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AHIP 2022Ms. 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 or Lou
Gehrig's disease, so she will be eligible for Medicare.
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.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health
plan may, at some time in the future, reduce his benefits below what is available in Original
Medicare. What should you tell him about his concern? - ANSMedicare health plans must
cover all benefits available under Medicare Part A and Part B. Many also cover Part D
prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few weeks.
She concerned about having prescription drug coverage. Which of the following statements
provides the best advice? - ANSPrescription drug coverage can be obtained by enrolling in a
Medicare Advantage plan that includes Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefit package of a Medicare Health Plan before she starts looking at
specific plans. What could you tell her? - ANSMedicare Health Plans may offer extra benefits
that Original Medicare does not offer such as vision, hearing, and dental services and must
include a maximum out-of-pocket limit on Part A and Part B services.
Mr. Meoni'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.Meoni? - 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.
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 over age 65 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. 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. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription
Drug policy? - ANSNo, he cannot purchase a Medicare Advantage or Part D policy because
he has not received Social Security or Railroad Retirement disability benefits for 24 months.
Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying
Medicare taxes.
What should you tell her? - ANSIn order to obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for
individuals with higher incomes.
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.
Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next year.
She heard she must enroll in Part B at the beginning
of the year to ensure no gap in coverage. What can you tell her? - ANSShe may enroll at
any time while she is covered under her employer plan, but she will have a special eight
month enrollment period that differs from the standard general enrollment period, during
which she may enroll in Medicare Part B.
Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment
in a Medicare health plan. What should you advise her to do before she will be able to enroll
into a Medicare health plan? - ANSIn order to join a Medicare health plan, she also must
enroll in Part B.
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance? -
ANSShe should contact her state Medicaid agency to see if she qualifies for one of several
programs that can help with Medicare costs for which she is responsible.
Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies
for some type of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and
wants to know what the assistance could do for him if he qualifies. What could you tell him? -
ANSHe might qualify for help with Part D prescription drug costs and help paying Part A
and/or Part B premiums, deductibles, and/or cost sharing.
,Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he
turns 66. He wants to understand the health care costs he might be exposed to under
Medicare if he were to require hospitalization as a result of an illness. In general terms, what
could you tell him about his costs for inpatient hospital services under Original Medicare? -
ANSUnder Original Medicare, there is a single deductible amount due for the first 60 days of
any inpatient
hospital stay, after which it converts into a per-day amount through day 90. After day 90, he
would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for all costs
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. Schmidt's skilled nursing services provided during the first 20
days of her stay, after which she would have a coinsurance until she has been in the facility
for 100 days.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover? - ANSMedicare will cover a total
of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Quinn has just turned 65 and 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% co-payments for these services, in addition to an
annual deductible.
Mr. Buck has several family members who died from different cancers. He wants to know if
Medicare covers cancer screening. What should you tell him? - ANSMedicare covers
periodic performance of a range of screening tests that are meant to provide early detection
of disease. Mr. Buck will need to check specific tests before obtaining them to see if they will
be covered.
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.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through acupuncture. She is concerned about whether or not Medicare will cover these
items and services. What should you tell her? - ANSMedicare does not cover acupuncture,
or, in general, glasses or dentures.
, Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health
plan may, at some
time in the future, reduce his benefits below what is available in Original Medicare. What
should you tell him about his concern? - ANSMedicare health plans must cover all benefits
available under Medicare Part A and Part B. Many also cover Part D prescription drugs.
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.
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.
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefit
package of a Medicare Health Plan before she starts looking at specific plans. What could
you tell her? - ANSMedicare Health Plans may offer extra benefits that Original Medicare
does not offer such as vision, hearing, and dental services and must include a maximum
out-of-pocket limit on Part A and Part B services.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through
acupuncture. She is concerned about whether or not Medicare will cover these items and
services. What should you tell her? - ANSMedicare does not cover acupuncture, or, in
general, glasses or dentures.
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.
Mrs. Quinn has 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% co-payments for these services, in addition to an
annual deductible.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA), but is not sure if the plan associated with the account will fit her needs. What specific
piece of information about a Medicare MSA plan would it be important for her to know, prior
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