Talking Points Title: 2024 Medicare Advantage – CMS Call Center Monitoring (prospect line)

EGWP responses are not included as CMS does not include them in accuracy because they vary by group.
Document last updated on: 02/07/2024.

# QUESTION ANSWER REFERENCE MATERIALS

C1 Can you answer Yes.
questions about Medicare
Part C?
Can you answer
questions about Fallon
Health benefits?
C2 My mother, who lives in Fallon Medicare Plus: All EOCs, Chapter 1, Section 4.1
<COUNTY> county, does Franklin, Hampden and Hampshire Counties premium
not get extra help and is Fallon Medicare Plus Green HMO $66
not on Medicaid. What is Fallon Medicare Plus Blue HMO $110
Barnstable, Berkshire, Bristol, Essex, Middlesex, Norfolk,
the monthly premium for Suffolk, Plymouth Counties
<PART C PLAN NAME>? Fallon Medicare Plus Green HMO $78
Fallon Medicare Plus Blue HMO $174
Worcester County
Fallon Medicare Plus Green HMO $99
Fallon Medicare Plus Blue HMO $207
Fallon Medicare Plus Central Blue HMO $123
Fallon Medicare Plus Central Green HMO $33
Statewide (except Duke and Nantucket Counties)
Fallon Medicare Plus Orange HMO $0
Fallon Medicare Plus Super Saver HMO $60
Fallon Medicare Plus Saver No Rx HMO $35

NaviCare:
$0
C3 Will joining <PART C Plan No All EOCs, Chapter 1, Section 4.1
Name> affect how much I
pay for my Part B
premium?
C4 If my mom goes to the Yes, if you are admitted to the hospital within 72 hours for the same All EOCs, Chapter 4, Section 2.1
emergency room, will the condition, you do not pay the emergency room copayment.
copayment be waived if
she is admitted to the
Note: The maximum emergency room cost-sharing if not admitted
hospital within a certain
within 72 hours is:
amount of time?
# QUESTION
C5 My Mother wants to enroll
in <PART C PLAN
NAME> and wants to
know if she would be
covered if she goes to an
out-of-network doctor.
C6 What is the star rating for
<PART C PLAN NAME>?
C7 Will I have to pay for
Medicare preventive
services like my diabetes
screening or my yearly
wellness visit?
C8 What is the maximum
amount I would pay for
chemotherapy?
ANSWER REFERENCE MATERIALS
Fallon Medicare Plus Blue HMO and Fallon Medicare Plus Central Blue
HMO: $120
All other Fallon Medicare Plus plans: $90
NaviCare: $0
No. Medicare Managed Care
Manual, Chapter 4, Section 110
All EOCs, Chapter 3, Section
1.2
Fallon Medicare Plus & NaviCare: Star Ratings Marketing Flyers
4 stars (out of 5 stars) *
*This Star Rating is for CY2024.
No 42 CFR 422.100(k) and 417.454
(d)
Medicare Managed Care
Manual, Chapter 4
All EOCs, Chapter 4, Section
2.1
All EOCs, Chapter 4, Section
Plan Amount 2.1
Fallon Medicare Plus Blue HMO and 10% of the cost
Fallon Medicare Plus Central Blue
HMO
Fallon Medicare Plus Orange HMO 20% of the cost
Fallon Medicare Plus Green HMO and 20% of the cost
Fallon Medicare Plus Central Green
HMO
Fallon Medicare Plus Super Saver 20% of the cost
HMO
Fallon Medicare Plus Saver No Rx 20% of the cost
HMO
NaviCare $0
# QUESTION
C9 What is the maximum
amount I would pay for
dialysis?
C10 How many days does
your plan cover for care at
a Skilled Nursing Facility?
C11 Do I have to pay for a <flu
shot or COVID-19
vaccinations>?
C12 Can my mom use her
Medigap to pay for
Medicare Advantage
plan's out-of-pocket costs,
like copays?
-or-
Can my mom use her
actual Medicare to pay for
her Medicare Advantage
deductible?
C13 Will you let me know if my
primary doctor leaves the
plan?
C14 For <PART C PLAN
ANSWER REFERENCE MATERIALS
Outpatient dialysis treatments (including dialysis treatments when All EOCs, Chapter 4, Section
temporarily out of the service area) are covered at the following 2.1
amounts:
Fallon Medicare Plus: Member pays 20% of the cost
NaviCare: Member pays $0
Fallon Medicare Plus: 100 days each benefit period. Medicare Managed Care Manual,
Chapter 4, Section 10.2
NaviCare: All EOCs, Chapter 4, Section 2.1
The coverage includes the Medicare-covered 100 days each benefit
period as well as additional day coverage under the MassHealth
(Medicaid) benefit as medically necessary.
No Source: Medicare & You 2024,
page 37
All EOCs, Chapter 4, Section 2.1
No Source: Medicare & You 2024,
page 78.
Yes 42 CFR 422.111(e)
Medicare Managed Care Manual,
Chapter 4, Section 110.1.2.3
All EOCs, Chapter 3, Section 2.3
No All EOCs, Chapter 4, Section 2.1
# QUESTION ANSWER REFERENCE MATERIALS
NAME> will my mom
need to get a referral for
outpatient lab
tests/outpatient blood
services (including
outpatient blood
transfusion)?
C15 What is the in-network Fallon Medicare Plus Blue HMO and Fallon Medicare Plus Central All EOCs, Chapter 4, Section 1.2
maximum out-of-pocket Blue HMO:
cost for [Part C plan $3,400 for covered services.
name]?
Fallon Medicare Plus Green HMO and Fallon Medicare Plus Central
Green HMO:
$5,200 for covered services.

