1. Mr. Chen is enrolled in his employer's group health plan and will be retiring
soon. He would like to know his options since he has decided to drop
... [Show More] his
retiree coverage and is eligible for Medicare. What should you tell him?0
I'm - Mr. Chen can disenroll from his employer-sponsored coverage to elect
a Medicare Advantage or Part D plan within 2 months of his disenrollment.
2. Mr. Kumar is considering a Medicare Advantage HMO and has questions
about his ability to access providers. What should you tell him? - In most
Medicare Advantage HMOs, Mr. Kumar must generally obtain his services
only from providers within the plan's network (except in an emergency or
where care is unavailable within the network).
3. ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its
enrollees' information to market non-health related products such as life
insurance and annuities. Which statement best describes ABC's obligation to
its enrollees regarding marketing such products? - XXXIt must obtain a
HIPAA complaint authorization from an enrollee that indicates the plan or
plan sponsor may use their information for marketing purposes.
4. Mr. Yoo's employer has recently dropped comprehensive creditable
prescription drug coverage that was offered to company retirees. The
company told Mr. Yoo that, because he was affected by this change, he
would qualify for a Special election period. Mr. Yoo contacted you to find
out more about what this means. What can you tell him? - It means that he
qualifies for a one-time opportunity to enroll in an MA-PD or Part D
prescription drug plan.
5. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but
accepts the plan's terms and conditions for payment. Mary Rodgers sees Dr.
Brennan for treatment. How much may Dr. Brennan charge? - Dr. Brennan
can charge Mary Rogers no more than the cost sharing specified in the PFFS
plan's terms and condition of payment which may include balance billing up
to 15% of the Medicare rate.
6. 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 psychiatric hospital stay that
Medicare will cover? - Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
7. 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. 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? - A meal cannot be
provided, but light snacks would be permitted.
8. You have approached a hospital administrator about marketing in her
facility. The administrator is uncomfortable with the suggestion. How could
you address her concerns? - Tell her that Medicare guidelines allow you to
conduct marketing activities in common areas of a provider's facility.
9. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each
day. Mr. Vaughn takes a prescription for helping to regrow his hair. They
are anxious to have their Medicare prescription drug plan cover these drug
needs. What should you tell them? - Medicare prescription drug plans are
not permitted to cover the prescription medications the Vaughns are
interested in under Part D coverage, however, plans may cover them as
supplemental benefits and the Vaughn's could look into that possibility.
10.Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription
drug plan. Under what circumstances can she do this? - If the Medicare
Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer
drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do
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