Case Study — Susie Que
Susie visits you in the SHINE office in November after receiving information about her current plan. She wants to know if her WellCare Extra plan is still a good option for her next year. How would you help her?
Currently enrolled in: Medex Bronze & Wellcare Extra
Income: $1275/month
DOB: 12/17/1941
Preferred Pharmacy: CVS
Medlist:
* Flovent 220 HFA 1/month
* Nexium 20mg/day
* Metoprolol tartrate 50mg 2/day
* Lisinopril 10mg/day
* Metformin 500mg 2/day
* Glipizide 10mg 1/day
* Coumadin (brand) 5mg/day
* Coumadin (brand) 1mg/day
· Screen for LIS: Income – Gross or Net? Assets?
· Plan Finder search
· Zip: 01701, ID: 8566235072, Password: 1/9/2015
· Without LIS - United American Essential
· With LIS – Wellcare Classic (not Extra – premium $26.70/mo)
· PA if Partial LIS
Case Study - Sam Curious
Sam and his daughter Samantha visit you at the SHINE office. Sam has just been approved for MassHealth under the PCA program and now needs to sign up for a Part D plan. Samantha is concerned about her father paying a high premium and a penalty. How would you help them?
Currently enrolled in: A & B only
Income: $1025/month
DOB: 3/1/1935
Preferred Pharmacy: Rite Aid
Medlist:
* Aricept (generic) 10mg/day
* Namenda 10mg 2/day
* Lorazepam 1mg 2/day
· Plan Finder search
· Zip Code: 01701, ID: 9016458240, Password: 1/9/2015
· Enter as Full LIS to get correct prices ($2.65/$6.60)
· Humana Preferred - $131 at Rite Aid and $127 at CVS
· Aetna - $9,263 (Rite Aid is out of network)
· All plans PA for Namenda XR
· Can take new generic for Namenda? (ask doctor)
Case Study - John Doe
John Doe visits you at the SHINE Office. He has just turned 65. He has already visited the local Social Security Office and has signed up for both Medicare Part A and Part B. He spoke with his doctor and found out that his doctor accepts both Blue Cross and Blue Shield plans. He has called Blue Cross and found out they have several different plans to choose from. He wants your help in finding out if BCBS HMO covers his medications better than Medex Bronze with Blue Medicare Rx Value Plus. How would you help him?
Currently enrolled in: A & B only
Income: $1790/month
DOB: 3/1/1949
Preferred Pharmacy: Wal-Mart
Medlist:
* Plavix 75mg
* Lipitor 20mg
* Metoprolol tartrate 25mg 2/day
* Prilosec (generic) 20mg/day
· Plan Finder search
· Zip Code: 01701, ID: 4091612864, Password: 1/9/2015
· With brand names: Best option – Bronze and United American Enhanced (high premium $71.30) covers brand names ($2845)
Blue Value Plus: 2 brand names not on formulary ($6000)
BCBS HMO: 2 brand names not on formulary ($6000)
· With generics (big savings, so ask doctor): Best option – Bronze and United American Essential (can consider BCBS HMO)
United American Essential at CVS is $293, at Wal-mart is $447 (clopidogrel, generic for Plavix, is Tier 2)
Blue Value Plus: at CVS is $1051, at Wal-mart is $1274 (clopidogrel is Tier 3)
BCBS HMO: is $560 (clopidogrel is Tier 2)
· PA application
Internet Training-2015