Fallon Medicare Plus Orange HMO:

$7,550 for covered services.

Fallon Medicare Plus Super Saver HMO:

$7,550 for covered services.

Fallon Medicare Plus Saver No Rx HMO:

$6,700 for covered services.
# QUESTION
C16 What is the most my mom
would pay for an
emergency ambulance
ride?
ANSWER
Plan
Fallon Medicare Plus Blue HMO and
Fallon Medicare Plus Central Blue
HMO
Fallon Medicare Plus Orange HMO
Fallon Medicare Plus Green HMO
and Fallon Medicare Plus Central
Green HMO
Fallon Medicare Plus Super Saver
HMO
Fallon Medicare Plus Saver No Rx
HMO
NaviCare
REFERENCE MATERIALS
All EOCs, Chapter 4, Section 2.1
amount
$125 with a $500 annual
maximum out-of-pocket limit
$295
$225 with a $900 annual
maximum out-of-pocket limit
$125
$250
$0

C17 Are routine eye exams Yes All EOCs, Chapter 4, Section 2.1
covered in <PART C
PLAN NAME>?
-or-
Does <PART C PLAN
NAME> include a regular
vision test?
C18 My mother wants to live at All Fallon Medicare Plus plans: All EOCs, Chapter 4, Sections
home, even though she’s No 2.1 and 3.1
not well. Are cooking and
cleaning services covered
under your home health NaviCare:
coverage? Yes. Homemaker and personal care homemaker services may be
authorized by the Primary Care Team. This may include meal
preparation, laundry, light housekeeping/cleaning, grocery shopping
and medication pick up.

C19 I live in <COUNTY Fallon Medicare Plus plans and NaviCare: All EOCs, Chapter 1, Section
NAME> COUNTY. Can I Barnstable, Berkshire, Bristol, Essex, Franklin, Hampden, Hampshire, 2.2
# QUESTION ANSWER REFERENCE MATERIALS
enroll in your plan? Middlesex, Norfolk, Plymouth, Suffolk, and Worcester counties:
Yes

Dukes and Nantucket counties:

No
C20 Would my mom be able to Yes 42 CFR 422.2263
get a member handbook,
provider directory, or
summary of benefits in
alternate formats such as
large print, braille, or
audio tape?
C21 Is a referral required to In most cases, yes. It is very important to get a referral (approval in All EOCs, Chapter 3, Sections
see a specialist? advance) from your PCP before you see a plan specialist or certain 2.2 and 2.3
other providers (there are a few exceptions, including routine women’s
health care, certain shots or vaccinations, and emergency services). If
you don’t have a referral from your PCP (approval in advance)
before you get services from a specialist, you may have to pay for
these services yourself.
C22 My mom wants to get a No. Medicare Part B does not cover preventive tetanus shots. Should a MLN Matters Number: SE0678:
preventive tetanus shot. beneficiary need a tetanus vaccination related to an accidental Payment for Part D Vaccines
She has not been injured. puncture wound, it would be covered under Medicare Part B. under the Medicare Drug Benefit
Is a preventive tetanus (Part D)
shot covered by Part B?
C23 Would a copy of a Yes June 27, 2007 HPMS Memo
Medicaid card that “Part D Guidance – Low-Income
includes my mom’s name Subsidy (LIS) Status
and eligibility date be Corrections Based on Best
acceptable evidence for Available Evidence”
low income subsidy?
C24 Is the Shingles Fallon Medicare Plus Saver No Rx HMO: No CMS approved 2024 formulary
(Shingrix/Zoster) vaccine
Medicare & You 2024, page 50
covered under <MA-
Note: Plans with Part D coverage do cover the Shingles vaccine. See
ONLY PLAN NAME>?
below under Part D ‘D3’ for response to all other plans.
C25 Are hearing aids covered Yes. All EOCs, Chapter 4, Section
under <PART C PLAN
# QUESTION ANSWER REFERENCE MATERIALS
NAME>? 2.1

