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AHIP 2021Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving
Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that
she has been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Quinn? - ANSPart B primarily covers physician services.
She will be paying a monthly premium and, with the exception of many preventive and
screening tests, generally will have 20% coinsurance for these services, in addition to an
annual deductible.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would
like to know which of the following services Original Medicare will cover if the appropriate
criteria are met? What could you tell her? - ANSOriginal Medicare covers ambulance
services.
Mr. Diaz continued working with his company and was insured under his employer's group
plan until he reached age 68. He has heard that there is a premium penalty for those who
did not sign up for Part B when first eligible and wants to know how much he will have to
pay. What should you tell him? - ANSMr. Diaz will not pay any penalty because he had
continuous coverage under his employer's plan.
Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare Part
A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's
older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. It not
only provides foreign travel emergency benefits but also covers his Medicare Part B
deductible. Anita comes to you for advice. What should you tell her? - ANSYou are sorry to
disappoint Anita but a Medigap Part F plan is no longer available to those who turn age 65
after January 1,2020. Anita might instead consider other Medigap plans that offer foreign
travel benefits but do not cover the Part B deductible.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage
Medicare Supplemental Insurance provides since his health care needs are different from
his wife's needs. What could you tell Mr. Moy? - ANSMedicare Supplemental Insurance
would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not cover.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social
Security Administration and has been receiving disability payments. He is wondering
whether he can obtain coverage under Medicare. What should you tell him? - ANSAfter
receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - ANSPart A, which
covers hospital, skilled nursing facility, hospice, and home health services and Part B, which
,covers professional services such as those provided by a doctor are covered under Original
Medicare.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make
it impossible for her to qualify for Medicare. What could you tell her to address her concern?
- ANSMedicare is a program for people age 65 or older and those under age 65 with certain
disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for
Medicare.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -
ANSMedicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the facility for 100
days.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
under Original Medicare. What should you tell Mr. Xi that best describes the health coverage
provided to Medicare beneficiaries? - ANSBeneficiaries under Original Medicare have no
cost-sharing for most preventive services which include immunizations such as annual flu
shots.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs. Geisler
can't remember what Part D is so she called you to ask what her neighbor was talking about.
What could you tell her? - ANSPart D covers prescription drugs and she should look at her
premiums, formulary, and cost-sharing among other factors to see if they have changed.
What impact, if any, will recent regulatory changes have upon Medigap plans? - ANSThe
Part B deductible will no longer be covered for individuals newly eligible for Medicare starting
January 1, 2020.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the
Part D low-income subsidy. Where might he turn for help with his prescription drug costs? -
ANSMr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program.
Madeline Martinez was widowed several years ago. Her husband worked for many years
and contributed into the Medicare system. He also left a substantial estate which provides
Madeline with an annual income of approximately $130,000. Madeline, who has only worked
part-time for the last three years, will soon turn age 65 and hopes to enroll in Original
Medicare. She comes to you for advice. What should you tell her? - ANSYou should tell
Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's long work record and participation in the Medicare system. You should
also tell Madeline that she will pay Part B premiums at more than the standard lowest rate
but less than the highest rate due her substantial income.
, Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan
which he has had for several years. However, the plan does not provide drug benefits. How
would you advise Agent John Miller to proceed? - ANSTell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present
coverage.
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
Medicare. What can you tell her about Medigap as an option to address this concern? -
ANSMedigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles
for medically necessary services
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him? - ANSHe may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time,
and paid taxes during that entire period. She is concerned that she will not qualify for
coverage under part A because she was not born in the United States. What should you tell
her? - ANSMost individuals who are citizens and age 65 or over are covered under Part A by
virtue of having paid Medicare taxes while working, though some may be covered as a result
of paying monthly premiums.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? - ANSMr. Singh can enroll in a stand-alone
prescription drug plan and continue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
employer-sponsored healthcare coverage. Juan is a naturalized citizen and has contributed
to the Medicare system for over 20 years. Juan asks you if he will be
entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare
coverage. How would you respond? - ANSJuan is likely to be eligible for Medicare once he
turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare
claims and Smallcap does not have to continue to offer him coverage comparable to those
under age 65 under its employer-sponsored group health plan.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - ANSMrs. Radford must be entitled to Part A and
enrolled in Part B to enroll in Medicare Advantage.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to
enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell
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