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    if a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type of medicare health plan could the individual also enroll in, without being automatically disenrolled from the stand-alone prescription drug plan?

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    get if a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type of medicare health plan could the individual also enroll in, without being automatically disenrolled from the stand-alone prescription drug plan? from EN Bilgi.

    Enrollment & Disenrollment in Medicare Advantage Plans

    If you want to join a Medicare Advantage (MA) plan, you must have Medicare Parts A and B. Your Part B premium will continue to be taken out of your Social

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    California Health Advocates

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    Enrollment & Disenrollment in Medicare Advantage Plans

    California Health Advocates > Medicare Advantage > Enrollment & Disenrollment in Medicare Advantage Plans

    Enrollment

    If you want to join a Medicare Advantage (MA) plan, you must have Medicare Parts A and B. Your Part B premium will continue to be taken out of your Social Security or Railroad Retirement benefits check, unless you are enrolled in a Medicare Savings Program (MSP) or have full Medi-Cal (see our section on Low-Income Help).

    You cannot be denied enrollment in an MA plan due to a pre-existing condition, which now includes if you have end-stage renal disease (ESRD) — permanent kidney failure. Also, the plan’s premium must be the same for all beneficiaries regardless of your health condition or age. Note: if you have ESRD, a Medicare Advantage plan may impose a 20% co-insurance for dialysis until you reach the maximum out-of-pocket for the year. (Contact your local Health Insurance Counseling and Advocacy Program (HICAP) for more information).

    If you want to join an MA plan, you must reside in the plan’s service area and the plan you choose must be accepting new members.

    You can only join MA plans during certain periods:

    Initial Coverage Election Period (ICEP): The 7-month period when you are first eligible for Medicare. Your coverage start date depends on which month you enroll.Annual Election Period (AEP): October 15 – December 7 each year. Coverage effective January 1.General Enrollment Period (GEP): If you have Medicare Part A and are enrolling in Part B for the first time during the GEP, which is from January 1 – March 31 each year, you can also enroll in a Medicare Advantage plan (with our without prescription drug coverage) or a Part D prescription drug plan between April 1 – June 30. Your coverage is effective July 1.

    To enroll, submit your application directly to the plan via the plan’s website or a plan sales representative. You can also call 1-800-MEDICARE or enroll on the Medicare website at Medicare.gov. The date your coverage starts depends on the period in which you enroll.

    Remember not to drop your existing coverage, if any, until your coverage with your MA plan has started.

    In addition, if you are already in a Medicare Advantage plan (with or without drug coverage), you also have the Medicare Advantage Open Enrollment Period, from January 1 – March 31 each year. During these 3 months, you can:

    Switch to another Medicare Advantage plan (with or without drug coverage), or

    Disenroll and return to Original Medicare. If you do so, you can also join a Part D prescription drug plan.

    There are Special Election Periods (SEPs) during which you may be able to enroll in or disenroll from your MA plan, depending on your situation. For example, if you move out of your plan’s service area, you have a Special Election Period (of up to 3 months) to disenroll from your plan and join a plan available in your new location. See Special Election Periods (SEPs).

    For enrollment information on other parts of Medicare, see:

    Enrolling in Medicare Parts A & B

    Enrolling in Medicare Part D

    Special Election Periods (SEPs) for Parts C & D

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    Disenrollment

    As enrollment in an MA plan is limited to certain periods, disenrollment is also limited to certain periods:

    Annual Election Period (same as mentioned above)Medicare Advantage Open Enrollment Period – January 1- March 31 each yearSpecial Election Periods (depending on the situation, as mentioned above)During the Annual Election Period (AEP), the Medicare Advantage Open Enrollment Period or in a Special Election Period (SEP), if you want to leave your MA plan and don’t want to join another MA plan, you must send a written request to the plan or call 1-800-MEDICARE during the enrollment period.If you want to switch from one MA plan to another, simply submit an enrollment application to the new plan and once you are accepted, you will be automatically disenrolled from your current plan. Again, in general, you can only make changes such as this during the AEP, MA-OEP or an SEP.Note: This method of disenrollment also applies to Part D prescription drug coverage. For example, if you are in an MA plan with Part D coverage (MA-PD) and wish to switch to a stand-alone prescription drug plan (PDP), enrolling in a PDP automatically disenrolls you from your previous MA-PD plan, and vice versa.

    Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31)

    If you’re in a Medicare Advantage plan with or without Part D coverage, you can:

    Switch to another Medicare Advantage plan with or without Part D coverage, ORDisenroll from your plan and return to Original Medicare anytime between January 1 – March 31. If you disenroll and return to Original Medicare, you are also given a Special Election Period (SEP) to enroll in a Part D plan during this time.