C26 My <mom> is a smoker Yes. All EOCs, Chapter 4, Section

and is trying to quit. Do 2.1
you provide counselors
for smoking?
C27 If my mom is enrolled in Yes. FMP Part D plans: EOC,
your plan can she change Chapter 10, Section 2.2
back to Original Medicare The Medicare Advantage open enrollment period (OEP) takes place
during open enrollment? from January 1st through March 31st annually. The OEP allows
individuals enrolled in an MA plan, including newly MA-eligible FMP Saver No Rx HMO: EOC,
individuals, to make a one-time election to go to another MA plan or Chapter 8, Section 2.2
Original Medicare. Individuals using the OEP to make a change may
make a coordinating change to add or drop Part D coverage.
NaviCare: EOC, Chapter 9,
Section 2.3

C28 Does “prior authorization” For certain items or services, you or your provider need to get approval All EOCs, Chapter 3, Section
mean that my mother from the plan before we will agree to cover the item or service for you. 2.3
must first obtain This is called prior authorization.
authorization from the
plan before the plan will
pay for a service?
C29 Can I find the Annual Yes. Fallon Medicare Plus:
Notice of Changes http://www.fchp.org/en/find-
(ANOC) for <PART C insurance/medicare/documents-
PLAN NAME> online? forms.aspx

NaviCare:
http://fchp.org/en/find-
insurance/navicare/information-
and-forms.aspx

C30 Does this plan cover the Yes. Source: Medicare & You 2024,
flu vaccine? page 41
# QUESTION ANSWER REFERENCE MATERIALS

All EOCs, Chapter 4, Section

2.1

C31 If my <mother’s> primary Yes. When you become a member of our plan, you must choose a plan All EOCs, Chapter 3, Section
care provider (PCP) does provider to be your PCP. 2.1
not accept the plan, does
my <mother> need to find
a different PCP?
C32 Do you have a list of Yes. Fallon Medicare Plus:
doctors on your website? fallonhealth.org/findphysician

NaviCare:
fallonhealth.org/findphysician

C3 Is the plan’s privacy Yes. Fallon Medicare Plus:

3 policy available on your https://www.fchp.org/find-
website? insurance/medicare/documents-
forms.aspx

NaviCare:
https://www.fchp.org/en/find-
insurance/navicare/information-
and-forms.aspx

C34 On <INSERT PLAN No. Medicare Managed Care

NAME>, If my mother Manual, Chapter 4, Section 110
sees a doctor that is out All EOCs, Chapter 3, Section
of network, will the 1.2
insurance cover her
outpatient cost?”

C35 If my <mother> enrolls Yes. [Representative will inform the caller that the Appointment of Fallon Medicare Plus:
in your plan, do you Representative form is available on our website and may also be https://fallonhealth.org/en/find-
have a form she can fill mailed or e-mailed to the caller upon request.] insurance/medicare/documents-
out to make me her forms
# QUESTION ANSWER REFERENCE MATERIALS
representative?
NaviCare:
https://fallonhealth.org/en/find-
insurance/navicare/information-
and-forms

