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    mr. 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 prescription drug plan, but does not want to purchase extra coverage that he will not need. what should you tell him?

    James

    Guys, does anyone know the answer?

    get mr. 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 prescription drug plan, but does not want to purchase extra coverage that he will not need. what should you tell him? from EN Bilgi.

    Part D late enrollment penalty

    The cost of the Part D late enrollment penalty, which is determined based on how long you are without creditable prescription drug coverage

    Part D late enrollment penalty

    The late enrollment penalty is an amount that's permanently added to your Medicare drug coverage (Part D) premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Medicare drug coverage or other

    creditable prescription drug coverage. You’ll generally have to pay the penalty for as long as you have Medicare drug coverage.

    Learn how to avoid the late enrollment penalty.

    Note If you get

    Extra Help, you don't pay the late enrollment penalty.

    How much is the Part D penalty?

    The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

    Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.37 in 2022) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

    The national base beneficiary premium may change each year, so your penalty amount may also change each year.

    Example

    Mrs. Martinez has Medicare, and her first chance to get Medicare drug coverage (during her Initial Enrollment Period) ended on July 31, 2018. She doesn’t have prescription drug coverage from any other source. She didn’t join a Medicare drug plan by July 31, 2018, and instead joined during the Open Enrollment Period that ended December 7, 2020. Her Medicare drug coverage started January 1, 2021.

    Since Mrs. Martinez was without creditable prescription drug coverage from August 2018–December 2020, her penalty in 2022 is 29% (1% for each of the 29 months) of $33.37 (the national base beneficiary premium for 2022) or $9.68 each month. Since the monthly penalty is always rounded to the nearest $0.10, she will pay $9.70 each month in addition to her plan’s monthly premium.

    Here's the math:.29 (29% penalty) × $33.37 (2022 base beneficiary premium) = $9.68$9.68 rounded to the nearest $0.10 = $9.70$9.70 = Mrs. Martinez's monthly late enrollment penalty for 2022

    How do I know if I owe a penalty?

    After you join a Medicare drug plan, the plan will tell you if you owe a penalty and what your premium will be. In general, you'll have to pay this penalty for as long as you have a Medicare drug plan.

    What if I don't agree with the late enrollment penalty?

    You may be able to ask for a "reconsideration." Your drug plan will send information about how to request a reconsideration.

    Complete the form, and return it to the address or fax number listed on the form. You must do this within 60 days from the date on the letter telling you that you owe a late enrollment penalty. Also send any proof that supports your case, like a copy of your notice of creditable prescription drug coverage from an employer or union plan.

    Do I have to pay the penalty even if I don't agree with it?

    By law, the late enrollment penalty is part of the premium, so you must pay the penalty with the premium. You must also pay the penalty even if you've asked for a reconsideration. Medicare drug plans can disenroll members who don't pay their premiums, including the late enrollment penalty portion of the premium.

    How soon will I get a reconsideration decision?

    In general, Medicare’s contractor makes reconsideration decisions within 90 days. The contractor will try to make a decision as quickly as possible. However, you may request an extension. Or, for good cause, Medicare’s contractor may take an additional 14 days to resolve your case.

    What happens if Medicare's contractor decides the penalty is wrong?

    If Medicare’s contractor decides that all or part of your late enrollment penalty is wrong, the Medicare contractor will send you and your drug plan a letter explaining its decision. Your Medicare drug plan will remove or reduce your late enrollment penalty. The plan will send you a letter that shows the correct premium amount and explains whether you'll get a refund.

    What happens if Medicare's contractor decides the penalty is correct?

    If Medicare’s contractor decides that your late enrollment penalty is correct, the Medicare contractor will send you a letter explaining the decision, and you must pay the penalty.

    Source : www.medicare.gov

    AHIP 2018 Module 3

    Start studying AHIP 2018 Module 3 - Part D and Other Coverage. Learn vocabulary, terms, and more with flashcards, games, and other study tools.

    AHIP 2018 Module 3 - Part D and Other Coverage

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    Mrs. 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 prescription drug plan?

    Choose one answer.

    a. Costs under the VA are significantly higher than those under a Medicare Part D plan.

    b. The VA will not offer drug coverage to Mrs. Fiore once she qualifies for the Medicare Part D program.

    c. 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.

    d. The VA does not offer creditable coverage and Mrs. Fiore may incur a Part D premium penalty if she enrolls in a Medicare prescription drug plan at some point after her initial eligibility date.

    Click card to see definition 👆

    c. 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.

    Click again to see term 👆

    Mr. 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 prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him?

    Choose one answer.

    a. 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 penalty.

    b. He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium penalty. To reduce his expenses, he should look for a plan with a zero premium.

    c. As long as he has any sort of employer coverage, regardless of the level of coverage, he will incur no penalty if he does not enroll in a Part D plan when first eligible.

    d. He should drop the employer coverage and enroll in a Medicare prescription drug plan. Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan.

    Click card to see definition 👆

    a. 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 penalty.

    Click again to see term 👆

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    Terms in this set (5)

    Mrs. 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 prescription drug plan?

