Medicare Part D Flashcards

Questions and Answers

What are the basic characteristics of Medicare Part D?

Medicare Part D helps cover the cost of prescription drugs, is run by Medicare-approved insurance companies, may help lower prescription drug costs, and may protect against higher costs in the future.

Patients must receive a _____ day notice for a formulary change.

What are associated costs with Medicare Part D?

Associated costs are premiums, deductibles, copayments, and co-insurance.

What is the coverage gap?

The coverage gap is the period of time a patient must pay 100% of all medication costs. Signup and view all the answers

How can patients get relief from the coverage gap?

Patients can pay higher premiums for plans with 'gap relief'; some plans offer fixed copays year-round; or patients may financially qualify for 'Medicare Extra Help.' Signup and view all the answers

What effect does closing the coverage gap have on the cost of medications?

The ACA included a ten-year plan to close the coverage gap by 2020. Drug manufacturers must cover 50% of brand medication costs. Patients will pay 25% of drug costs until the annual out-of-pocket limit is reached. Signup and view all the answers

What are the benefits of Medicare Extra Help?

Medicare Extra Help helps pay drug plan costs, eliminates the coverage gap, eliminates late enrollment penalties with a transition to/from the program, and allows patients to switch plans outside of an enrollment period. Signup and view all the answers

What is the Medicare Part D late enrollment penalty?

The late enrollment penalty is a financial penalty if an individual fails to sign up for a creditable prescription drug plan. Signup and view all the answers

How is a late enrollment penalty paid?

A late enrollment penalty amount is added to the patient's Medicare Part D premium. Signup and view all the answers

What are the different ways patients can enroll in Medicare Part D?

Patients can enroll in Medicare Part D by enrolling online at medicare.gov, completing a paper enrollment form, enrolling online on the health plan's website, calling the health plan directly, or calling Medicare at 1-800-Medicare. Signup and view all the answers

What information will a patient need initially before enrolling in a Medicare Part D plan?

Patients will need their Medicare number and the date their Part A or Part B coverage started. Signup and view all the answers

Can a pharmacist choose a drug plan for a patient?

False Signup and view all the answers

Can a marketplace healthcare plan be sold to a Medicare member?

False Signup and view all the answers

What medicare benefits were expanded under the Affordable Care Act?

Under the Affordable Care Act, Medicare must offer free preventive benefits, cancer screenings, and an annual wellness visit along with discounts on brand name medications once the donut hole hits. Signup and view all the answers

What is the goal of a quality-based healthcare model?

The goal of a quality-based healthcare model is to reward quality healthcare plans and help inform patient enrollment decisions. Signup and view all the answers

What are the four domains of Medicare Part D quality and care?

Drug plan customer service, member complaints and changes in the drug plan's performance, member experience with the drug plan, and drug pricing and patient safety are the four domains of Medicare Part D quality and care. Signup and view all the answers

What are the primary medication use quality measures?

Adherence to Diabetes Medications, Adherence to Hypertension Medications (RAS antagonists), and Adherence to Cholesterol Medications (Statins) are the primary medication use quality measures. Signup and view all the answers

What medication use display measures will be new in 2020?

Medication use display measures that will be new in 2020 include antipsychotic use in persons with dementia, diabetes medication dosing, drug-to-drug interactions, and high-risk medications in elderly patients. Signup and view all the answers

Study Notes

Medicare Part D Overview

Medicare Part D covers prescription drug costs and is managed by Medicare-approved insurance companies.
Aims to lower prescription drug costs and offers protection against future price increases.

Formulary Changes

Patients must be notified 60 days before any changes to the formulary.

Associated Costs

Costs linked to Medicare Part D include premiums, deductibles, copayments, and coinsurance.

Coverage Gap

Also known as the "donut hole," it is the period when patients pay 100% of their medication costs after reaching a certain spending limit.

Relief from Coverage Gap

Higher premiums for plans with "gap relief," fixed copays, and eligibility for "Medicare Extra Help" assist patients during the coverage gap.

Closing the Coverage Gap

The Affordable Care Act (ACA) initiated a ten-year plan to close the coverage gap by 2020, requiring drug manufacturers to pay 50% of brand medication costs.

Medicare Extra Help Benefits

Medicare Extra Help covers drug plan costs, eliminates the coverage gap, waives late enrollment penalties, and allows off-cycle plan switching.

Late Enrollment Penalty

A financial penalty is incurred for not signing up for a creditable prescription drug plan on time.

Paying the Late Enrollment Penalty

The penalty amount is added to the patient's Medicare Part D premium.

Enrollment in Medicare Part D

Enrollment methods: online at medicare.gov, paper form submission, health plan website, phone calls to health plans or Medicare at 1-800-Medicare.

Required Information for Enrollment

Patients need their Medicare number and the start date of their Part A or Part B coverage.

Pharmacist Restrictions

Pharmacists are legally prohibited from choosing a drug plan for patients.

Affordable Care Act Changes

Expanded Medicare benefits to include free preventive services, cancer screenings, annual wellness visits, and discounts on brand-name medications.

Marketplace Health Plans and Medicare

Selling marketplace health plans to Medicare members is illegal.

Quality-Based Healthcare Model

Aims to reward high-quality healthcare plans and guide patient enrollment decisions.

Quality and Care Domains in Medicare Part D

Four main domains: drug plan customer service, member complaints and performance changes, member experience, and pricing/patient safety.

Primary Medication Use Quality Measures

Includes adherence metrics for diabetes, hypertension (RAS antagonists), and cholesterol (statins) medications.

New Medication Use Display Measures in 2020

New measures: antipsychotic use in dementia patients, diabetes medication dosing, drug interactions, and high-risk medications in the elderly.

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Description

Test your knowledge on Medicare Part D with these flashcards. Learn about the fundamental characteristics of the program, including coverage options and important patient notice requirements. This quiz will help reinforce your understanding of prescription drug coverage and its implications.