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?
...
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? Ans-He will need to mail in his payment with his enrollment form.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include
drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan.
What should you tell her? Ans-She could enroll in a PFFS plan and a stand-alone Medicare
prescription drug plan.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify a plan that covers all of her
medications. She does not want to make an abrupt change to new drugs that would be covered
and asks what she should do. What should you tell her? Ans-Every Part D drug plan is required
to cover a single one-month fill of her existing medications sometime during a 90-day transition
period.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD plan.
He is worried that he will lose his coverage now when he needs it the most. He is certain his plan
will disenroll him because that is what happened to a friend of his in a similar type of plan. What
can you tell Mr. Robinson about his situation? Ans-Plan sponsors have the option to do nothing
when a plan member does not pay their premiums or disenroll the member after a grace period
and notice.
Mrs. Allen has a rare condition for which two different brand name drugs are the only available
treatment. She is concerned that since no generic prescription drug is available and these drugs
are very high cost, she will not be able to find a Medicare Part D prescription drug plan that
covers either one of them. What should you tell her? Ans-Medicare prescription drug plans are
required to cover drugs in each therapeutic category. She should be able to enroll in a Medicare
prescription drug plan that covers the medications she needs.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her
neighbors called TrOOP. She asks you to explain it. What do you say? Ans-TrOOP stands for
true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and include
not only expenses paid by a beneficiary but also in some instances drug manufacturer discounts.
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits
(FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and become
Medicare eligible for the first time. What issues might she consider about whether to enroll in a
Medicare prescription drug plan? Ans-She could compare the coverage to see if the Medicare
Part D plan offers better benefits and coverage than the FEHB plan for the specific medications
she needs and whether any additional benefits are worth the Part D premium costs on top of her
FEHB contribution.
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?
Ans-Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days
of her stay, after which she would have a copay until she has been in the facility for 100 days.
Madeline Martinez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also left a substantial estate which provides Madeline
with an annual income of approximately $130,000. Madeline, who has only worked part-time for
the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to
you for advice. What should you tell her? Ans-You should tell Madeline that she will be able to
enroll in Medicare Part A without paying monthly premiums due to her husband's long work
record and participation in the Medicare system. You should also tell Madeline that she will pay
Part B premiums at more than the standard lowest rate but less than the highest rate due her
substantial income.
Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: "We
offer Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if you
would like to learn more." Which of the following best describes the obligation(s) of Winthrop
Brokerage regarding the advertisement? Ans-Winthrop Brokerage does not need to submit the
advertisement to CMS for prior approval because it does not include information about the plans'
benefits structures, cost-sharing, or information about measures or ranking standards.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at
severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is
likely to be most appropriate for him? Ans-C-SN
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