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.
(Medicare Part D Rx coverage, basics, eligibility) - An...
AHIP TRAINING MODULE # 3
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.
(Medicare Part D Rx coverage, basics, eligibility) - Answer- Mr. Carlini can stay with
Original Medicare and ALSO enroll in a Medicare Rx 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.
What should you tell her?
(Medicare Part D Rx coverage, basics, eligibility) - 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 DOESN'T 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 drugs in 2016 under the standard
coverage?
(Medicare Part D Rx coverage, basics, eligibility) - 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 generic and brand name drugs in the coverage gap, and
co-pays or co-insurance after the coverage gap.
ANDREWS is preparing a budget for next year because she takes quite a few Rx's, 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, but she doesn't think the calculations are correct
because her out of pocket expenses would be lower than last year.
(Medicare Part D Rx coverage, basics, eligibility) - Answer- It would NOT be unusual for
her costs to be a bit less because each year until 2020, an enrollee's share of the drug
costs in the coverage gap are less.
JACOB understands that there is a standard Medicare Part D Rx 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?
(Medicare Part D Rx coverage, basics, eligibility) - 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 government.
What types of tools can Medicare Part D Rx plan use that affect the way their enrollees
can access medications?
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