AHIP
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1. Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-
PD plan and was disappointed with the service she received from her primary
care physician because she was told she would have to wait five weeks to
get an appointment when she was feeling ill. She called you to ask what she
could do so she would not have to put up with such poor access to care.
What could you tell her?: She could file a grievance with her plan to complain
about the lack of timeliness in getting an appointment.
2. Edward IP suffered from serious kidney disease. As a result. Edward be-
came eligible for Medicare coverage due to end-stage renal disease (ESRD).
A close relative donated their kidney and Edward successfully underwent
transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say?: Individuals eligible for
Medicare based on ESRD generally lose eligibility 36 months after the month in
which the individual receives a kidney transplant unless they are eligible for
Medicare on another basis such as age or disability. Edward may, however, remain
enrolled in Part B but solely for coverage of immunosuppressive drugs if he has no
other health care coverage that would cover the drugs.
3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years
ago. Mildred recently learned that she is suffering from inoperable cancer
and has just a few months to live. She would like to spend these final months
in hospice care. Mildred's family asks you whether hospice benefits will be
paid for under the Allcare Medicare Advantage plan. What should you say?:
Mildred may remain enrolled in Allcare and make a hospice election. Hospice
benefits will be paid for by Original Medicare under Part A and Allcare will continue
to pay for any non-hospice services.
4. 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?:
Mr.
Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
5. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell Mr.
Moy?: Medicare Supplemental Insurance would help cover his Part A and Part B
deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as
possibly some services that Medicare does not cover.
,6. 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
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that she will not qualify for coverage under part A because she was not born
in the United States. What should you tell her?: Most 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.
7. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
abled 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?: After receiving such disability payments for 24
months, he will be automatically enrolled in Medicare, regardless of age.
8. 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?:
Ben-eficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
9. Mrs. PeHa 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?: She may enroll at
any time while she is covered under her employer plan, but she will have a special
eight-month enrollment period after the last month on her employer plan that differs
from the standard general enrollment period, during which she may enroll in
Medicare Part B.
10. 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?: He may sign-up
for Medicare at any time however coverage usually begins on the fourth month
after dialysis treatments start.
11. 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 approx-
imately $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?: You 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. 12.
, Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
Study online at https://quizlet.com/_dgbewk
1. Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-
PD plan and was disappointed with the service she received from her primary
care physician because she was told she would have to wait five weeks to
get an appointment when she was feeling ill. She called you to ask what she
could do so she would not have to put up with such poor access to care.
What could you tell her?: She could file a grievance with her plan to complain
about the lack of timeliness in getting an appointment.
2. Edward IP suffered from serious kidney disease. As a result. Edward be-
came eligible for Medicare coverage due to end-stage renal disease (ESRD).
A close relative donated their kidney and Edward successfully underwent
transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say?: Individuals eligible for
Medicare based on ESRD generally lose eligibility 36 months after the month in
which the individual receives a kidney transplant unless they are eligible for
Medicare on another basis such as age or disability. Edward may, however, remain
enrolled in Part B but solely for coverage of immunosuppressive drugs if he has no
other health care coverage that would cover the drugs.
3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years
ago. Mildred recently learned that she is suffering from inoperable cancer
and has just a few months to live. She would like to spend these final months
in hospice care. Mildred's family asks you whether hospice benefits will be
paid for under the Allcare Medicare Advantage plan. What should you say?:
Mildred may remain enrolled in Allcare and make a hospice election. Hospice
benefits will be paid for by Original Medicare under Part A and Allcare will continue
to pay for any non-hospice services.
4. 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?:
Mr.
Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
5. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell Mr.
Moy?: Medicare Supplemental Insurance would help cover his Part A and Part B
deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as
possibly some services that Medicare does not cover.
,6. 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
, AHIP
Study online at https://quizlet.com/_dgbewk
that she will not qualify for coverage under part A because she was not born
in the United States. What should you tell her?: Most 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.
7. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
abled 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?: After receiving such disability payments for 24
months, he will be automatically enrolled in Medicare, regardless of age.
8. 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?:
Ben-eficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
9. Mrs. PeHa 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?: She may enroll at
any time while she is covered under her employer plan, but she will have a special
eight-month enrollment period after the last month on her employer plan that differs
from the standard general enrollment period, during which she may enroll in
Medicare Part B.
10. 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?: He may sign-up
for Medicare at any time however coverage usually begins on the fourth month
after dialysis treatments start.
11. 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 approx-
imately $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?: You 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. 12.
, Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
