. 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? - ANSWER Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with Original Medicare coverage....
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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? - ANSWER Medigap plans
help beneficiaries cover Original Medicare benefits, but they coordinate with Original Medicare
coverage.
Anita Magri will turn age 65 in August 2023. 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 Plan F 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? - ANSWER You are sorry to disappoint Anita, but a Medigap 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.
What impact, if any, have recent regulatory changes had on Medigap plans? - ANSWER b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1,
2020.
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? - ANSWER Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
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? - ANSWER
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
massage therapy. She is concerned about whether or not Medicare will cover these items and services.
What should you tell her? - ANSWER Medicare does not cover massage therapy, or, in general, glasses or
dentures.
, Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a
PPO that does not include drug coverage. What should you tell her about obtaining drug coverage? -
ANSWER She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.
Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare prescription
drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What
should you tell her? - ANSWER An individual who is entitled to Part A or enrolled under Part B is eligible
to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not
need to enroll under Part B before enrolling in a prescription drug plan.
Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies
under a program known as Medicare Advantage (MA), not by the government. He likes Original
Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage.
What should you tell him? - ANSWER Mr. Carlini can stay with Original Medicare and also enroll in a
Medicare prescription drug plan through a private company that has contracted with the government to
provide only such drug coverage to eligible Medicare beneficiaries.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors
called TrOOP. She asks you to explain it. What do you say? - ANSWER TrOOP stands for true out-of-pocket
expenses that count toward the Medicare Part D catastrophic limit and include not only expenses paid
by a beneficiary but also in some instances drug manufacturer discounts.
Mr. Rice is 68, actively working, and has coverage for medical services and medications through his
employer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B
and switching to an MA-PD because he is paying a very large part of his group coverage premium, and it
does not provide coverage for a number of his medications. Which of the following is NOT a
consideration when making the change? - ANSWER
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable coverage
previously available through her husband's employer. She is interested in enrolling in a Medicare Part D
prescription drug plan (PDP). What should you tell her? - ANSWER
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an
automatic monthly withdrawal from his savings account until it is exhausted, and then have his
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