Part D
D1 Can you answer Yes
questions about Medicare
Part D?
D2 Does <PART D PLAN [Representative will provide answer <Yes> or <No> based upon the CMS approved 2024 formulary
NAME> cover <DRUG current year CMS approved plan formulary.]
NAME>?
D3 Is the Shingles Yes CMS approved 2024 formulary
(Shingrix/Zoster) vaccine
Medicare & You 2024, page 50
covered under <PART D
PLAN NAME>?
Note: MA-only plans do not cover the Shingles vaccine. See above
under Part C ‘C24’ for response to MA-only plans.
D4 My mom wants to get a Yes Medicare Prescription Drug
preventive tetanus shot. Benefit Manual, Chapter 6,
She has not been injured. Appendix C, Attachment II,
Is a preventive tetanus Vaccines, Question 1
shot covered by Part D?
D5 What does “quantity limit” It is the limit on how much medication you can get at a time. Medicare & You 2024, page 86.
for a drug mean?
# QUESTION
D6 My mom thinks it is
cheaper to buy some of
her prescriptions at Target
and pay $4.00 for a
generic drug instead of
using her insurance. If she
enrolls in your plan, does
she have to show her plan
card and buy her drugs
through your plan or can
she continue to pay for
drugs on her own?
D7 If my mom joins your plan,
and one of her medications
is not covered by your
plan, can she at least get a
one-time, temporary
supply of her medicine
within the first 108 days of
her enrollment in the plan?
D8 Would a copy of a
Medicaid card that
includes my mom’s name
and eligibility date be
acceptable evidence for
low income subsidy?
D9 What is the annual drug
deductible for <Part D
Plan Name>? My mom
does not get Extra Help
and she is not on
Medicaid.
ANSWER
She can pay for her drugs on her own.
Yes. She may request a transition supply.
Yes
Plan
Fallon Medicare Plus Orange HMO
Fallon Medicare Plus Green HMO
Fallon Medicare Plus Central Green
HMO
Fallon Medicare Plus Blue HMO
Fallon Medicare Plus Central Blue
REFERENCE MATERIALS
Medicare Prescription Drug
Benefit Manual, Chapter 14,
§50.4.2, Beneficiary Cash
Purchases
Medicare Prescription Drug
Benefit Manual, Chapter 6,
§30.4.1, Transition
Requirements
June 27, 2007 HPMS Memo
“Part D Guidance – Low-Income
Subsidy (LIS) Status
Corrections Based on Best
Available Evidence”
amount FMP Part D plans: EOC,
$200 for Tiers 3-5 Chapter 6, Section 4
$175 for Tiers 3-5
$0
# QUESTION
D10 For <Part D Plan Name>
what is the maximum cost
share for a one-month
supply of a Tier 1
(preferred generic/generic)
drug at an in-network
pharmacy?
D11 My mom is moving, so
she will need to change
plans mid-year. Will her
new plan be made aware
of the payments that she
made for her drugs while
she was enrolled in her
old plan?
D12 My mother, who lives in
<County> COUNTY, does
not get extra help and she
is not on Medicaid. What
is the monthly premium
for <PART D PLAN
NAME>?
ANSWER REFERENCE MATERIALS
HMO
Fallon Medicare Plus Super Saver $545 for Tiers 1-5
HMO
NaviCare $0*
*Due to all members being full duals with LIS levels 1-3.
All Fallon Medicare Plus Part D plans: FMP Part D plans: EOC,
Retail copay: $0 Chapter 6, Section 5.2
NaviCare:
$0
Yes Medicare Prescription Drug
Benefit Manual, Chapter 14,
Section 50.8
Fallon Medicare Plus: All EOCs, Chapter 1, Section 4.1
Franklin, Hampden and Hampshire Counties premium
Fallon Medicare Plus Green HMO $66
Fallon Medicare Plus Blue HMO $110
Barnstable, Berkshire, Bristol, Essex, Middlesex, Norfolk,
Suffolk, Plymouth Counties
Fallon Medicare Plus Green HMO $78
Fallon Medicare Plus Blue HMO $174
Worcester County
Fallon Medicare Plus Green HMO $99
Fallon Medicare Plus Blue HMO $207
Fallon Medicare Plus Central Blue HMO $123
Fallon Medicare Plus Central Green HMO $33
Statewide (except Duke and Nantucket Counties)
Fallon Medicare Plus Orange HMO $0
Fallon Medicare Plus Super Saver HMO $60
Fallon Medicare Plus Saver No Rx HMO $35
NaviCare:
# QUESTION
D13 If a doctor prescribes a
brand name drug that is
covered by your plan,
how much of a discount
will there be while in the
coverage gap?
D14 How are RX copays
affected by the coverage
gap?
D15 Do my premium
payments count toward
the coverage gap?
D16 My mom is worried about
paying for her drugs if she
falls into the coverage
gap. Does this plan offer
any extra coverage during
the gap?
D17 My mom thinks that she
may qualify for your
Medication Therapy
Management program.
Can you tell me generally
how she qualifies?
ANSWER REFERENCE MATERIALS
$0
A 75% savings on the plan’s cost. FMP Part D plans: EOC,
Chapter 6, Sections 2.1 and 6.1
Fallon Medicare Plus: FMP Part D plans: EOC,
During the coverage gap, you pay 25% of the price for brand name Chapter 2, Section 7 and
drugs (plus a portion of the dispensing fee) and 25% of the price for Chapter 6, Sections 2.1 and 6
generic drugs.
You stay in this stage until your year-to-date “out-of-pocket costs”
NaviCare: EOC, Chapter 2,
(your payments) reach a total of $8,000. This amount and rules for
Section 7
counting costs toward this amount have been set by Medicare.
NaviCare:
You will pay $0 all year because of your MassHealth (Medicaid)
