Medicare Module 1 questions with solved
solutions
What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
have upon Medigap plans? - ANSWER>>The Part B deductible will no longer be covered for
individuals newly eligible for Medicare starting January 1, 2020.The Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA) will make changes to Medigap plans effective 2020.
Specifically, for individuals newly eligible
to Medicare, the Part B deductible cannot be covered. Therefore, Plans C and F will no longer
be an option for newly eligible individuals starting January 1, 2020. However, individuals who
already have Plans C and F will be able to keep their current versions of the plans and
individuals eligible for Medicare prior to January 1, 2020, can purchase the current version of
Plans C and F on or after January 1, 2020
Mrs. Lenard is enrolled in a Medicare Cost plan. Recently the cost plan has transitioned to a
Medicare Advantage (MA) contract, and Mrs. Lenard has been told that she has been subject to
"deemed enrollment." What does this mean? - ANSWER>>Some cost plans transitioning to MA
contracts will
have "deemed" or facilitated enrollment. That is,
unless a cost plan enrollee opts out, he/she will be
automatically enrolled in an MA plan offered by the same organization.Individuals subject to
deemed enrollment will be notified by CMS and the plan and given the opportunity to choose
another option.
Mr. Carter, who is enrolled in a stand-alone Part D plan, receives the Part D low-income subsidy
and just received a letter from the Social Security Administration informing him that he will no
longer qualify for the subsidy? He is wondering if he can switch to a lower cost Part D plan.
What should you tell him? - ANSWER>>Medicaid: help with health care costs.
,Medicare Savings Program: help paying for the Medicare Part B premium and, in some cases,
deductibles and coinsurance.
Part D low-income subsidy: help paying for prescription drug coverage. The State Medicaid
office will check eligibility for this and other programs such as the Medicare
Savings Program. Persons interested in Part D help only may call the Social Security
Administration (SSA) at 1-800-772-1213 or apply online at www.ssa.gov/prescriptionhelp.
Supplemental Security Income (SSI) benefits: help with cash for basic needs. You also may apply
through SSA.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -
ANSWER>>Skilled nursing and rehabilitative care only after a three day hospital stay, up to 100
days in a benefit period (as defined by Medicare). In 2017, beneficiaries pay $164.50
coinsurance for days 21-100 each benefit period.Inpatient psychiatric care (up to 190 lifetime
days) Part A does not cover custodial or long-term care Cost-sharing may differ for enrollees of
Medicare
BestCare Health Plan has received a request from a state insurance department in connection
with the investigation of several marketing representatives licensed by the state who sell
Medicare Advantage plans. What action(s) should BestCare take in response? -
ANSWER>>Agent Armstrong is an independent agent under contract with MarketCo, a third
party marketing organization. MarketCo has a contract with BestChoice health plan, a Medicare
Advantage organization, to offer marketing services through its contracted agents and agencies.
Agent Armstrong returns calls to individuals who call
MarketCo in response to its mailers promoting
, BestChoice health plan. Agent Armstrong is a marketing representative of BestChoice. Thus, he
is obligated to comply with all marketing requirements, including those regarding using only
approved call scripts.
Agent Mark Andrews would like to employ technology to facilitate the growth of his Medicare
Advantage (MA) practice. What step(s) would you recommend that Mark take? -
ANSWER>>Plans/Part D Sponsors must submit to CMS social media (e.g.,Facebook, Twitter,
YouTube, LinkedIn, Scan Code, or QR Code)posts that meet the definition of marketing
materials, specifically
those that contain plan-specific benefits, premiums, cost-sharing,or Star Ratings.
Social media posts are subject to marketing requirements, such as those related to
testimonials. Generally disclaimers are not required unless a communication written for social
media has the
potential to be disseminated via other mediums, such as youtube.Plans/Part D Sponsors must
not include content on social/electronic media that discusses plan-specific benefits, premiums,
cost-sharing, or Star Ratings for products offered in the
next contract year prior to October 1.
