1. Mrs.Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in
Medicare
...
1. Mrs.Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in
Medicare Advantage.
2. Mr. Romero is 64, retiring soon, and considering enrollment in his employersponsored retiree group health plan that includes drug coverage withnominal
copays. He heard about a neighbor's MA-PD plan that you representand because he
takes numerous prescription drugs,he is considering signingup for it. What should
you tell him?
Answer: He should compare the benefits in his employer-sponsored retiree group
health plan with the benefitsin his neighbor's MA-PDplan to determine which one
will provide sufficient coverage for his prescription needs.
3. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care
he has received under Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs).What could youtell him?
Answer: SNPs have special programs for enrollees with chronic conditions, like
Mr. Sinclair, and they provide prescription drug coverage that could be very helpful
as well
4. Mrs. Lyons is in good health, uses a single prescription, and lives independently
in her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA) but is not sure if the plan associated with the account will
fit her needs.What specific piece of information about aMedicare MSA plan would
it be important for her to know, prior to enrolling insuch a plan?
Answer: All MSAs cover Part A and Part Bbenefits, but not Part D prescriptiondrug
benefits, which could be obtained by also enrolling in a separate prescription drug
plan.
5. Dr.ElizabethBrennan does not contract with the ABCPFFS plan but acceptsthe
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennanfor
treatment. How much may Dr. Brennan charge?
Answer: Dr. Brennan can charge Mary Rogers no more than the cost sharing
specified in the PFFS plan's terms andcondition of payment which may include
balance billing up to 15%of the Medicare rate
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