benefits under our plan.
No
Fallon Medicare Plus: FMP Part D plans: EOC,
No Chapter 6, Section 6
NaviCare: NaviCare: EOC, Chapter 2,
You will pay $0 all year because of your MassHealth (Medicaid) Section 7
benefits under our plan.
The Medication Therapy Management Program is offered to qualifying Medicare Prescription Drug
Medicare Advantage Prescription Drug plan members. Members who Benefit Manual, Chapter 7,
met certain criteria are automatically included in our Medication Section 30
Therapy Management program but may choose to opt-out at any time.
HPMS Memo 04/21/2023
Criteria: “Contract Year 2024 Medication
 Take eight or more medications per month; Therapy Management Program
 Are diagnosed with three of our qualifying disease states; and Information and Submission
Instructions”
 Have expected medication costs of $5,330 or more per year.
# QUESTION
D18 My <mother> heard that
the plan has a program
where she will be asked
to talk to a pharmacist
about her medications. If
she does not participate,
will she still be able to
enroll in the plan?
D19 If I am required to pay an
extra amount for
prescription drug
coverage because of my
income, can I just add it to
my plan’s monthly
premium payment?
D20 Who will tell me if I have
to pay Part D-IRMAA,
which is the Income-
Related Monthly
Adjustment Amount?
D21 My mom has been paying
an extra premium amount
for her prescription drug
coverage based on last
year’s income, but she
just retired and her
ANSWER REFERENCE MATERIALS
<<C.S.: The qualifying disease states are: Chronic obstructive
pulmonary disease (COPD), Diabetes, Depression, Dyslipidemia,
Hypertension, and Congestive Heart Failure (CHF)>>
Yes Medicare Prescription Drug
Benefit Manual, Chapter 7,
Section 30
Medicare & You 2024, page 88.
HPMS Memo 04/15/2022
“Contract Year 2023 Medication
Therapy Management Program
Information and Submission
Instructions”
No 42 CFR 423.293(d)
10/10/2010 HPMS memo titled,
“Part D-Income Related Monthly
Adjustment Amount—Frequently
Asked Questions & Answers”
and updated memos from
5/27/2011 and 7/29/2015
Social Security will send you a letter. 42 CFR 423.286(d)(4)
10/10/2010 HPMS memo titled,
“Part D-Income Related Monthly
Adjustment Amount—Frequently
Asked Questions & Answers”
and updated memos from
5/27/2011 and 7/29/2015
EOC, Chapter 1, Section 4.4
Medicare uses the modified adjusted gross income reported on your IRS https://www.medicare.gov/part-
tax return from 2 years ago (the most recent tax return information d/costs/premiums/drug-plan-
provided to Social Security by the IRS). If your modified adjusted gross premiums.html
income is above a certain amount, you may pay a Part D income-related
monthly adjustment amount (Part D-IRMAA). You'll pay the Part D-IRMAA
amount in addition to your monthly plan premium, and this extra amount is
# QUESTION
income has dropped. If
she enrolls in <plan
name>, can she get the
amount reduced?
D22 What does “prior
authorization” for a drug
mean?
-or-
Does “prior authorization”
mean that my mother
must first obtain
authorization from the
plan before the plan will
pay for a drug?
D23 Are there any retail
pharmacies where my
mother can save money?
OR
If my mom buys medicine
within network and she
wants to pay less, will you
be able to tell her what
pharmacy to go to?
D24 If <my mother> enrolls in
<plan name>, can <she>
add her Part D-IRMAA
premium amount to her
plan premium?
D25 Is the <plan name>
formulary listed online?
ANSWER REFERENCE MATERIALS
paid directly to Medicare, not to our plan. Medicare & You 2024, page 82.
If you have to pay an extra amount and you disagree (for example, you
EOC, Chapter 1, Section 4.4
have a life event that lowers your income), visit socialsecurity.gov or
call Social Security at 1-800-772-1213. TTY users should call
1-800-325-0778.
For certain drugs, you or your provider need to get approval in advance FMP Part D plans: EOC,
from the plan before we will agree to cover the drug for you. This is Chapter 5, Section 4.2
called prior authorization.
NaviCare: EOC, Chapter 5,
Section 4.2
Fallon Medicare Plus: FMP Part D plans: EOC,
The Pharmacy Directory will tell you which of pharmacies are in the Chapter 5, Section 2.2
network.
http://fallonhealth.org/
NaviCare: pharmacyfinder
Since members in NaviCare do not have any cost-sharing, she may go
to any of our network pharmacies and will not have to pay for her
medications.
No. The Part D-IRMAA amount is paid directly to Medicare, not to our https://www.medicare.gov/part-
plan. d/costs/premiums/drug-plan-
premiums.html
Medicare & You 2024, page 82.
EOC, Chapter 1, Section 4.4
Yes. Fallon Medicare Plus:
fallonhealth.org/medicare-
formulary
NaviCare:
www.fallonhealth.org/navicare-
# QUESTION ANSWER REFERENCE MATERIALS
formulary
D26 Does <PART D PLAN [Representative will provide answer <Yes> or <No> based upon the CMS approved 2024 formulary
NAME> require prior current year CMS approved plan formulary.]
authorization for <DRUG
NAME>?

