Case Study Will E

Case Study - Will E. Nffly

Will calls you for help with getting coverage in a Medicare Advantage plan. He explains that he has Medicare A, B & D and was on the CommonHealth program due to a disability. He received a letter from MassHealth saying he is no longer eligible for CommonHealth as he is over income. He just turned 65, and his gross monthly income is $1,448. Will wants to join a Tufts MA plan. When he called Tufts, he was told he could not join until the annual open enrollment. A case worker at his therapy clinic told him to call SHINE.

How would you help him?

Case Study — Penny Less

Penny Less calls you on August 20th from the home of her mother-in-law (MIL). An insurance broker had just left after meeting with them to tell her MIL about AARP. She still has some questions and remembered a SHINE counselor was helpful with her friend when she was retiring. Her MIL is on BCBS Medex Gold. The broker told her she could switch to an AARP Supplement One plan and save a great deal of money. He told them that because her Gold is creditable coverage, she could drop it and join a Part D plan. She thought this sounded too good to be true and wanted a second opinion.

How would you help her?

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Case Study — Bob Kat

Bob calls you on June 8th to get information about Medicare. He tells you he will be 66 on October 16th and eligible to retire with Social Security. He doesn’t know much about Medicare and isn’t sure what he needs to do to enroll. He tells you he has some health problems and thinks he would like to retire from his job but isn’t sure if that’s a good idea. He has excellent health insurance now with his employer and wonders whether he would be able to have coverage as good under Medicare. He is also concerned about the costs he will incur under Medicare. He’s heard that the Medicare drug program is expensive and doesn’t provide much coverage especially for expensive medications like those he currently takes.

1. What questions would you ask?

1. What information would you review with him?

1. What materials would you send/give to him?

1. Would you refer him to any other agency? If so, which one(s)?

1. What phone calls, if any, would you make on his behalf?

1. What follow-up, if any, is required in this case?

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Case Study — Sal Manella

Sal meets with you on February 2nd. He tells you he has been on a Tufts plan with prescription coverage for the last couple of years. He changed to Tufts 2 years ago when his doctor changed to that plan. However, his doctor just informed him that he will no longer take Tufts after March 31 and, in fact, will take no other Medicare Advantage plans. Sal tells you he has great confidence in his doctor as he is convinced that the doctor’s diagnostic skills saved his life in the past. He wants to know what coverage will allow him to stay with his doctor.

How would you help him?

Case Study — Ben There

Ben meets with you on June 1 for help with his prescription costs. He is 72, single, and on Medicare A & B only. He has no other insurance and never joined a Part D plan. His monthly income is $4,600. He is not a veteran. He saw a doctor recently after many years because he was having dizzy spells. Following a series of tests the doctor gave him prescriptions for several brand medications inc1uding one to treat anemia, which will run hundreds of dollars per month.

Ben wants to know what Medicare drug plan he can join to help with this cost.

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Case Study — Carrie Kature

Carrie calls for assistance with her father’s health care and prescription costs. He has Medex Bronze and the VA Health Plan for his meds. However, the VA doesn’t cover one of his drugs. His income is just under $1100/month. She doesn’t know the exact dollar amount of his assets but doesn’t think he has more than $5,000-6,000.

How would you help her?

Case Study — Sal E. Vate

Sal meets with you to see if he is eligible for help from MassHealth. He tells you his gross monthly income is $860, but that $104.90 is taken out for Part B. He lives with his girlfriend in the home she owns. He is 73 and has Medicare A & B only. He never signed up for Part D. His doctor gave him a prescription for Advair, but he can’t afford it. You ask for some additional information and learn that he is a veteran as he served in the National Guard in his 20’s. He tells you he has $1,000 in the bank and a life insurance policy with a face value of $1400.

How would you help him?

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Case Study — Doug Out

Doug meets with you on June 1st. He is 69 years old, single and lives in his own home. He is retired and has Medicare A & B only. He is not a vet. Until recently, he was very healthy and saw no reason to purchase additional insurance or join a Medicare drug plan. He is now being treated for a health condition which requires that he take what has turned out to be a couple of very expensive medications.

He inquired with his doctor’s office to see what Medicare plans they accept. He was told that they accept Tufts Medicare Preferred HMO and Blue Cross Medex. After calling Tufts and Blue Cross, he understands that Tufts would be cheaper. He is thinking that the Tufts Medicare Preferred Prime Rx Plus plan would make the most sense as it provides additional prescription coverage.

He explains that his income is $31,000/year and he has assets which he uses to maintain his home. He would like to get coverage for his health care and prescriptions so he does not deplete his assets to cover these expenses.

He wants to check that the Tufts plan is probably the best that he can do.

How would you help him?

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Case Study — Bobbi Sox

Bobbi calls on September 15thfor assistance with her brother’s insurance. She explains that her brother, Red, has a disability and was covered under CommonHealth for several years. He turned 65 in May. He enrolled in Medicare Part A but did not pick up Part B because he was covered under CommonHealth. He just received a notice that he would no longer be covered under CommonHealth. His income is $1,300/month.

Bobbi called Medicare to enroll her brother and was told that he could not enroll until the general open enrollment in January. Bobbi heard about the Frail Elder program for her brother and wants to know if this will cover him without Part B.

What information would you give her?

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Review – 20161