1. Mr.. / Romero. / is. / 64,. / retiring. / soon,. / and. / considering. / enrollment. / in. / his. / em-
ployer-
sponsored. / retiree. / group. / health. / plan. / that. / includes. / drug. / coverage. / with. / nomi
nal. / copays.. / He. / heard. / about. / a. / neighbor's. / MA-
PD. / plan. / that. / you. / represent./and. / because. / he. / takes. / numerous. / prescription. / dru
gs,. / he. / is. / considering. / signing. / up./for./it../What./should./you./tell./him?:./He./should./compare./th
e./benefits./in./his./employer-sponsored./retiree./group./health./plan./with./the./benefits./in./his./neighbor's./MA-
PD./plan./to./determine./which./one./will./provide./suflcient./coverage./for./his./prescription./needs.
2. 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?:./She./could./enroll./in./a./PFFS./plan
./and./a./stand-alone./Medicare./prescription./drug./plan.
3. Mr.. / Kelly. / wants. / to. / know. / whether. / he. / is. / eligible. / to. / sign. / up. / for. / a. / private
fee-for-
service. / (PFFS). / plan.. / What. / questions. / would. / you. / need. / to. / ask. / to. / deter-
mine./his./eligibility?:./You./would./need./to./ask./Mr../Kelly./if./he./is./entitled./to./Part./A,./enrolled./in./Part./B,./and./if./h
e./lives./in./the./PFFS./plan's./service./area.
4. Mrs.. / Radford. / asks. / whether. / there. / are. / any. / special. / eligibility. / requirements. / f
or
Medicare./Advantage../What./should./you./tell./her?:./Mrs../Radford./must./be./entitled./to./Part./A./and./e
nrolled./in./Part./B./to./enroll./in./Medicare./Advantage.
5. Dr../Elizabeth./Brennan./does./not./contract./with./the./ABC./PFFS./plan./but./accepts./th
e. / plan's. / terms. / and. / conditions. / for. / payment.. / Mary. / Rodgers. / sees. / Dr.. / Brennan
./for./treatment../How./much./may./Dr../Brennan./charge?:./Dr../Brennan./can./charge./Mary./Rogers
./no./more./than./the./cost./sharing./specified./in./the./PFFS./plan's./terms./and./condition./of./payment./which./may./include./bal
ance./billing./up./to./15%of./the./Medicare./rate.
6. Mr.. / Lopez. / has. / heard. / that. / he. / can. / sign. / up. / for. / a. / product. / called. / "Medicar
e./Advantage". / but. / is. / not. / sure. / about. / what. / type. / of. / plan. / designs. / are. / availa
ble./through. / this. / program.. / What. / should. / you. / tell. / him. / about. / the. / types. / of. / h
ealth./plans./that./are./available./through./the./Medicare./Advantage./program?:./Ther
e./are./Medicare./health./plans./such./as./HMOs,./PPOs,./PFFS,./and./MSAs.
./ .
/
, 7. Mrs../Velasquez./cares./for./her./frail./elderly./mother,./Maria,./who./lives./in./North./C
arolina.. / She. / is. / worried. / that. / without. / additional. / support,. / her. / mother. / will. / need.
/to./go./into./a./nursing ./home. ./Mrs. ./Velasquez ./asks./you./if./there ./is./any./Medicare ./pl
an./that./might./allow./her./mother./to./remain./in./the./community./rather./than
./ .
/
ployer-
sponsored. / retiree. / group. / health. / plan. / that. / includes. / drug. / coverage. / with. / nomi
nal. / copays.. / He. / heard. / about. / a. / neighbor's. / MA-
PD. / plan. / that. / you. / represent./and. / because. / he. / takes. / numerous. / prescription. / dru
gs,. / he. / is. / considering. / signing. / up./for./it../What./should./you./tell./him?:./He./should./compare./th
e./benefits./in./his./employer-sponsored./retiree./group./health./plan./with./the./benefits./in./his./neighbor's./MA-
PD./plan./to./determine./which./one./will./provide./suflcient./coverage./for./his./prescription./needs.
2. 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?:./She./could./enroll./in./a./PFFS./plan
./and./a./stand-alone./Medicare./prescription./drug./plan.
3. Mr.. / Kelly. / wants. / to. / know. / whether. / he. / is. / eligible. / to. / sign. / up. / for. / a. / private
fee-for-
service. / (PFFS). / plan.. / What. / questions. / would. / you. / need. / to. / ask. / to. / deter-
mine./his./eligibility?:./You./would./need./to./ask./Mr../Kelly./if./he./is./entitled./to./Part./A,./enrolled./in./Part./B,./and./if./h
e./lives./in./the./PFFS./plan's./service./area.
4. Mrs.. / Radford. / asks. / whether. / there. / are. / any. / special. / eligibility. / requirements. / f
or
Medicare./Advantage../What./should./you./tell./her?:./Mrs../Radford./must./be./entitled./to./Part./A./and./e
nrolled./in./Part./B./to./enroll./in./Medicare./Advantage.
5. Dr../Elizabeth./Brennan./does./not./contract./with./the./ABC./PFFS./plan./but./accepts./th
e. / plan's. / terms. / and. / conditions. / for. / payment.. / Mary. / Rodgers. / sees. / Dr.. / Brennan
./for./treatment../How./much./may./Dr../Brennan./charge?:./Dr../Brennan./can./charge./Mary./Rogers
./no./more./than./the./cost./sharing./specified./in./the./PFFS./plan's./terms./and./condition./of./payment./which./may./include./bal
ance./billing./up./to./15%of./the./Medicare./rate.
6. Mr.. / Lopez. / has. / heard. / that. / he. / can. / sign. / up. / for. / a. / product. / called. / "Medicar
e./Advantage". / but. / is. / not. / sure. / about. / what. / type. / of. / plan. / designs. / are. / availa
ble./through. / this. / program.. / What. / should. / you. / tell. / him. / about. / the. / types. / of. / h
ealth./plans./that./are./available./through./the./Medicare./Advantage./program?:./Ther
e./are./Medicare./health./plans./such./as./HMOs,./PPOs,./PFFS,./and./MSAs.
./ .
/
, 7. Mrs../Velasquez./cares./for./her./frail./elderly./mother,./Maria,./who./lives./in./North./C
arolina.. / She. / is. / worried. / that. / without. / additional. / support,. / her. / mother. / will. / need.
/to./go./into./a./nursing ./home. ./Mrs. ./Velasquez ./asks./you./if./there ./is./any./Medicare ./pl
an./that./might./allow./her./mother./to./remain./in./the./community./rather./than
./ .
/
