What do the new guidelines mean for Medicare Advantage Marketing materials?
Which statement about Medicare marketing standards is FALSE? A) Every insurer must establish an audit program to verify compliance B) It is an unfair trade practice to frighten a person into buying Medicare supplement policies C) Require an applicant for a Medicare supplement policy to prove that no other health policies exist
Can I advertise Medicare plans in a healthcare facility?
Jun 28, 2013 · The Guidelines are for use by Medicare Advantage Plans (MAs), Medicare Advantage Prescription Drug Plans (MA-PDs), Prescription Drug Plans (PDPs) and 1876 Cost Plans. The guidelines allow organizations offering both Medicare Advantage and Prescription Drug Plans the ability to reference one document when developing marketing materials. …
What is the difference between Medicare and American accounting's plan?
Which of the following statements about Medicare is false? Enrollment into Part A is automatic. Enrollment into Part B is optional, as it requires payment of an additional premium. Almost all Medicare enrollees (98 percent) participate in both Parts A and B. 88 percent of those with Medicare have supplemental insurance.
What are the differences between standard Medigap and Medicare supplement plans?
Mar 28, 2018 · While you can’t leave materials in restricted areas yourself—because this would be considered a marketing activity—Medicare does allow you to give materials to providers or facility staff to distribute on your behalf. So a healthcare staff member can leave materials in a restricted area, such as waiting room.
Which statement is incorrect concerning Part B of Medicare quizlet?
Which statement is incorrect concerning Part B of Medicare? Medicare Part B does not cover prescription drugs at all.
Which of the following is not covered by Medicare Part A quizlet?
Medicare Part A covers 80% of the cost of durable medical equipment such as wheelchairs and hospital beds. The following are specifically excluded: private duty nursing, non-medical services, intermediate care, custodial care, and the first three pints of blood.
Which of the following statements correctly describes enrollment in Medicare Part B?
Which of the following statements correctly describes enrollment in Medicare Part B? Once a person is eligible to enroll in Medicare Part A, Medicare Part B enrollment is automatic unless coverage is declined. Medicare Part B does not cover private duty nursing services.
When must an insurer provide a Medicare Supplement Buyer's Guide and an outline of coverage?
The insurer must provide a Medicare Supplement Buyer's Guide and an Outline of Coverage at the time of application. LTC policies may define a preexisting condition as: a condition for which advice or treatment was recommended or received within 6 months of the effective date of coverage.
Which is not covered by Medicare part A?
Part A does not cover the following: A private room in the hospital or a skilled nursing facility, unless medically necessary. Private nursing care.
Which of the following is not covered by Medicare?
In general, Original Medicare does not cover: Long-term care (such as extended nursing home stays or custodial care) Hearing aids. Most vision care, notably eyeglasses and contacts. Most dental care, notably dentures.
Which of the following is covered by Medicare Part B quizlet?
Part B helps cover medically-necessary services like doctors' services, outpatient care, durable medical equipment, home health services, and other medical services.
What is Medicare Part B also known as quizlet?
Medicare Part B is also called. Supplemental Medical Insurance. Durable Medical Equipment is covered by. Medicare Part B.
What is Medicare quizlet?
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who meet other special criteria.
Which renewal provision must all Medicare supplement policies contain quizlet?
A continuation provision must include any reservation by the issuer of the right to change premiums and any automatic renewal premium increases based on the policy holders age. Provisions must be captioned and appear on the first page of the policy. What is excluded under Medigap?
When can an insurer cancel a Medicare supplement plan quizlet?
An insurer can cancel a Medicare Supplement Plan after the non-payment of premiums. In general the following six minimum standards apply to all policies designated as Medicare supplement insurance, the policy must supplement both part A and Part B of Medicare.
When must the OOC outline of coverage be delivered to the applicant by the agent?
10233.5. (a) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means which prominently direct the attention of the recipient to the document and its purpose.
Can I provide a brochure for I-SNP?
The facility staff must distribute brochures only to residents who meet the eligibility requirements for enrollment. Brochures may include eligibility requirements and benefits of an I-SNP. In addition, brochures may include a reply card or your telephone number for a resident or responsible party to request more information or a meeting.
Can you conduct marketing activities in a provider facility?
You can only conduct marketing activities in provider facilities with which a plan sponsor has an agreement for such activities. Provider facilities include hospitals, pharmacies, and long-term care residences such as nursing homes and assisted-living facilities.
