How does the Medicare Agency regulate the marketing of Medicare products?
The Medicare agency conducts only complaint-based oversight and he can market the products he represents as he sees fit, as long as he does so in a manner that would be considered ethical by a reasonable lay person. c. The state sets most requirements for marketing Medicare health plans, but each plan has different policies that he must adhere to.
Do I have to comply with Medicare marketing rules?
Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules. d. Your coworker is correct. You are subject only to requirements issued by your state department of insurance.
What is a BRC and how do I use it?
A BRC may be used to document a beneficiary's scope of appointment agreement provided it has been submitted to CMS for approval and includes a statement informing the beneficiary that a salesperson may call. You will be holding a sales event in the near future, at which you would like to offer door prizes to attendees.
How can agents use referrals to market Medicare Advantage plans?
Since they are a common marketing technique, agents can simply send them to lists of prospects. Ordinarily, you obtain referrals from a third-party that initiates contact with potential clients and usually sets up appointments for you. How would the guidelines for marketing Medicare Advantage and Part D plans apply to this practice?
Can plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members?
Plan sponsors may undertake the following marketing activities with current MA plan members? Market non-Medicare health related products, such as dental insurance, to current members as permitted by HIPPA privacy rules.
What must all Medicare Advantage sponsors have in place in order to meet CMS guidelines?
Medicare Advantage Plans Must Follow CMS Guidelines In the United States, according to federal law, Part C providers must provide their beneficiaries with all services and supplies that Original Medicare Parts A and B cover. They must also provide any additional benefits proclaimed in their Part C policy.
When a beneficiary is trying to decide between plans during a sales appointment it is okay?
Marks: 1 When a beneficiary is trying to decide between plans during a sales appointment, it is okay to omit information critical to the beneficiary if they don't ask pointed questions.
What is Medicare Advantage quizlet?
A Medicare Advantage Plan (like an HMO or PPO). If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs.
Can you solicit Medicare Advantage prospects through email?
The only caveat: If you are initiating contact via email, you're required to include an opt-out opportunity. Direct unsolicited contact, such as text and direct messaging over social media, falls into the same category as unsolicited phone calls and door-to-door solicitation. This means it is not permitted.
Do Medicare Advantage plans have to follow LCDs?
Medicare Advantage plans are required to follow all Medicare laws and coverage policies, including LCDs (Local Coverage Decisions - coverage policies set by Medicare Fee-for-Service Contractors in your geographic area), when determining coverage for a particular service.
How do I advertise with Medicare?
Marketing Medicare Advantage to prospective new patients as they turn 65Mailers to people turning 65.Hospital newsletters.Community events.Retargeting and pay-per-click ads.Facebook and other social media ads.
What are three main ways in which Medicare sales occur?
There are three different types of Medicare products sold by agents and brokers: Medicare Supplement plans (Also called Medigap plans), Medicare Advantage plans and Medicare Part D Rx plans.
How Should agent Erin respond when consumer Mrs Rose notices that the presented MA plan has a star rating of 2 stars?
How should agent Erin respond when consumer Mrs. Rose notices that the presented MA Plan has a Star Rating of 2 stars? Erin should tell Mrs. Rose that the plan has received a "Below Average" rating.
What is Med C?
Medicare Advantage, or Medicare Part C, is a type of Medicare plan that uses private health insurance to cover all the services you'd receive under Medicare Parts A and B. Anyone who is eligible for original Medicare Parts A and B is eligible for the Medicare Advantage programs in their area.
Which of the following types of benefits would not be covered by Medicare?
Some of the items and services Medicare doesn't cover include:Long-Term Care. ... Most dental care.Eye exams related to prescribing glasses.Dentures.Cosmetic surgery.Acupuncture.Hearing aids and exams for fitting them.Routine foot care.
Which Medicare Part provides the Medicare Advantage program quizlet?
Medicare Part C offers plans provided by private health insurance companies called Medicare Advantage, as an option to coverage under the Original Medicare Plan.
What is Medicare compliance?
The Medicare Compliance Program is specifically designed to prevent, detect, and correct noncompliance as well as fraud, waste, and abuse. The following are some examples of how we try to meet these goals: • Publicizing standards of conduct and other Medicare compliance.
Which of the following is an allowable form of contact for prospecting for Medicare Advantage clients?
Due to a change reflected in the 2019 MCMG and now in the Medicare Advantage & Part D Communication Requirements, agents are permitted to make unsolicited direct contact with potential enrollees via email.
What are the 3 main ways in which Medicare sales occur?
There are three different types of Medicare products sold by agents and brokers: Medicare Supplement plans (Also called Medigap plans), Medicare Advantage plans and Medicare Part D Rx plans.
Who approves Medicare marketing materials?
