Ms. gibson recently lost her employer group health and drug coverage and now she wants to enroll in a ppo that does not include drug coverage. what should you tell her about obtaining drug coverage?

High school
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ms. gibson recently lost her employer group health and drug coverage and now she wants to enroll in a ppo that does not include drug coverage. what should you tell her about obtaining drug coverage?

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Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage?

Answer:

When Ms. Gibson loses her employer group health and drug coverage and wants to enroll in a PPO (Preferred Provider Organization) that does not include drug coverage, the following steps and information are essential to help her secure drug coverage elsewhere:

  1. Medicare Part D:

    • Overview:
      Ms. Gibson should be informed about Medicare Part D, which is a standalone prescription drug plan (PDP) that can be added to Original Medicare or a PPO without drug coverage.

    • Eligibility and Enrollment Periods:
      Since Ms. Gibson recently lost her employer coverage, she may qualify for a Special Enrollment Period (SEP) to enroll in a Medicare Part D plan. This SEP typically lasts for two months after the loss of her previous coverage.

    • Choosing a Plan:
      Encourage Ms. Gibson to compare different Medicare Part D plans available in her area. She should consider factors like premium costs, formulary (list of covered drugs), the plan’s network of pharmacies, and out-of-pocket costs.

  2. Medicare Advantage (MA) Plans with Drug Coverage:

    • Alternative Option:
      If Ms. Gibson prefers an integrated plan that includes both health and drug coverage, she might consider enrolling in a Medicare Advantage plan that includes prescription drug coverage (MA-PD).

    • Comparing Plans:
      These plans are also required to cover all services included in Original Medicare and often offer additional benefits. Ms. Gibson should compare the options to find a plan that suits her health and budgetary needs.

  3. State Pharmaceutical Assistance Programs (SPAPs):

    • State-Specific Assistance:
      Some states offer pharmaceutical assistance programs to help residents with the cost of prescription drugs. Ms. Gibson can check if her state offers such a program and whether she qualifies for assistance.

  4. Extra Help Program:

    • Low-Income Subsidy:
      If Ms. Gibson has limited income and resources, she may qualify for the Extra Help program (also known as the Low-Income Subsidy). This program can significantly lower her prescription drug costs under Medicare Part D.

  5. COBRA Continuation Coverage:

    • Temporary Option:
      If eligible, Ms. Gibson may consider electing COBRA continuation coverage from her previous employer. This coverage can temporarily continue her previous employer-sponsored health and drug benefits, typically up to 18 months.

    • Cost Consideration:
      While it can be more expensive since she might be required to pay the full premium plus an administrative fee, this option could provide her additional time to explore other drug coverage options.

Final Answer:
Ms. Gibson should consider obtaining drug coverage through standalone Medicare Part D plans during her Special Enrollment Period. Alternatively, she could look into Medicare Advantage plans with integrated drug coverage, state pharmaceutical assistance programs, the Extra Help program, or temporary COBRA continuation coverage. It’s important for her to compare available plans to find the one that best meets her healthcare and budgetary needs.