D27 Are over-the-counter Fallon Medicare Plus Orange HMO:

drugs covered by <PART Yes. Each calendar year, plan members receive a Benefit Bank card
D PLAN NAME>? loaded with $275 in credits designated for purchase of covered OTC
products. These credits will expire at the end of the calendar year.

Fallon Medicare Plus Green HMO and Fallon Medicare Plus Central
Green HMO:
Yes. Each calendar year, plan members receive a Benefit Bank card
loaded with $255 in credits designated for purchase of covered OTC
products. These credits will expire at the end of the calendar year.

Fallon Medicare Plus Saver No Rx HMO

Yes. Each calendar year, plan members receive a Benefit Bank card
loaded with $125 in credits designated for purchase of covered OTC
products. These credits will expire at the end of the calendar year.

All other Fallon Medicare Plus plans:

No NaviCare:
EOC, Chapter 4, Section 2.1
NaviCare: Yes, under the MassHealth (Medicaid) benefit NaviCare OTC list available at:
covers certain over-the-counter drugs (drugs for which no prescription www.fallonhealth.org/navicare-
is required by federal or state law; sometimes referred to as non-legend formulary
drugs). These drugs are listed on the current MassHealth Over-the-
Counter (OTC) Drug List. MassHealth (Medicaid) and NaviCare require
a prescription for both covered prescription and covered over-the-
counter drugs.

NaviCare members also receive a medical benefit of a Save Now card

with an allowance of $162 quarterly to use toward certain Over-the-
Counter (OTC) items such as first aid supplies, dental care, and cold
# QUESTION ANSWER REFERENCE MATERIALS
symptoms supplies. Any money remaining at the end of each quarter
will not roll over into the following quarter.

D28 Do you have a list of Yes. Fallon Medicare Plus:

doctors on your website? fallonhealth.org/findphysician

NaviCare:
fallonhealth.org/findphysician

D29 Does my mom need a [Representative will provide answer <Yes> or <No> based upon the CMS approved 2024 formulary
prior authorization to get current year CMS approved plan formulary.]
<DRUG NAME>?

D30 The doctor wants to Fallon Medicare Plus: FMP Part D plans: EOC,
prescribe a medication for No, if your doctor prescribes less than a full month’s supply, you will not Chapter 6, Section 5.3
less than 30 days, to see have to pay for the full month’s supply for certain drugs. The amount
how <my mother> will you pay when you get less than a full month’s supply will depend on
respond. Does<she> whether you are responsible for paying coinsurance or a copayment.
have to pay the full 30-
day copay amount?
For coinsurance: <If you are responsible for coinsurance, you pay a
percentage of the total cost of the drug. Because the entire drug cost
will be lower if you get less than a full month’s supply, the amount you
pay will be less.>

For copayment: <If you are responsible for a copayment for the drug,
your copay will be based on the number of days of the drug that you
receive.>

NaviCare:
No.

D31 Do you have a list of Yes. Fallon Medicare Plus and

network pharmacies on NaviCare:
your website?

http://fallonhealth.org/
# QUESTION ANSWER REFERENCE MATERIALS
pharmacyfinder