Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans? - ANSWER MSAs may have either a partial network, full network, or no network of providers. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits. Non-network providers mus...
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CORRECT
Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans? -
ANSWER MSAs may have either a partial network, full network, or no network of providers. MSA plans
cover Part A and Part B benefits but not Part D prescription drug benefits. Non-network providers must
accept the same amount that Original Medicare would pay them as payment in full.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in
a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug
coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? - ANSWER Mrs. Chi
may enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and
conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan
charge? - ANSWER Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing up to 15%of the Medicare
rate.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - ANSWER In most Medicare Advantage HMOs, Mr. Kumar must
generally obtain his services only from providers within the plan's network (except in an emergency or
where care is unavailable within the network).
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group
health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan
that you represent and because he takes numerous prescription drugs, he is considering signing up for it.
What should you tell him? - ANSWER An individual cannot be covered under two different Medicare
Advantage plans, so he would have to decide whether to enroll in the employer plan or his neighbor's
MA-PD. Also, MA-PD plans do not serve as supplemental coverage for another Medicare Advantage plan.
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments.
He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned
that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What
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