -Cover all Part A and Part B benefits; -Provide plan cost-sharing actuarially equivalent to cost sharing under Medicare Parts A and B, but may be different for specific services; and -Include an annual maximum out-of-pocket (MOOP) limit on total enrollee cost sharing (deductibles, coinsurance, and copayments) for Part A and Part B services. -Cover the following services even when provided by non-network providers: emergency services: out-of-area urgently neede...

Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern? a. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal government. If she or her husband were ever employed by the federal government, she can enroll in Medicare. b. M...

Types of Medicare Advantage Plans - Answer PPO, HMO, MSA, Cost Plan, PFFS Medicare-Medicaid plans - Answer Serve both Medicare and Medicaid individuals. Include Part D coverage. Individuals sometimes referred to as dual eligibles Medicare Cost Plan - Answer Type of Medicare health plan. Have Part B to enroll. Can join anytime plan is accepting new members. A non network provider will can charge higher coinsurances and deuctibles. Different enrollment/disenrollment periods apply. Can ...

Annual Enrollment period (AEP) - Answer The AEP occurs October 15 through December 7 each year. During this time, all Medicare eligible beneficiaries can enroll in, disenrollment from or change MA,, MA-PD or PDP plans. coverage changes made during the AEP are effective January 1 of the following year. If Medicare eligible beneficiaries do not make a change, their current coverage continues into the next year with any applicable premium or benefit design adjustments. Appeal - Answer A Spec...

Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue, what should you say? - Answer Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month in which the individual receives a kidney ...

Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance? - Answer She should contact her state Medicaid agency to see if she qualifies forprograms that can help with Medicare costs for which she is responsible. Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of approxi...

Medicare - Answer Parts A & B, Original Medicare Supplement - Answer Medicare Supplement, Medigap Advantage - Answer Medicare Advantage, MA, MAPD Part D - Answer Part of MAPD OR Stand-alone PDP Pre-Medicare - Answer Under 65, Individual and Family, Affordable Care Act (ACA or PPACA), Obamacare Ancillary - Answer Dental, Vision Veterans Administration (VA) Benefits - Answer Government program for Veterans Healthcare Tricare - Answer Insurance program for Caree...

What impact, if any, have recent regulatory changes had upon Medigap plans? A. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. B. The Part A deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020. C. The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020. D. The Part B deductible is now covered for some newly eligible individuals de...