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    mr. sanchez has just turned 65 and is entitled to part a but has not enrolled in part b because he has coverage through an employer plan. if he wants to enroll in a medicare advantage plan, what will he have to do?


    Guys, does anyone know the answer?

    get mr. sanchez has just turned 65 and is entitled to part a but has not enrolled in part b because he has coverage through an employer plan. if he wants to enroll in a medicare advantage plan, what will he have to do? from EN Bilgi.

    Test 5 Flashcards

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    Test 5

    28cards Desireé S. Business

    Legal Environment Of Business

    Mrs. Walters is entitled to part a and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in part B. Since the employer plan does not cover prescription drugs she wants to enroll in a PDP. Will she be able to

    Yes. Mrs. Walters must be entitled to part eight or enrolled in party to be eligible for coverage under Medicare PDP

    Mr. Sanchez is entitled to part a but has not enrolled in partly because he has coverage through an employer. If you wants to enroll in an M a plan but will you have to do

    He will have to enroll in part B

    Mr. Kelly wants to know whether he is eligible to sign up for a PFFS plan. What questions would you need to ask him

    You would need to ask him if he is enrolled in part a and part B and if he lives in the Planned service area

    Mr. Gonzales is entitled to part A, but has not yet enrolled in part B. If you wants to enroll in a PFFS plan, what will he have to do

    He will have to enroll in party prior to enrolling in the PFS plan

    Mrs. Berkowitz wants to enroll in a M a plan but does not include drug coverage and also enroll in a standalone PDP. Under what circumstances can she do this

    If the M a plan is a PFS that does not offer drug coverage or an MSA

    Mrs. Roberts has original Medicare I would like to enroll in a PFFS. All types of PFFS plans are available in her area. Which option should she consider before selecting a plan

    And M a – PBP – PFS plan that combines medical benefits and part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFS plan in combination with a standalone PDP

    Mr. and Mrs. Nunez attended one of your sales presentations and her ask you to come to their house to clear up a few questions. During the presentation Mrs. Nunez tells you that her husband can finish things up and goes to bed. At the end of the discussion Mr. Nunez says he wants to enroll both of them what do you do

    As long as she is able to do so, only miss Nunez confine her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time

    You are visiting with Mr. Talley. He is advanced Alzheimer’s. Kenny’s daughter fill out the enrollment form and sign it for him?

    Mr. Talley‘s daughter can only do so if she is authorized under state law as a court – appointed legal guardian, has durable power of attorney for healthcare decisions, or is authorized under state Surrogate consent laws to make his decisions

    You are meeting with Miss Berlin and she has completed enrollment form for AMA – PD plan. The hand writing is 11 legible and as a result the spelling of your street looks incorrect. What should you do?

    You may correct this information as long as you add your initials and date next to the correction

    Phiona Works in IT department of best care health plan. Which of the following must you consider

    2&3 only

    2. All data elements required to complete an enrollment request must be captured.

    3. The process must include a clear distinct stuffed that requires the applicant to activate and enroll now or I agree type of button or two

    Mr. block is currently enrolled in an MA plan that includes drug coverage and finds a standalone PDP that is cheaper

    If Mr. block in rolls in the standalone PDP, he will be disenrolled from the MA plan

    You are doing a sales presentation for Mrs. Pearson. You know that Medicare marketing guidelines prohibit certain statements. Which one

    If you were not in very good health, you will probably do better with a different product

    You have come to Mrs. Midler’s home for a sales presentation. At the beginning of the presentation she tells you that she has a copy of your medical records available

    You can only ask her questions about conditions that affect eligibility, specifically whether she has end-stage renal disease or one of the conditions that would qualify her for an SNP

    Willard works as a representative focus on the senior marketplace. What is prohibited

    Implying that only seniors can enroll in Medicare advantage plan when meeting with Mr. Hernandez who 58 for qualifies because she is disabled

    Mr. Garrett just entered his ICEP

    He will have one opportunity to enroll in a Medicare advantage plan

    Mrs. Kendrick is six months away from turning 65 she wants know what to do to enroll in MA

    She may enroll anime beginning three months before her first entitlement to both part a and part B

    Mr. Zigler is turning 65 next month and wants know what he can do about rolling in part D

    He is currently in the IEP and during this time he may make one enrollment choice including a standalone PDP or anM a – PD plan

    Miss Claggett is 66 years old. She’s covered by original Medicare for the last six years due to her disability. She’s never in rolled in MA or a part D plan. She wants your on the part D plan. When can she do it

    It occurs three months before and three months after the month when she meets eligibility requirements for part B, so she will not be able to use it for enrolling in part D right now

    When Mira first became eligible, she enrolled in original Medicare. She is now 67 and would like to enroll in an MA plan

    She should remain in original Medicare until the AEP running from October 15 to December 7 during which she can select an M a play

    Source : www.chegg.com

    [House Hearing, 113 Congress]

    [From the U.S. Government Publishing Office]




    HEARING before the


    of the




    SECOND SESSION __________ JULY 24, 2014 __________ Serial No. 113-HL15 __________