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? - ANSWER>>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
solutions
What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
have upon Medigap plans? - ANSWER>>The Part B deductible will no longer be covered for
individuals newly eligible for Medicare starting January 1, 2020.The Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA) will make changes to Medigap plans effective 2020.
Specifically, for individuals newly eligible
to Medicare, the Part B deductible cannot be covered. Therefore, Plans C and F will no longer
be an option for newly eligible individuals starting January 1, 2020. However, individuals who
already have Plans C and F will be able to keep their current versions of the plans and
individuals eligible for Medicare prior to January 1, 2020, can purchase the current version of
Plans C and F on or after January 1, 2020
Mrs. Lenard is enrolled in a Medicare Cost plan. Recently the cost plan has transitioned to a
Medicare Advantage (MA) contract, and Mrs. Lenard has been told that she has been subject to
"deemed enrollment." What does this mean? - ANSWER>>Some cost plans transitioning to MA
contracts will
have "deemed" or facilitated enrollment. That is,
unless a cost plan enrollee opts out, he/she will be
automatically enrolled in an MA plan offered by the same organization.Individuals subject to
deemed enrollment will be notified by CMS and the plan and given the opportunity to choose
another option.
Mr. Carter, who is enrolled in a stand-alone Part D plan, receives the Part D low-income subsidy
and just received a letter from the Social Security Administration informing him that he will no
longer qualify for the subsidy? He is wondering if he can switch to a lower cost Part D plan.
What should you tell him? - ANSWER>>Medicaid: help with health care costs.
,Medicare Savings Program: help paying for the Medicare Part B premium and, in some cases,
deductibles and coinsurance.
Part D low-income subsidy: help paying for prescription drug coverage. The State Medicaid
office will check eligibility for this and other programs such as the Medicare
Savings Program. Persons interested in Part D help only may call the Social Security
Administration (SSA) at 1-800-772-1213 or apply online at www.ssa.gov/prescriptionhelp.
Supplemental Security Income (SSI) benefits: help with cash for basic needs. You also may apply
through SSA.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -
ANSWER>>Skilled nursing and rehabilitative care only after a three day hospital stay, up to 100
days in a benefit period (as defined by Medicare). In 2017, beneficiaries pay $164.50
coinsurance for days 21-100 each benefit period.Inpatient psychiatric care (up to 190 lifetime
days) Part A does not cover custodial or long-term care Cost-sharing may differ for enrollees of
Medicare
BestCare Health Plan has received a request from a state insurance department in connection
with the investigation of several marketing representatives licensed by the state who sell
Medicare Advantage plans. What action(s) should BestCare take in response? -
ANSWER>>Agent Armstrong is an independent agent under contract with MarketCo, a third
party marketing organization. MarketCo has a contract with BestChoice health plan, a Medicare
Advantage organization, to offer marketing services through its contracted agents and agencies.
Agent Armstrong returns calls to individuals who call
MarketCo in response to its mailers promoting
, BestChoice health plan. Agent Armstrong is a marketing representative of BestChoice. Thus, he
is obligated to comply with all marketing requirements, including those regarding using only
approved call scripts.
Agent Mark Andrews would like to employ technology to facilitate the growth of his Medicare
Advantage (MA) practice. What step(s) would you recommend that Mark take? -
ANSWER>>Plans/Part D Sponsors must submit to CMS social media (e.g.,Facebook, Twitter,
YouTube, LinkedIn, Scan Code, or QR Code)posts that meet the definition of marketing
materials, specifically
those that contain plan-specific benefits, premiums, cost-sharing,or Star Ratings.
Social media posts are subject to marketing requirements, such as those related to
testimonials. Generally disclaimers are not required unless a communication written for social
media has the
potential to be disseminated via other mediums, such as youtube.Plans/Part D Sponsors must
not include content on social/electronic media that discusses plan-specific benefits, premiums,
cost-sharing, or Star Ratings for products offered in the
next contract year prior to October 1.
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? - ANSWER>>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
