Medicare exam Study Guide Questions And Answers Verified 100% Correct

Medicare exam Study Guide Questions And Answers Verified 100% Correct Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare health plan? MODULE 2 - ANSWER Medicaid will coordinate benefits only with Medicaid participating providers. Lombardi is interested in MA PPO 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 Rx plan. MODULE 2 - ANSWER He could enroll in one of the MA plans that include Rx coverage or a Medigap plan and a stand alone Rx plan, but he CAN'T enroll in the MAonly PPO and a stand alone Rx plan. Chou likes a PFFS plan available in his area that does NOT offer drug coverage. She wants to enroll in the plan and enroll in a stand alone Rx plan. MODULE 2 - ANSWER She could enroll in a PFFS plan and a stand alone Medicare Rx plan. Lopez has heard that he can sign up for a product called MA, but is not sur3e about what type of plan designs are available through this program. MODULE 2 - ANSWER They are Medicare health plans such as HMO, PPO, PFFS, SNP and MSA. Whalen is trying to understand the difference between Original Medicare and MA. MODULE 2 - ANSWER MA is a way of covering all of the Original Medicare benefits through private health ins. companies. Katz reached the Part D coverage gap in August last year. His Rx's have not changed, he is keeping the same Part D plan and the benefits, cost sharing, and coverage of his drugs are all the same as last year. MODULE 3 - ANSWER Because he reached the coverage gap last year, he will probably reach it again this year close to the same time. Grant uses several very expensive drugs and anticipates that she will enter catastrophic coverage at some point during the year. To help her determine when she is likely to qualify for catastrophic coverage, she asked which expenses count toward the out of pocket limit that qualifies her for catastrophic coverage. MODULE 3 - ANSWER Rx drugs she purchases when in the Part D coverage gap. Sharpiro gets by on a very small fixed income. He has heard there may be extra help paying for Part D Rx for Medicare beneficiaries with limited income. MODULE 3 - ANSWER The extra help is available to beneficiaries whose income and assets do NOT exceed annual limits specified by the government. Fields wants to know whether applying for the Part D lower income subsidy will be worth the time to fill out the paperwork. MODULE 3 - ANSWER The Part D low income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office or calling the SS Administration. Fitzgerald did not quite qualify for the extra help low income subsidy under the Medicare Part D Rx program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. MODULE 3 - 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. Quinn has just turned 65, is in excellent health, and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare Rx plan if she does not need the coverage. MODULE 3 - ANSWER If she does not sign up for a Medicare Rx plan as soon as she is eligible to do so, if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. Torres has a small savings acct. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings acct. until it is exhausted, and then have his premiums withheld from his SS check. MODULE 3 - ANSWER In general, he must select a single Part D premium payment mechanism that will be used throughout the year. Fiore was in the Army for 35 years and is now retired. She has drug coverage through the VA. What issues might she consider with regard to whether to enroll in a Medicare Rx plan? MODULE 3 - ANSWER She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the VA for the specific medications she needs and whether any additional benefits are worth the Part D premium costs. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare Rx plan, but does not want to purchase extra coverage that he will not need. MODULE 3 - ANSWER If the drug coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment. Jenkins has coverage for medical services and medications through his employer's retiree plan. He is considering switching to a Medicare Rx plan because his retiree plan does not cover two important medications. MODULE 3 - ANSWER If Mr. Jenkins drops his drug coverage through the retiree plan, he may NOT be able to get it back and he also may lose his medical health coverage. McIntire is enrolled in her states Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen with respect to her drug coverage? MODULE 3 - ANSWER Unless she chooses a Medicare Part D Rx plan on her own, she will be automatically enrolled in one available in her area. Carlini has heard that Medicare Rx plans are only offered through private companies under a program known as MA, not by the government. He likes Original Medicare and does NOT want to sign up for an MA product, but he also wants Rx coverage. MODULE 3 - ANSWER Mr. Carlini can stay with Original Medicare Rx drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. Mulcahy is concerned that she may not qualify for enrollment in a Medicare Rx plan because although she is entitled to Part A, she is not enrolled under Medicare Part B. MODULE 3 - ANSWER Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare Rx plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a Rx plan. All plans must cover at least the standard Part D coverage or its actuarial equivalent. What costs would a beneficiary incur for Rx in 2016 under the standard coverage? MODULE 3 - ANSWER Standard Part D coverage would require payment of an annual deductible, 25% cost sharing up to the coverage gap, a portion of costs for both generics and brand name drugs in the coverage gap, and co-pays or co-ins. Andrews was preparing a budget for next year because she takes quite a few Rx drugs, she will reach the coverage gap, and wants to be sure she has enough money set aside for those months. She received assistance calculating her projected expenses from her daughter who is a pharmacist. She doesn't think the calculations are correct because her out of pocket expenses would be lower than last year.