Module 3 - Medicare Part D: Prescription Drug Coverage
Question 1: I'm on a fixed income and heard about extra help paying for Part D prescription drugs. Do I
qualify?
Answer: The extra help is available to beneficiaries whose income and assets do not exceed annual
limits specified by the g...
Module 3 - Medicare Part D: Prescription Drug Coverage
Question 1: I'm on a fixed income and heard about extra help paying for Part D prescription drugs. Do I
qualify?
Answer: The extra help is available to beneficiaries whose income and assets do not exceed annual
limits specified by the government.
Question 2: Which of the following statements about Medicare Part D are correct?
Answer: a. I, II, and III only. Part D plans must enroll any eligible beneficiary who applies regardless of
health status except in limited circumstances. Private fee-for-service (PFFS) plans are not required to use
a pharmacy network but may choose to have one. Beneficiaries enrolled in a MA-Medical Savings
Account (MSA) plan may only obtain Part D benefits through a standalone PDP.
Question 3: Can my Medicare plan cover the cost of shingles vaccination?
Answer: Yes, there is no cost sharing for the shingles vaccine even in the deductible phase of her
prescription drug plan because it is an adult vaccine recommended by the Advisory Committee on
Immunization Practices (AICP).
Question 4: Why do Medicare Part D plans have different costs and benefit structures?
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.
Question 5: Can I get prescription drug coverage without enrolling in a Medicare Advantage (MA) plan?
Answer: Yes, you can get prescription drug coverage through Medicare prescription drug plans, which
are offered by private companies under a program known as Medicare Part D, not through Original
Medicare.
d.Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan
through a private company that has contracted with the government to provide only such drug coverage
, to eligible Medicare beneficiaries. ✔️a.Mr. Carlini can keep Original Medicare, but if he does not sign
up for an MA plan that includes prescription drug coverage, he will only be able to obtain prescription
drug coverage through a Medigap plan.
b.To obtain prescription drug coverage, Mr. Carlini must enroll in an MA plan. The plan will cover his
Part A and Part B services, as well as provide him with the desired prescription drug coverage.
c.Mr. Carlini can obtain drug coverage through the Federal government's fallback plans, which are
designed to provide an alternative to privately sponsored Medicare Advantage plans.
d.Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan
through a private company that has contracted with the government to provide only such drug coverage
to eligible Medicare beneficiaries.
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?
c.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. ✔️a.Mr. Schultz should seek to continue employer group coverage through COBRA
because it is likely to have superior benefits at a more permanent solution.
b.Mr. Schultz can wait up to 180 days after the loss of his creditable employer group coverage before
enrolling in a Part D plan without worrying payment a premium penalty.
c.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.
d.Mr. Schultz should immediately enroll in a Part D plan but he can expect to pay a premium penalty
because he failed to enroll when first eligible.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and
also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?
c.If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug
coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this. ✔️a.Mrs. Berkowitz can apply
for any Medicare Advantage plan and, if it offers drug coverage, ask to have that element of the
coverage eliminated, after which she can enroll in a stand-alone Medicare prescription drug plan in her
service area.
b. Mrs. Berkowitz can enroll in any Medicare Advantage plan, regardless of whether it offers drug
coverage, and enroll in any stand-alone Medicare prescription drug plan.
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