Question: Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP?

Answer: She would be disenrolled automatically from her MAPD Plan.

Question: What is Medicare Part D?

Answer: A voluntary program, offered by private insurance companies that are contracted with the federal government, that provides prescription drug coverage for an additional monthly plan premium

Question: Which of the following statements is true about eligibility requirements for stand-alone Medicare Prescription Drug Plans?

Answer: A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B

Question: Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare-eligible consumer get Part D prescription drug coverage?

Answer: They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP).

Question: In what order do the four prescription drug coverage stages occur?

Answer: Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage

Question: Which of these statements is true about the drug utilization management (UM) rules?

Answer: Prior authorization, quantity limit, and step therapy are some examples of UM rules.

Question: A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for ______________.

Answer: 63 or more continuous days

Question: Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs?

Answer: Through subsidies such as lower or no monthly plan premiums and lower or no copayments

Question: Formulary is defined as:

Answer: A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists.

Question: When is a Medicare Supplement Insurance consumer subject to underwriting and screened for eligibility?

Answer: When the consumer is not in their Medicare Supplement Open Enrollment or does not meet Guaranteed Issue criteria.