    Choose one answer.

    a. Costs under the VA are significantly higher than those under a Medicare Part D plan.

    b. The VA will not offer drug coverage to Mrs. Fiore once she qualifies for the Medicare Part D program.

    c. 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.

    d. The VA does not offer creditable coverage and Mrs. Fiore may incur a Part D premium penalty if she enrolls in a Medicare prescription drug plan at some point after her initial eligibility date.

    c. 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.

    Mr. 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 prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him?

    Choose one answer.

    a. 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 penalty.

    b. He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium penalty. To reduce his expenses, he should look for a plan with a zero premium.

    c. As long as he has any sort of employer coverage, regardless of the level of coverage, he will incur no penalty if he does not enroll in a Part D plan when first eligible.

    d. He should drop the employer coverage and enroll in a Medicare prescription drug plan. Employer plans are almost always more costly for beneficiaries and most do not cover the same range of drugs available from a Medicare prescription drug plan.

    a. 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 penalty.

    Source : quizlet.com

    Test 3 Flashcards

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    Test 3

    25cards Desireé S. Pharmacy Pharmacy

    Mr Carini has heard that PDP's are only offered through private companies under a program known as MA, not by the government

    He can stay with original Medicare and also enroll in Medicare pDP through a private company that has contracted with the government to provide only such drug coverage to Medicare eligibles

    Mrs. Mulcahy is concerned that she may not qualify for enrollments in a PDP because she is not enrolled in Medicare part B

    Everyone who is entitled to part a or in rolled in part B is eligible for a PDP. As long as they're entitled to part A, they do not need to enroll under part B before enrolling in a PDP

    Mrs. Lopez has enrolled in a MA-cost plan. She recently lost credible coverage previously available through her husband's employer. She's interested in a PDP.

    If part D benefit is offered through her plans she may choose to enroll in that plan or a standalone PDP

    All plans must cover at least the standard part D coverage or it's equivalent. What costs would a beneficiary incur for prescription drugs in 2018 and under standard coverage?

    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 gap, and co-pays or coinsurance after the coverage gap.

    Mrs. Andrews is preparing a budget for next year because she takes quite a few prescription drugs. She wants to be sure she has enough money set-aside for those months. She got help calculating her expenses from her pharmacist, but thinks the calculations are incorrect because her out-of-pocket expense would be lower than last year

    It would not be unusual for her cost to be last because each year until 2020 the share of drug costs in coverage gap decrease

    Mr. Jacob understands that there is a standard Medicare part D prescription drug benefit, but when he looks at information on various plans he sees a wide range of deductibles, premiums, and Cost sharing . Explain.

    Medicare part D drug plans may have different benefits fractures, but on average, they must all be at least as good as the standard model established by the government

    Miss Edwards is in rolled in a Medicare advantage plan that includes a PDP. She's traveling and wishes to fill her two prescriptions, how do you advise her?

    She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost

    What types of tools can Medicare part D prescription drug plans use that affect the way their enrollees Can access medication

    Part D plans do not have to cover all medications. As a result, their formularies, or list of all the coverage, will Gary from Planned to Planned. In addition, they can use cost containment techniques such as tiered copayments and prior authorization

    Mrs. Allen has a rare condition for which two different brand-name drugs are the only available treatment. She is concerned that since no generic prescription drug is available and these drugs are very expensive she will not be able to find Medicare part D prescription drug plan that covers either one of them.

    Medicare prescription drug plans are required to cover drugs in each therapeutic category. She should be able to enroll and he Medicare prescription drug plan that covers the medications she needs

    Under what conditions can Medicare prescription drug plan reduce its coverage for a given drug midway through the year

    When a new generic drug for the same condition becomes available or when the FDA or manufacture withdraws the drug from the market, a brand-name drug can be replaced.

    Mrs. Roswell is a new Medicare recipient and is interested in selecting part D prescription drug plan. She takes a number of medications and is concerned that she’s not been able to identify the plan that covers all of her medications. She does not want to make an abrupt change to new drugs that would be covered and asked what she should do.

    Every part D plan is required to cover a 30 day supply of existing locations sometime during a 90 day transition period

    Mr Zachow Has a condition for which three drugs are available. He has tried to, but had an allergic reaction to them. Only the third drug works for him and it is not on his part D formulary.

    He has a right to request a formulary exception to obtain coverage for this drug. He or his position could’ve changed the standardized request from the Planned website fill it out and submit it to the carrier

    Mr. and Mrs.Vaughn both take a specialized multivitamin prescription each day. Mr. von also takes a prescription for hair growth. They are anxious to have their Medicare drug plan cover these drugs

    Medicare prescription drug plans are not permitted to cover the prescription medications Vons are interested in under part D coverage, however, Planned may cover them as supplemental benefits

    Mr. Katz reached the part D coverage gap in August last year. His prescriptions have not changed, he is keeping the same plan and benefits, Katherine, and coverage as last year. He asked what to expect for this year regarding his out-of-pocket expenses

    Because he reach the coverage gap last year, he will probably reach it again this year close to the same time

    Mr. Schapiro gets by on a very low income. He has heard there may be extra help paying for prescription drugs he wants to know whether or not he will qualify

    Source : www.chegg.com

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