1
1
1
Mrs.1West1wears1glasses1and1dentures1and1has1enjoyed1considerable1pain1relief1from1arthritis1thro
ugh1acupuncture.1She1is1concerned1about1whether1or1not1Medicare1will1cover1these1items1and1serv
ices.1What1
should1you1tell1her?1-1ANS1✔-Medicare1does1not1cover1acupuncture,1or,1in1general,1
glasses1or1dentures.Mr.1Bickford1did1not1quite1qualify1for1the1 1extra1help1low-
income1subsidy1under1the1Medicare1Part1D1Prescription1Drug1program1and1he1is1wondering1if1there
1is1any1other1option1he1has1for1obtaining1help1
with1his1considerable1drug1costs.1What1should1you1tell1him?1-1ANS1✔-He1could1check1
with1the1manufacturers1of1his1medications1to1see1if1they1offer1an1assistance1program1to1help1people1
with1limited1means1obtain1the1medications1they1need.1Alternatively,1he1could1check1to1see1whether1
his1stateMr.1Lombardi1is1
1interested1in1a1Medicare1Advantage1(MA)1PPO1plan1that1you1represent.1It1is1one1has1a1pharmacy1as
sistance1program1of1 to1help1him1with1his1expenses.1
three1plans1operated1by1the1same1organization1in1Mr.1Lombardi's1area.1The1MA1PPO1plan1does1no
t1
include1drug1coverage,1but1the1other1two1plans1do.1Mr.1Lombardi1likes1the1PPO1plan1that1does1not
1
include1drug1coverage1and1intends1to1obtain1his1drug1coverage1through1a1stand-
alone1Medicare1prescription1drug1plan.1What1should1you1tell1him1about1this1situation?1-1ANS1✔-
He1could1enroll1in1one1of1the1MA1plans1that1include1prescription1drug1coverage1or1a1Medigap1plan1
and1aMr.1Torres1
1has1a1small1savings1account.1He1would1like1to1pay1for1his1monthly1Part1D1premiums1with1standan1
-alone1prescription1drug1plan,1but1he1cannot1enroll1in1the1MA-
only1PPO1plan1and1a1standaloneautomatic1monthly1withdrawal1
1from1his1savings1account1until1it1is1exhausted,1and1then1have1his1
prescription1drug1plan.premiums1withheld1from1his1
1Social1Security1check.1What1should1you1tell1him?1-1ANS1✔-
11
,1
1
1
1 1
1In1general,1he1must1select1a1single1Part1D1premium1payment1mechanism1that1will1be1use
d1throughout1
theAgent1Jennings1makes1a1presentation1on1Medicare1advertised1as1year.1
1an1educational1event.1Agent1Jennings1
distributes1materials1that1are1solely1educational1in1nature.1However,1she1gives1a1brief1presentation
1that1
mentions1plan-
specific1premiums.1Is1this1a1prohibited1activity1at1an1event1that1has1been1advertised1as1
educational?1Mrs.1Mulcahy1is-1ANS11concern✔-
Yes.ed1that1When1an1event1has1she1may1not1qualify1for1enrollment1been1advertised1as1"educational,"
1in1a1Medicare1prescription1drug1 1discussing1planplan1because,1although1she-
specific1premiums1is1entitled1to1Part1is1impermissible.1A,1she1is11not1enrolled1under1Medicare1Part1B
.1What1should1
you1tell1her?1-1ANS1✔-Everyone1who1is1entitled1to1Part1A1or1enrolled1under1Part1B1is1
eligible1to1enroll1in1a1Medicare1prescription1drug1plan.1As1long1as1Mrs.1Mulcahy1is1entitled1to1Par
t1A,1she1does1not1need1to1enroll1under1Part1B1before1enrolling1in1a1prescription1drug1plan.1
Mr.1Jacob1understands1that1there1is1a1standard1Medicare1Part1D1prescription1drug1benefit,1but1when
1he1
looks1at1information1on1various1plans1available1in1his1area,1he1sees1a1wide1range1in1what1they1charg
e1for1
deductibles,1premiums1and1cost1sharing.1How1can1you1explain1this1to1him?1-1ANS1✔-1
Medicare1Part1D1drug1plans1may1have1different1benefit1structures,1but1on1average,1they1must1all1be1
atMs.1Moore1
1plans1to1retire1when1she1turns1651in1a1few1months.1She1is1in1excellent1health1and1will1leasthave 1as1g
ood1as1the1standard1model1established1by1the1government.1
considerable1income1when1she1retires.1She1is1concerned1that1her1income1will1make1it1impossible1fo
r1her1
to1qualify1for1Medicare.1What1could1you1tell1her1to1address1her1concern?1-1ANS1✔-1
Medicare1is1a1program1for1people1age1651or1older1and1those1under1age1651with1certain1disabilities,1e
ndAgent11Armstrong1is1employed1by1XYZ1Agency,1which1is1under1contract1with1ABC1Health1Plan,1a1
stageMedicare1renal1Advantage1(MA)1disease1or1Lou1Gehrig's1disease,11plan1that1offers1plansso1she1i
n11will1be1eligible1for1Medicare.multiple1states.1XYZ1Agency1maintains1 1a1website1
marketing1the1MA1plans1with1which1it1has1contracts.1Agent1Armstrong1follows1up1with1individuals1
who1
21
