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 pro-
gram 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.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthri-
tis 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 acu-
puncture, or, in general, glasses or dentures.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums
with an automatic monthly withdrawal from his savings account until it is exhausted, and
then have his premiums withheld from his Social Security check. What should you tell him? -
ANSWER In general, he must select a single Part D premium payment mechanism that
will be used throughout the year.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a
brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an
event that has been advertised as educational? - ANSWER Yes. When an event has been
advertised as "educational," discussing plan-specific premiums is impermissible.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is
one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO
plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO
plan that does not include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him about this situation?
1
, - ANSWER He could enroll in one of the MA plans that include prescription drug coverage
or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-
only PPO plan and a stand-alone prescription drug plan.
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescrip-
tion drug plan because, although she is entitled to Part A, she is not enrolled under Medi-
care Part B. What should you tell her? - ANSWER Everyone who is entitled to Part A or
enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as
Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling
in a prescription drug plan.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit,
but when he looks at information on various plans available in his area, he sees a wide range
in what they charge for deductibles, premiums and cost sharing. How can you explain this to
him? - ANSWER Medicare Part D drug plans may have different benefit structures, but on
average, they must all be at least as good as the standard model established by the govern-
ment.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make
it impossible for her to qualify for Medicare. What could you tell her to address her concern?
- ANSWER Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible for
Medicare.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Origi-
nal Fee-for-Service (FFS) Medicare? What could you tell him? - ANSWER Part A, which co-
vers hospital, skilled nursing facility, hospice and home health services and Part B, which co-
vers professional services such as those provided by a doctor are covered under Original
Medicare.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan,
a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a
website marketing the MA plans with which it has contracts. Agent Armstrong follows up
with individuals who request more information about ABC MA plans via the website and
2
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 pro-
gram 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.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthri-
tis 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 acu-
puncture, or, in general, glasses or dentures.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums
with an automatic monthly withdrawal from his savings account until it is exhausted, and
then have his premiums withheld from his Social Security check. What should you tell him? -
ANSWER In general, he must select a single Part D premium payment mechanism that
will be used throughout the year.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a
brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an
event that has been advertised as educational? - ANSWER Yes. When an event has been
advertised as "educational," discussing plan-specific premiums is impermissible.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is
one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO
plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO
plan that does not include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him about this situation?
1
, - ANSWER He could enroll in one of the MA plans that include prescription drug coverage
or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-
only PPO plan and a stand-alone prescription drug plan.
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescrip-
tion drug plan because, although she is entitled to Part A, she is not enrolled under Medi-
care Part B. What should you tell her? - ANSWER Everyone who is entitled to Part A or
enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as
Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling
in a prescription drug plan.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit,
but when he looks at information on various plans available in his area, he sees a wide range
in what they charge for deductibles, premiums and cost sharing. How can you explain this to
him? - ANSWER Medicare Part D drug plans may have different benefit structures, but on
average, they must all be at least as good as the standard model established by the govern-
ment.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make
it impossible for her to qualify for Medicare. What could you tell her to address her concern?
- ANSWER Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible for
Medicare.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Origi-
nal Fee-for-Service (FFS) Medicare? What could you tell him? - ANSWER Part A, which co-
vers hospital, skilled nursing facility, hospice and home health services and Part B, which co-
vers professional services such as those provided by a doctor are covered under Original
Medicare.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan,
a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a
website marketing the MA plans with which it has contracts. Agent Armstrong follows up
with individuals who request more information about ABC MA plans via the website and
2
