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Ms. Lewis understands that Medicare prescription drug plans
may use various methods to control the use of specific drugs.
She has heard about a technique called "step therapy" and is
wondering if you can explain what that is. What should you tell
her? - ANSWER -Step therapy involves using one or more lower
priced drugs before trying a more expensive drug when all are
used to treat the same condition.
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.
Mr. Castillo, a naturalized citizen, previously enrolled in
Medicare Part B but has recently stopped paying his Part B
premium. Mr. Castillo is still covered by Part A. He would like to
enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him? - ANSWER -He is not eligible
,to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
You will be holding a sales event soon, at which you would like
to offer door prizes to attendees. Under guidelines from the
Medicare agency, what types of
gifts or prizes would not be allowed in this situation? -
ANSWER -Gift cards or
gift certificates of $15 or less that can be readily
converted to cash.
Mrs. West wears glasses and dentures and has enjoyed
considerable pain relief from arthritis through acupuncture. She
is concerned about whether or not Medicare will cover these
items and services. What should you tell her? - ANSWER -
Medicare does not cover acupuncture, or, in general, glasses or
dentures.
Mr. Bickford did not quite qualify for the extra help low-income
subsidy under the Medicare Part D Prescription Drug program
and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should
you tell him? - ANSWER -He could check with the
manufacturers of his medications to see if they offer an
assistance program to help people with limited means obtain
the medications they need. Alternatively, he could check to see
whether his state has a pharmacy assistance program to help
him with his expenses.
, Ms. Edwards is enrolled in a Medicare Advantage plan that
includes prescription drug plan (PDP) coverage. She is
traveling and wishes to fill two of her prescriptions that she has
lost. How would you advise her? - ANSWER -She may fill
prescriptions for covered drugs at non-network pharmacies,
but likely at a higher cost than paid at an in-network pharmacy.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but
because he continues to work and is covered by an employer
health plan, he has not enrolled in Part B or Part D. He receives
a notice on June 1 that his employer is cutting back on
prescription drug benefits and that as of July 1 his coverage
will no longer be creditable. He has come to you for advice.
What advice would you give Mr. Rockwell about special
enrollment periods (SEPs)? - ANSWER -Mr. Rockwell is eligible
for a SEP due to his involuntary loss of creditable drug
coverage; the SEP begins in June and ends September 1 - two
months after the loss of creditable coverage.
Mr. Rainey is experiencing paranoid delusions and his
physician feels that he should be hospitalized. What should you
tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover? -
ANSWER -Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
Mr. Rainey is experiencing paranoid delusions and his
physician feels that he should be hospitalized. What should you
tell Mr. Rainey (or his representative) about the length of an