AHIP MEDICARE TRAINING QUESTIONS AND ANSWERS

AHIP MEDICARE TRAINING QUESTIONS
AND ANSWERS

WhichkofkthekfollowingkstatementskaboutkMedicarekPartkDkis/arekcorrect?
I.kPartkDkplanskmustkenrollkanykeligiblekbeneficiarykwhokapplies,kregardlesskofkh
ealthkstatus,kexceptkinklimitedkcircumstances.
II.kPrivatekfee-for-
servicek(PFFS)kplanskareknotkrequiredktokusekakpharmacyknetworkkbutkmaykcho
osektokhavekone.
III.kBeneficiarieskenrolledkinkankMA-
MedicalkSavingskAccountk(MSA)kplankmaykonlykobtainkPartkDkbenefitskthroughka
kstandalonekPDP.
IV.kBeneficiarieskenrolledkinkankMA-
PPOkmaykobtainkPartkDkbenefitskthroughkakstandalonekPDPkorkthroughktheirkpla
n.k-kI,kII,kandkIIIkonly

Mr.kAguilarkiskaknewlykenrolledkMedicarekPartkDkbeneficiarykandkonekofkyourkcli
ents.kInkadditionktokdrugskonkhiskplan'skformulary,khektakeskseveralkotherkmedic
ations.kThesekincludekakprescriptionkdrugknotkonkhiskplan'skformulary,kover-the-
counterkmedicationskforkcoldskandkallergies,kvitamins,kandkdrugskfromkankInternet
-
basedkCanadiankpharmacyktokpromotekhairkgrowthkandkreducekjointkswelling.kHis
kneighborkrecentlyktoldkhimkaboutkakconceptkcalledkTrOOPkandkhekaskskyoukifk
anykofkhiskotherkmedicationskcouldkcountktowardkTrOOPkshouldkhekeverkreachkt
hekPartkDkcatastrophicklimit.kWhatkshouldkyouksay?
Questionk2Answerk-
kNonekofkthekcostskofkMr.kAguilar'skotherkmedicationskwouldkcurrentlykcountktow
ardkTrOOPkbutkhekmaykwishktokaskkhiskplankforkankexceptionktokcoverkthekpre
scription,knotkonkitskformulary.

WhatktypeskofktoolskcankMedicarekPartkDkprescriptionkdrugkplanskusekthatkaffect
kthekwayktheirkenrolleeskcankaccesskmedications?k-
kPartkDkplanskdoknotkhavektokcoverkallkmedications.kAskakresult,ktheirkformulari
es,korklistskofkcoveredkdrugs,kwillkvarykfromkplanktokplan.kInkaddition,ktheykcank
usekcostkcontainmentktechniquesksuchkasktieredkco-paymentskandkstepktherapy.

Mrs.kEsmeraldakAvilakiskakMedicarekbeneficiarykenrolledkinkakMA-
PDkplankyoukrepresent.kHerkneighborkrecentlyksufferedkfromkakpainfulkcasekofks
hingles.kMrs.kAvilakhopesktokavoidksuchkankillnesskthroughkvaccination.kShekasks
kyoukwhetherkthekcostkofkthekshingleskvaccinationkwillkbekcoveredkunderkthekpla
nkyoukrepresent.kWhatkshouldkyouksay?k-
kYes,ktherekisknokcostksharingkforkthekshingleskvaccinekevenkinkthekdeductiblekp

,hasekofkherkprescriptionkdrugkplankbecausekitkiskankadultkvaccinekrecommended
kbykthekAdvisorykCommitteekonkImmunizationkPracticesk(AICP)

Mrs.kSharmakhaskOriginalkMedicarekandkwouldklikektokenrollkinkakPrivatekFee-
for-
Servicek(PFFS)kplan.kAllktypeskofkPFFSkplanskarekavailablekinkherkarea.kWhichk
optionskcouldkMrs.kSharmakconsiderkbeforekselectingkakPFFSkplan?k-
kAkMedicarekAdvantagekPrescriptionkDrugk(MA-
PD)kPFFSkplankthatkcombineskmedicalkbenefitskandkPartkDkprescriptionkdrugkcov
erage,kakPFFSkplankofferingkonlykmedicalkbenefits,korkakPFFSkplankinkcombinati
onkwithkakstand-alonekprescriptionkdrugkplan.

Mrs.kNguyenkiskakretiredkfederalkworkerkwithkcoveragekunderkakFederalkEmploye
ekHealthkBenefitsk(FEHB)kplankthatkincludeskcreditablekdrugkcoverage.kShekiskre
adyktokturnk65kandkbecomekMedicarekeligiblekforkthekfirstktime.kWhatkissueskmig
htkshekconsiderkaboutkwhetherktokenrollkinkakMedicarekprescriptionkdrugkplan?k-
kShekcouldkcomparekthekcoveragektokseekifkthekMedicarekPartkDkplankofferskbe
tterkbenefitskandkcoveragekthankthekFEHBkplankforkthekspecifickmedicationskshe
kneedskandkwhetherkanykadditionalkbenefitskarekworthkthekPartkDkpremiumkcosts
konktopkofkherkFEHBkcontribution.

Mrs.kWood,kagek65,kiskconcernedkthatkshekmayknotkqualifykforkenrollmentkinkak
Medicarekprescriptionkdrugkplankbecause,kalthoughkshekiskentitledktokPartkA,kshe
kisknotkenrolledkunderkMedicarekPartkB.kWhatkshouldkyouktellkher?k-
kAnkindividualkwhokiskentitledktokPartkAkorkenrolledkunderkPartkBkiskeligiblektok
enrollkinkakMedicarekprescriptionkdrugkplan.kAsklongkaskMrs.kWoodkiskentitledkto
kPartkA,kshekdoesknotkneedktokenrollkunderkPartkBkbeforekenrollingkinkakprescri
ptionkdrugkplan.

