Medicare Module 1 Graded A+
Question 1: What changes will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
bring to Medigap plans?
Answer: Starting January 1, 2020, individuals newly eligible for Medicare will no longer be able to
purchase Plans C and F, which cover the Part...
Question 1: What changes will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
bring to Medigap plans?
Answer: Starting January 1, 2020, individuals newly eligible for Medicare will no longer be able to
purchase Plans C and F, which cover the Part B deductible. However, individuals already enrolled in
these plans can keep their current coverage, and those eligible for Medicare before 2020 can still
purchase the current versions of Plans C and F.
Question 2: What does it mean when Mrs. Lenard is told she has been subject to "deemed enrollment"
with her Medicare Advantage (MA) plan?
Answer: Mrs. Lenard's cost plan has transitioned to an MA contract, and she has been automatically
enrolled in an MA plan offered by the same organization unless she opts out. She will be notified by CMS
and the plan, and given the opportunity to choose another option.
Question 3: If Mr. Carter loses his Part D low-income subsidy, what options are available to him?
Answer: Mr. Carter can contact the State Medicaid office or the Social Security Administration (SSA) to
check eligibility for other programs that may help with healthcare costs, such as Medicaid or Medicare
Savings Programs.
Question 4: How long will Mrs. Shields' skilled nursing facility stay be covered under Original Medicare?
Answer: Mrs. Shields will be covered for up to 100 days of skilled nursing and rehabilitative care after a
three-day hospital stay, with a $164.50 coinsurance for days 21-100 in each benefit period.
Question 5: What action should BestCare take in response to a state insurance department investigation
into marketing representatives selling Medicare Advantage plans?
Answer: BestCare should ensure that its marketing representatives comply with all marketing
requirements, including those related to using approved call scripts.
,Question 6: How can Agent Mark Andrews grow his Medicare Advantage practice using technology?
Answer: Agent Andrews can use social media platforms to promote his practice, but must ensure that
his posts meet marketing requirements, such as those related to plan-specific benefits and premiums.
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.
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