What is Medicare Supplement Insurance?
Medicare supplement insurance fills the gaps in coverage left by Medicare, which provides hospital and medical expense benefits for persons aged 65 and older. All Medicare supplement policies must cover 100% of the Part A hospital coinsurance amount for each day used from.
What is Medicaid in the US?
Medicaid is a federal and state program designed to help provide needy persons, regardless of age, with medical coverage. A contract designed primarily to supplement reimbursement under Medicare for hospital, medical or surgical expenses is known as. A) an alternative benefits plan. B) a home health care plan.
What is the core plan?
The benefits in Plan A, which is known as the core plan, must be contained in all other plans sold. Among the core benefits is coverage of Medicare Part A-eligible expenses for hospitalization, to the extent not covered by Medicare, from the 61st day through the 90th day in any Medicare benefit period.
How long does Medicare cover skilled nursing?
Medicare will cover treatment in a skilled nursing facility in full for the first 20 days. From the 21st to the 100th day, the patient must pay a daily co-payment. There are no Medicare benefits provided for treatment in a skilled nursing facility beyond 100 days. Medicare Part A covers.
What is intermediate care?
Intermediate care is provided under the supervision of a physician by registered nurses, licensed practical nurses, and nurse's aides. Intermediate care is provided in nursing homes for stable medical conditions that require daily, but not 24-hour, supervision. Tom is covered under Medicare Part A.
How old do you have to be to qualify for Medicaid?
To qualify for Medicaid nursing home benefits, an individual must be at least 65 years old, blind, or disabled; be a U.S. citizen or permanent resident alien; need the type of care that is provided only in a nursing home; and meet certain asset and income tests.
What is co-branding in Medicare?
Co-branding is defined as a relationship between two or more separate legal entities, one of which is an organization that sponsors a Medicare Plan. Co-branding is when a Plan/Part D sponsor displays the name(s) or brand(s) of the co-branding entity or entities on its materials to signify a business arrangement. Co-branding arrangements allow a Plan/Part D sponsor and its co-branding partner(s) to promote enrollment in the plan. Co-branding relationships are entered into independent of the contract that the Plan/Part D sponsor has with CMS.
What is the penalty for misusing Medicare name and marks?
In general, it authorizes the Inspector General of DHHS to impose penalties on any person who misuses the term Medicare or other names associated with DHHS in a manner which the person knows or should know gives the false impression that DHHS has approved, endorsed, or authorized it. Offenders are subject to fines of up to $5,000 per violation or in the case of a broadcast or telecast violation, $25,000.
What is MCMG in Medicare?
The Medicare Communications and Marketing Guidelines (MCMG) interpret and provide guidance on the marketing and communication rules for Medicare Advantage (MA-only, MA- PD) plans (also referred to as “plans”), Medicare Prescription Drug plans (PDP) (also referred to as “Part D sponsors”), and except where otherwise specified, Section 1876 cost plans (also referred to as “plans”) and employer/union-sponsored group MA or Part D plans. These plans are governed under Title 42 of the Code of Federal Regulations (CFR), Parts 422, 423, and 417. These requirements also apply to Medicare-Medicaid Plans (MMPs), except as modified or clarified in state-specific marketing guidance for each state’s demonstration. Such state-specific guidance for MMPs is considered an addendum to the MCMG, and will be posted to:
How long does Medicare last?
An individual who is aging into Medicare eligibility, typically the seven month period consisting of three months prior to the individual’s birth month, the individual’s birth month, and three months following the individual’s birth month.
What is a third party marketing organization?
Third-party marketing organizations are entities such as a Field Marketing Organization (FMO), General Agent (GA), or similar type of organization that has been retained to sell or promote a Plan’s/Part D sponsor’s Medicare products on the Plan’s/Part D sponsor’s behalf either directly or through sales agents or a combination of both.
What is 422.2262?
42 CFR §§ 422.2262, 422.2268(a)(7), 423.2262, 423.2268(a)(7) Plans/Part D sponsors are not required to submit non-English language materials that are based on an English version. If a Plan/Part D sponsor creates a material to be used only in a non- English language, the Plan/Part D sponsor must submit an English translation to HPMS.
Can SB be submitted as a template?
The SB must be submitted in HPMS as one document under the File & Use process using code 1099. SBs may not be submitted as a template or with bracketed information (Refer to section 90 for information on the material submission process).