    Printed for the use of the Committee on Ways and Means



    20-996 WASHINGTON : 2016


    For sale by the Superintendent of Documents, U.S. Government Publishing

    Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800;

    DC area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC,

    Washington, DC 20402-0001


    DAVE CAMP, Michigan, Chairman

    SAM JOHNSON, Texas SANDER M. LEVIN, Michigan


    PAUL RYAN, Wisconsin JIM MCDERMOTT, Washington

    DEVIN NUNES, California JOHN LEWIS, Georgia

    PATRICK J. TIBERI, Ohio RICHARD E. NEAL, Massachusetts

    DAVID G. REICHERT, Washington XAVIER BECERRA, California


    PETER J. ROSKAM, Illinois MIKE THOMPSON, California

    JIM GERLACH, Pennsylvania JOHN B. LARSON, Connecticut


    VERN BUCHANAN, Florida RON KIND, Wisconsin

    ADRIAN SMITH, Nebraska BILL PASCRELL, JR., New Jersey



    ERIK PAULSEN, Minnesota DANNY DAVIS, Illinois


    DIANE BLACK, Tennessee

    TOM REED, New York TODD YOUNG, Indiana

    MIKE KELLY, Pennsylvania

    TIM GRIFFIN, Arkansas


    Jennifer M. Safavian, Staff Director and General Counsel

    Janice Mays, Minority Chief Counsel



    KEVIN BRADY, Texas, Chairman

    SAM JOHNSON, Texas JIM MCDERMOTT, Washington

    PAUL RYAN, Wisconsin MIKE THOMPSON, California

    DEVIN NUNES, California RON KIND, Wisconsin


    JIM GERLACH, Pennsylvania BILL PASCRELL, JR., New Jersey

    TOM PRICE, Georgia

    VERN BUCHANAN, Florida

    ADRIAN SMITH, Nebraska

    C O N T E N T S __________ Page

    Advisory of July 24, 2014 announcing the hearing................. 2


    Joe Baker, President, Medicare Rights Center..................... 42

    Robert A. Book, Ph.D, Senior Research Director, Health Systems

    Innovation Network, LLC Outside Healthcare and Economics

    Expert, American Action Forum.................................. 35

    Jeff Burnich, M.D., Senior Vice President & Executive Officer,

    Sutter Medical Network, on behalf of CAPG...................... 22

    Chris Wing, Chief Executive Officer, SCAN Health Plans........... 11


    Alliance of Community Health Plans, ACHP......................... 108

    American Federation of State, County and Municipal Employees,

    AFSCME......................................................... 113

    Priority Health.................................................. 117

    Senior Whole Health, SWH......................................... 122


    HEALTH PLANS ----------

    THURSDAY, JULY 24, 2014

    U.S. House of Representatives,

    Committee on Ways and Means,

    Subcommittee on Health,

    Washington, DC.

    The subcommittee met, pursuant to notice, at 10:00 a.m., in

    Room 1100, Longworth House Office Building, the Honorable Kevin

    Brady [Chairman of the Subcommittee] presiding.

    [The advisory announcing the hearing follows:]


    Chairman BRADY. Good morning, everyone. The subcommittee

    will come to order.

    Today we will hear testimony regarding the Medicare

    Advantage Program. We will hear about these private plans that

    are chosen by an increasing number of seniors, and we will hear

    about how these private plans can combine high quality and low


    We will look to the future of the popular program and ask:

    when scheduled cuts to Medicare Advantage Plans in the

    Affordable Care Act take place, can these popular plans

    continue to effectively serve seniors?

    Will the policies of the Obama Administration narrow choice

    and plan flexibility, further impacting our seniors?

    Since seniors were first given the option to select a

    private health plan to receive their Medicare benefits, they

    have shown a strong preference for these plans. Over the past

    Source : www.govinfo.gov

    AHIP 2022 Test Answers » Quizzma

    We thoroughly check each answer to a question to provide you with the most correct answers. Found a mistake? Let us know about it through the REPORT button at the bottom of the page. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. … AHIP 2022 Test Answers Read More »

    AHIP 2022 Test Answers

    By Quizzma Team

    We thoroughly check each answer to a question to provide you with the most correct answers. Found a mistake? Let us know about it through the REPORT button at the bottom of the page.

    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?

    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 and offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. How would you respond?

    Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan.

    Mr. Moy’s wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife’s needs. What could you tell Mr. Moy?

    Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.

    Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her?

    She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period after the last month on her employer plan that differs from the standard general enrollment period, during which she may enroll in Medicare Part B.

    Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her?

    Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums.

    Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her?

    Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan.

    Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through massage therapy. She is concerned about whether or not Medicare will cover these items and services. What should you tell her?

    Medicare does not cover massage therapy, or, in general, glasses or dentures.

    Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. In general terms, what could you tell him about his costs for inpatient hospital services

    under Original Medicare?

    Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs.

    Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her?

    To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes.

    Mr. Alonso receives some help paying for his two generic prescription drugs from his employer’s retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling into a standard MedicarePart D prescription drug plan. What should you tell him?

    He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.

    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?

    Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig’s disease so she will be eligible for Medicare.

    Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries?

    Source : quizzma.com

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