Time period when a beneficiary can change their Part D coverage.
What is the Annual Election Period (Open Enrollment)?
100
Drug coverage a person has through another source that is as good or better than Medicare.
What is creditable coverage?
100
The program for low income beneficiaries that assists with drug costs (premiums and copays).
What is Extra Help (or LIS)?
100
Name(s) for the period of coverage when total drug costs for the year have reached $3700 and the beneficiary must pay significantly higher costs for medications.
What is the donut hole or coverage gap?
100
The time period that Medi Medi, MSP, and/or LIS beneficiaries can change their drug plan (or Medicare Advantage) enrollment.
What is anytime, all year, continuous open enrollment, etc. ?
200
To be eligible for Medicare Part D, a beneficiary must have this other part of Medicare.
What is Part A or Part B?
200
The entity to which the beneficiary pays the Part D penalty.
What is their Part D Plan (or MA-PD Plan)?
200
Three (or more!) counselor resources HICAP Counselors can use to help clients reduce drug costs.
What are E-H1 Low Income Program Comparison Chart, D-H2 Rx Resource Guide, LIS Application, Plan Finder at medicare.gov ?
200
The best tool for a beneficiary to enroll in a plan with the lowest total costs for drug plan premiums and copays over the course of the year *and* the minimum frequency at which they should do this.
What is plan finder at Medicare.gov and once a year during open enrollment?
200
The 6 drug plans that may be automatically assigned to Medi Medi beneficiaries that will have $0 monthly premium.
Bonus question - are there other plans beyond these 6 that could have $0 monthly premium?
What are "Benchmark" plans?
300
During the Medicare Advantage dis-enrollment period from January 1 to February 14, a beneficiary can do this regarding their drug coverage.
What is pick a Part D plan?
300
Notice provided to beneficiaries with other drug coverage (i.e. employer or retiree coverage) tells them if their coverage is this.
What is Creditable?
300
The term for when a client's prescribing physician helps the client get a particular medication covered by the drug plan (or Medicare Advantage plan) when it was not already on the plan's formulary.
What is Formulary Exception Request?
300
The list of all medications covered by a plan and what "tier" each medication is in.
What is formulary?
300
The names of the low income programs that include automatic eligibility into LIS (Extra Help).
What are SSI, Medi-Cal (including Working Disabled Program), MSPs ?
400
Three (or more!) examples of coverage that is "creditable" for Part D.
What are VA, Tri-Care for Life, EGHP (large employer), retiree coverage
400
Amount of time a beneficiary has to enroll in a Part D plan without penalty after losing creditable coverage.
What is 63 days after loss of coverage?
400
The term for when a client's prescribing physician helps get a particular medication covered by the drug plan (or Medicare Advantage plan) at a lower "tier" than the tier in which the drug was originally categorized.
What is Tiering Exception Request?
400
Name(s) for the period of coverage when total TrOOP reaches $4950 and the beneficiary's will now pay a maximum of 5% of the cost of each medication.
What is Catastrophic Coverage?
400
Medi Medi beneficiaries should never pay more than this amount for brand name drugs. If they are paying more it is likely the drug is not on the formulary.
What is $8.25?
500
The 12 month initial period during which a beneficiary may drop their Medicare Advantage plan and have guaranteed issue for Medigap and a special enrollment period for a Part D plan.
What is "trial right"?
500
The formula for calculation of the Part D Penalty.
What is 1% of the national base beneficiary premium times the number of uncovered months (.01 x $35.63 x months).
500
Programs, sometimes offered by drug manufacturers, that help patients pay for drug costs (often when they are in the donut hole).
What are Patient Assistance Programs?
500
What TrOOP stands for. HICAP Counselors can help clients calculate this if clients are concerned there has been an error.
What is True Out of Pocket Costs?
500
While most beneficiaries making over $1508 a month (single) or $2030 a month (couple) do not qualify for Extra Help, some disabled beneficiaries could make more than that and still qualify automatically for Extra Help because they qualify for this program.