    Source : cahealthadvocates.org

    2020 AHIP Flashcards

    Study Guide For AHIP Certification Test Learn with flashcards, games, and more — for free.

    2020 AHIP

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    Mrs. Chou likes a PFFS plan available in her area that does not offer drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her?

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    She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.

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    Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her?

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    Part D covers prescription drugs and she should look at her premiums, formulary and cost-sharing among other factors to see if they have changed.

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    Study Guide For AHIP Certification Test

    Terms in this set (50)

    Mrs. Chou likes a PFFS plan available in her area that does not offer drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her?

    She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.

    Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her?

    Part D covers prescription drugs and she should look at her premiums, formulary and cost-sharing among other factors to see if they have changed.

    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 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.

    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.

    Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him?

    He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. Alternately, he could check to see whether his state has a pharmacy assistance program to help him with expenses.

    Mr. Wong is a single individual. He has a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $80,000. Mr. Wong has health coverage through his employer but will sign-up for Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums?

    Due to his participation in the workforce he will not have to pay a premium for Part A but he will pay higher premiums for Part B and Part D due to the amount of his income.

    During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor told him about. What should his agent do?

    Since Mr. Peters requested a description of the Part D plan, his agent must have Mr. Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan so Mr. Peters can compare plans and make an informed enrollment choice during the appointment.

    By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefit package. What should you do to make sure your clients know about these pieces of information?

    You may make comparisons between plans if you can support them by studies or statistical data and such comparisons are factually based.

    Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her?

    The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office or calling the Social Security Administration.

    Mr. Decaro has looked a Medicare prescription drug plans available in his area and noted a wide range in premiums. He thought that all 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 him?

    Some prescription drug plans may have higher operating costs and/or may offer enhanced coverage in return for an additional premium amount. He could look at plan designs to see if one of the enhanced plans would serve his needs better than a plan based on the standard design.

    Source : quizlet.com

    Changing Part D plans

    In most cases, you can only make changes to your Medicare Part D prescription drug coverage during Fall Open Enrollment (October 15 through December […]

    Changing Part D plans

    Medicare Part D enrollment

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    In most cases, you can only make changes to your Medicare Part D prescription drug coverage during Fall Open Enrollment (October 15 through December 7). Your new coverage begins January 1 of the following year. You can change plans as many times as you need during Fall Open Enrollment, and your last choice takes effect January 1. To avoid enrollment problems, it is usually a good idea to make as few changes as possible.

    If you have a Medicare Advantage Plan, you can also change your Part D coverage during the Medicare Advantage Open Enrollment Period (MA OEP), which runs January 1 through March 31 each year. To change your drug coverage during this period, you must disenroll from your Medicare Advantage Plan and join a different Medicare Advantage Plan with prescription drug coverage or Original Medicare with a stand-alone Part D plan. Changes made during the MA OEP will take effect the first of the month following the month you enroll. If you want to keep your Medicare Advantage Plan, you should not use the MA OEP to change drug coverage.

    Under certain circumstances, you may be eligible to use a Special Enrollment Period (SEP) to make changes to your Part D coverage. You may have an SEP if one of the following events occurs:

    You lose creditable coverage through no fault of your own.

    You make a change to your job-based drug coverage.

    You move out of your Part D plan’s service area.

    You disenroll from your Medicare Advantage Plan and enroll in Original Medicare, assuming you joined the MA Plan when you first qualified for Medicare based on age and want to disenroll within the first year.

    There is a five-star plan in your service area that you would like to join.

    You have or lose Extra Help.

    You are admitted into or reside in a qualifying institution.

    You receive inadequate information about whether your existing prescription drug coverage is creditable.

    Your Part D plan stops offering coverage, fails to provide benefits on a timely basis, or misled you about what benefits you would get.

    You enroll or fail to enroll in a Part D plan because of a federal employee’s error.

    You enroll in an All-inclusive Care for the Elderly (PACE) program.

    You become eligible for a Special Needs Plan (SNP).

    For a full list of SEPs and requirements, please see the Part D Special Enrollment Period (SEP) Chart.

    Note: After the first 60 days of the year, a Part D plan can make changes to its formulary. If any of your drugs are removed from the formulary through such a mid-year change, your plan should continue to cover the drug for you until the end of the calendar year unless there are safety issues or there is a generic form of your drug. You do not get an SEP if your plan stops covering a drug you need.

    To switch plans, you should usually call 1-800-MEDICARE to enroll in your new plan without disenrolling from your old plan. You should be automatically disenrolled from your previous plan when your new coverage begins. To avoid gaps in coverage, try to enroll at the beginning of an enrollment period.

    Source : www.medicareinteractive.org

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