Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't
sufficiently cover his prescription drug needs. He is interested in changing
plans during the upcoming MA Open Enrollment Period. What are his options
during the MA OEP?
He can switch to a MA-PD plan.
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll in a MA-PD plan. What enrollment
rules would apply in this case?
He can make as many enrollment changes as he likes during the Annual
Election Period and the last choice made before the end of the period will be
the effective one as of January 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 his
retiree coverage and is eligible for Medicare. What should you tell him?
Mr. Chen can disenroll from his employer-sponsored coverage to elect a
Medicare Advantage or Part D plan within 2 months of his disenrollment.
Mr. Garcia was told he qualifies for a special election period (SEP), but he lost
the paper that explains what he could do during the SEP. What can you tell
him?
If the SEP is for MA coverage, he will generally have one opportunity to
change his MA coverage.
, You would like to offer gifts of nominal value to potential enrollees who call
for more information about a plan you represent. You would then like to offer
additional gifts if they come to a marketing event. Each of the gifts meets
the CMS definition of nominal value, but together, the gifts are more than the
nominal value. Is this permissible?
Yes, as long as each of the gifts is $10 or less in value, and the total value of
all gifts given to an enrollee in a year does not exceed $20.
Mr. Polanski likes the cost of an HMO plan available in his area but would like
to be able to visit one or two doctors who aren't participating providers. He
wants to know if the Point of Service (POS) option available with some HMOs
will be of any help in this situation. What should you tell him?
The POS option might be a good solution for him as it will allow him to visit
out-of-network providers, generally without prior approval. However, he
should be aware that it is likely he will have to pay higher cost-sharing for
services from out-of-network providers.
This year you decide to focus your efforts on marketing to employer and
union groups. Which of the following statements best describes what you can
and cannot do in order to stay in compliance?
You do not need to complete a scope of appointment, but CMS can ask you
to reconstruct one if there is a subsequent employee complaint.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover
his premiums for the entire year. What should you tell him?
He will need to mail in his payment with his enrollment form.
sufficiently cover his prescription drug needs. He is interested in changing
plans during the upcoming MA Open Enrollment Period. What are his options
during the MA OEP?
He can switch to a MA-PD plan.
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll in a MA-PD plan. What enrollment
rules would apply in this case?
He can make as many enrollment changes as he likes during the Annual
Election Period and the last choice made before the end of the period will be
the effective one as of January 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 his
retiree coverage and is eligible for Medicare. What should you tell him?
Mr. Chen can disenroll from his employer-sponsored coverage to elect a
Medicare Advantage or Part D plan within 2 months of his disenrollment.
Mr. Garcia was told he qualifies for a special election period (SEP), but he lost
the paper that explains what he could do during the SEP. What can you tell
him?
If the SEP is for MA coverage, he will generally have one opportunity to
change his MA coverage.
, You would like to offer gifts of nominal value to potential enrollees who call
for more information about a plan you represent. You would then like to offer
additional gifts if they come to a marketing event. Each of the gifts meets
the CMS definition of nominal value, but together, the gifts are more than the
nominal value. Is this permissible?
Yes, as long as each of the gifts is $10 or less in value, and the total value of
all gifts given to an enrollee in a year does not exceed $20.
Mr. Polanski likes the cost of an HMO plan available in his area but would like
to be able to visit one or two doctors who aren't participating providers. He
wants to know if the Point of Service (POS) option available with some HMOs
will be of any help in this situation. What should you tell him?
The POS option might be a good solution for him as it will allow him to visit
out-of-network providers, generally without prior approval. However, he
should be aware that it is likely he will have to pay higher cost-sharing for
services from out-of-network providers.
This year you decide to focus your efforts on marketing to employer and
union groups. Which of the following statements best describes what you can
and cannot do in order to stay in compliance?
You do not need to complete a scope of appointment, but CMS can ask you
to reconstruct one if there is a subsequent employee complaint.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover
his premiums for the entire year. What should you tell him?
He will need to mail in his payment with his enrollment form.