Ms.kRamoskiskenrolledkinkakMedicarekAdvantagekplankthatkincludeskprescriptionk
drugkplank(PDP)kcoverage.kShekisktravelingkandkwishesktokfillktwokofkthekprescri
ptionskthatkshekhasklost.kHowkwouldkyoukadvisekher?k-
kShekmaykfillkprescriptionskforkcoveredkdrugskatknon-
networkkpharmacies,kbutklikelykatkakhigherkcostkthankpaidkatkankin-
networkkpharmacy.

Mr.kSuttonkhaskaksmallksavingskaccount.kHekwouldklikektokpaykforkhiskmonthlyk
PartkDkpremiumskwithkankautomatickmonthlykwithdrawalkfromkhisksavingskaccount
kuntilkitkiskexhausted,kandkthenkhavekhiskpremiumskwithheldkfromkhiskSocialkSec
uritykcheck.kWhatkshouldkyouktellkhim?k-
kInkgeneral,khekmustkselectkaksinglekPartkDkpremiumkpaymentkmechanismkthatk
willkbekusedkthroughoutkthekyear

Mrs.kRussokiskentitledktokPartkAkandkhaskmedicalkcoveragekwithoutkdrugkcovera
gekthroughkankemployerkretireekplan.kShekisknotkenrolledkinkPartkB.kSincektheke
mployerkplankdoesknotkcoverkprescriptionkdrugs,kshekwantsktokenrollkinkakMedic

, arekprescriptionkdrugkplan.kWillkshekbekablekto?k-
kYes.kMrs.kRussokmustkbekentitledktokPartkAkand/
orkenrolledkinkPartkBktokbekeligiblekforkcoveragekunderkthekMedicarekprescription
kdrugkprogram.

Mr.kChenkwaskstillkworkingkwhenkhekfirstkqualifiedkforkMedicare.kAtkthatktime,khe
khadkemployerkgroupkcoveragekthatkwaskcreditable.kDuringkhiskinitialkPartkDkeligi
bilitykperiod,khekdecidedknotktokenrollkbecausekhekwasksatisfiedkwithkhiskdrugkco
verage.kItkisknowkakyearklaterkandkMr.kChenkhasklostkhiskemployerkgroupkcover
agekwithinktheklastktwokweeks.kHowkwouldkyoukadvisekhim?k-
kMr.kChenkshouldkenrollkinkakPartkDkplankbeforekhekhaskak63-
daykbreakkinkcoveragekinkorderktokavoidkakpremiumkpenalty.

Mrs.kStricklandkiskaknewkMedicarekbeneficiarykwhokhaskjustkretiredkfromkretailkw
ork.kShekiskinterestedkinkselectingkakMedicarekPartkDkprescriptionkdrugkplan.kSh
ektakeskseveralkmedicationskandkiskconcernedkthatkshekhasknotkbeenkablektokid
entifykakplankthatkcoverskallkofkherkmedications.kShekdoesknotkwantktokmakekan
kabruptkchangektoknewkdrugskthatkwouldkbekcoveredkandkaskskwhatkshekshould
kdo.kWhatkshouldkyouktellkher?k-
kEverykPartkDkdrugkplankiskrequiredktokcoverkaksinglekone-
monthkfillkofkherkexistingkmedicationsksometimekduringkak90-dayktransitionkperiod.

Mrs.kCastrokhaskjustkturnedk65,kiskinkexcellentkhealthkandkhaskakrelativelykhighk
income.kShekusesknokmedicationskandkseesknokreasonktokspendkmoneykonkakM
edicarekprescriptionkdrugkplankifkshekdoesknotkneedkthekcoverage.kShekcurrently
kdoesknotkhavekcreditablekcoverage.kWhatkcouldkyouktellkherkaboutkthekimplicati
onskofksuchkakdecision?k-
kIfkshekdoesknotksignkupkforkakMedicarekprescriptionkdrugkplankasksoonkaskshe
kiskeligiblektokdokso,kandkifkshekdoesksignkupkatkaklaterkdate,kherkpremiumkwill
kbekpermanentlykincreasedkbyk1%kofktheknationalkaveragekpremiumkforkeverykm
onthkthatkshekwasknotkcovered.

Mrs.kKellykwantsktokenrollkinkakMedicarekAdvantagekplankthatkdoesknotkincludek
drugkcoveragekandkalsokenrollkinkakstand-
alonekMedicarekprescriptionkdrugkplan.kUnderkwhatkcircumstanceskcankshekdokthi
s?k-kIfkthekMedicarekAdvantagekplankiskakPrivatekFee-for-
Servicek(PFFS)kplankthatkdoesknotkofferkdrugkcoveragekorkakMedicalkSavingskAc
countkplan,kMrs.kKellykcankdokthis.

Mrs.kMcFarrenkiskenrolledkinkherkstate'skMedicaidkplankandkhaskjustkbecomekelig
iblekforkMedicarekaskwell.kWhatkcankshekexpectkwillkhappenktokherkdrugkcovera
ge?k-
kUnlesskshekchooseskakMedicarekPartkDkprescriptionkdrugkplankonkherkown,ksh
ekwillkbekautomaticallykenrolledkinkonekavailablekinkherkarea.