CMSAll marketing materials need to be filed and approved by CMS. Agent created communications to members do not need CMS approval. Any agent created communication must follow the CMS Medicare Communications and Marketing Guidelines.
Can you make unsolicited calls to Medicare?
Third parties may not make unsolicited calls, visits, or emails to Medicare beneficiaries in order to set up such appointments, or for any other reason related to the marketing of Medicare Advantage or Part D plans.
Does Medicare have to comply with complaints?
Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative. d. Medicare health plans must comply with requests for information from state insurance departments investigating complaints about a marketing representative.
Does Medicare endorse or recommend any plan?
c. Tell her that the Medicare agency does not endorse or recommend any plan. 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.
Can I represent Medicare Advantage?
You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. c.
Does Medicare MSA cover prescription drugs?
a. The materials must make clear that Medicare MSA plans do not cover prescription drugs and that beneficiaries can join a separate Part D prescription drug plan.
When does Ralph Lopez enroll in Medicare?
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph disenrolls on February 12th because he did not understand that the plan did not cover services furnished by several of his longtime providers.
Does Medicare endorse or recommend any plan?
c. Tell her that the Medicare agency does not endorse or recommend any plan. Correct. 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.
Does BestCare Health Plan sell Medicare Advantage plans?
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 .
When does Ralph Lopez enroll in Medicare?
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph disenrolls on February 12th because he did not understand that the plan did not cover services furnished by several of his longtime providers.
Can you present a prescription drug plan to Mrs. Hall?
c. You must make a telephone call from a location outside Mrs. Hall's home to ensure that the discussion of the prescription drug plan can take place.
Does Medicare MSA cover prescription drugs?
The materials must make clear that Medicare MSA plans do not cover prescription drugs and that beneficiaries can join a separate Part D prescription drug plan. c. The materials must make clear that those who enroll must make monthly deposits into the custodial savings account associated with plan. d.
Does CMS require corrective action plan?
... Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state laws are preempted with regard to the marketing of Medicare health plans, he doesn't have much to worry about.
Can marketing representatives participate in educational events?
You should tell your colleague no, because marketing representatives are not permit ted to participate, in any way, in an educational event. d. Agent Mary Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature.
Is my coworker correct?
Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules. d. Your coworker is correct. You are subject only to requirements issued by your state department of insurance.
What materials are used to market Medicare Advantage?
Materials used to market Medicare Advantage, and Part D plans (including but not limited to, letters, postcards, brochures, scripts, radio and television ads, billboards, banners, signs, yellow page ads, church bulletin ads, ...
What is generic marketing material for Medicare?
What is considered generic marketing material for Medicare? Generic material, by MMG definition, is any marketing material that is free of the plan or product information, brands or carrier logos. These types of pieces do not need to be approved but must comply with CMS guidelines.
Does Agent Pipeline have Medicare?
Agent Pipeline has several pre-approved Medicare marketing mailers, flyers, postcards, business-reply-cards and other materials available for our agents to use. You can also customize many carrier pieces by visiting their Agent Portal. If you need more information on customizing your materials, submitting them for approval, ...
When does Ralph Lopez enroll in Medicare?
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph disenrolls on February 12th because he did not understand that the plan did not cover services furnished by several of his longtime providers.
When is the open enrollment period for Medicare in Massachusetts?
There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because eligibility to use the OEP is available only to MA enrollees. Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is currently enrolled in Original Medicare (Parts A and B) ...
What is the cost sharing for Part D?
Standard Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap.
Does MSA cover Part A?
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits . III. An individual who is eligible for health care benefits through the Veteran's Administration may enroll in an MSA.
Is Maria Gonzales in Medicare?
Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected.
Does Medicare endorse or recommend any plan?
Tell her that the Medicare agency does not endorse or recommend any plan. 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.
Is Dr Rivera covered by Medicare?
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service.
How long does Mrs Kelly have to enroll in Medicare?
She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B.
How to get prescription drug coverage?
Prescription drug coverage can be obtained by enrolling in a Medicare Advantage plan that includes Part D coverage. Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific plans.
How many days of psychiatric care does Medicare cover?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey’s entire lifetime. Mrs. Quinn has just turned 65 and received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means.
How long does Medicare pay for inpatient hospital stay?
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 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.
When will Medicare Part B deductible be removed?
The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program.
What is the cost sharing for Part D?
Standard Part D coverage would require payment of an annual deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both generics and brand-name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap.
When a new generic drug for the same condition becomes available or when the FDA or manufacturer withdraws the drug from the
When a new generic drug for the same condition becomes available or when the FDA or manufacturer withdraws the drug from the market , a brand name drug can be replaced. Mrs. Roswell is a new Medicare beneficiary and is interested in selecting a Medicare Part D prescription drug plan.