1
1
Mrs.1West1wears1glasses1and1dentures1and1has1enjoyed1considerable1pain1relief1from1arthritis1thro
ugh1acupuncture.1She1is1concerned1about1whether1or1not1Medicare1will1cover1these1items1and1serv
ices.1What1
should1you1tell1her?1-1ANS1✔-Medicare1does1not1cover1acupuncture,1or,1in1general,1
glasses1or1dentures.Mr.1Bickford1did1not1quite1qualify1for1the1 1extra1help1low-
income1subsidy1under1the1Medicare1Part1D1Prescription1Drug1program1and1he1is1wondering1if1there
1is1any1other1option1he1has1for1obtaining1help1
with1his1considerable1drug1costs.1What1should1you1tell1him?1-1ANS1✔-He1could1check1
with1the1manufacturers1of1his1medications1to1see1if1they1offer1an1assistance1program1to1help1people1
with1limited1means1obtain1the1medications1they1need.1Alternatively,1he1could1check1to1see1whether1
his1stateMr.1Lombardi1is1
1interested1in1a1Medicare1Advantage1(MA)1PPO1plan1that1you1represent.1It1is1one1has1a1pharmacy1as
sistance1program1of1 to1help1him1with1his1expenses.1
three1plans1operated1by1the1same1organization1in1Mr.1Lombardi's1area.1The1MA1PPO1plan1does1no
t1
include1drug1coverage,1but1the1other1two1plans1do.1Mr.1Lombardi1likes1the1PPO1plan1that1does1not
1
include1drug1coverage1and1intends1to1obtain1his1drug1coverage1through1a1stand-
alone1Medicare1prescription1drug1plan.1What1should1you1tell1him1about1this1situation?1-1ANS1✔-
He1could1enroll1in1one1of1the1MA1plans1that1include1prescription1drug1coverage1or1a1Medigap1plan1
and1aMr.1Torres1
1has1a1small1savings1account.1He1would1like1to1pay1for1his1monthly1Part1D1premiums1with1standan1
-alone1prescription1drug1plan,1but1he1cannot1enroll1in1the1MA-
only1PPO1plan1and1a1standaloneautomatic1monthly1withdrawal1
1from1his1savings1account1until1it1is1exhausted,1and1then1have1his1
prescription1drug1plan.premiums1withheld1from1his1
1Social1Security1check.1What1should1you1tell1him?1-1ANS1✔-
11
,1
1
1
1 1
1In1general,1he1must1select1a1single1Part1D1premium1payment1mechanism1that1will1be1use
d1throughout1
theAgent1Jennings1makes1a1presentation1on1Medicare1advertised1as1year.1
1an1educational1event.1Agent1Jennings1
distributes1materials1that1are1solely1educational1in1nature.1However,1she1gives1a1brief1presentation
1that1
mentions1plan-
specific1premiums.1Is1this1a1prohibited1activity1at1an1event1that1has1been1advertised1as1
educational?1Mrs.1Mulcahy1is-1ANS11concern✔-
Yes.ed1that1When1an1event1has1she1may1not1qualify1for1enrollment1been1advertised1as1"educational,"
1in1a1Medicare1prescription1drug1 1discussing1planplan1because,1although1she-
specific1premiums1is1entitled1to1Part1is1impermissible.1A,1she1is11not1enrolled1under1Medicare1Part1B
.1What1should1
you1tell1her?1-1ANS1✔-Everyone1who1is1entitled1to1Part1A1or1enrolled1under1Part1B1is1
eligible1to1enroll1in1a1Medicare1prescription1drug1plan.1As1long1as1Mrs.1Mulcahy1is1entitled1to1Par
t1A,1she1does1not1need1to1enroll1under1Part1B1before1enrolling1in1a1prescription1drug1plan.1
Mr.1Jacob1understands1that1there1is1a1standard1Medicare1Part1D1prescription1drug1benefit,1but1when
1he1
looks1at1information1on1various1plans1available1in1his1area,1he1sees1a1wide1range1in1what1they1charg
e1for1
deductibles,1premiums1and1cost1sharing.1How1can1you1explain1this1to1him?1-1ANS1✔-1
Medicare1Part1D1drug1plans1may1have1different1benefit1structures,1but1on1average,1they1must1all1be1
atMs.1Moore1
1plans1to1retire1when1she1turns1651in1a1few1months.1She1is1in1excellent1health1and1will1leasthave 1as1g
ood1as1the1standard1model1established1by1the1government.1
considerable1income1when1she1retires.1She1is1concerned1that1her1income1will1make1it1impossible1fo
r1her1
to1qualify1for1Medicare.1What1could1you1tell1her1to1address1her1concern?1-1ANS1✔-1
Medicare1is1a1program1for1people1age1651or1older1and1those1under1age1651with1certain1disabilities,1e
ndAgent11Armstrong1is1employed1by1XYZ1Agency,1which1is1under1contract1with1ABC1Health1Plan,1a1
stageMedicare1renal1Advantage1(MA)1disease1or1Lou1Gehrig's1disease,11plan1that1offers1plansso1she1i
n11will1be1eligible1for1Medicare.multiple1states.1XYZ1Agency1maintains1 1a1website1
marketing1the1MA1plans1with1which1it1has1contracts.1Agent1Armstrong1follows1up1with1individuals1
who1
21
