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AHIP 2024 MODULE 3
- Which of the following statements about Medicare Part D are correct
ANS I, II, and III only -I. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances.II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one.III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP.
- Mr. Schultz was still working when he first qualified for Medicare. At that
time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Schultz has lost his employer group coverage within the last two weeks. How would you advise him
ANS Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty.
- Mrs. Fiore is a retired federal worker with coverage under a Federal Employ-
ee Health Benefits (FEHB) plan that includes creditable drug coverage. She is 1 / 2
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ready to turn 65 and become Medicare eligible for the first time. What issues might she consider about whether to enroll in a Medicare prescription drug plan
ANS She could compare the coverage to see if the Medicare Part D plan offers better benefits and coverage than the FEHB plan for the specific medications she needs and whether any additional benefits are worth the Part D premium costs on top of her FEHB contribution.
- Mrs. Fields wants to know whether applying for the Part D low income
subsidy will be worth the time to fill out the paperwork. What could you tell he
ANS The Part D low income subsidy could substantially lower her overall costs.She can apply by contacting her state Medicaid office, or calling the Social Security Administration.
- Mrs. Walters is entitled to Part A and has medical coverage without drug
coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to
ANS Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program.
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