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Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
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for the Part D low-income subsidy. Where might he turn for help with his prescription
drug costs?correct answersMr. Wu may still qualify for help in paying Part D costs
Ed
through his State Pharmaceutical Assistance Program.
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?correct answersPart D covers prescription drugs
and she should look at her premiums, formulary, and cost-sharing among other factors
to see if they have changed.
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?correct answersMr. Diaz will not pay any
penalty because he had continuous coverage under his employer's plan.
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?correct answersMedigap plans help beneficiaries cover Original Medicare
benefits, but they coordinate with Original Medicare coverage.
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Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
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would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met? What could you tell her?correct answersOriginal Medicare
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covers ambulance services.
Ed
Anita Magri will turn age 65 in August 2022. 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?correct answersYou 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.
Mrs. 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?correct answersPart 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.
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Ed
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Ed
, Ed
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What impact, if any, have recent regulatory changes had upon Medigap plans?correct
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answersThe Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Ed
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?correct answersMedicare 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.
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefits package of a Medicare Advantage Plan before she starts
looking at specific plans. What could you tell her?correct answersMedicare Advantage
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. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access
to services since she receives some assistance for her health care costs from the State.
What should you tell her?correct answersMedicaid may provide additional benefits, but
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Medicaid will only pay for these services if they are furnished by Medicaid participating
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providers.
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Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What
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should she be aware of when considering enrollment in a Medicare Advantage (MA)
plan?correct answersShe can submit any bills she has for co-payments under Medicare
Ed
to the state's Medicaid program and they will always be fully covered.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise
her to do before she will be able to enroll in a Medicare Advantage plan?correct
answersTo join a Medicare Advantage plan, she also must enroll in Part B.
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?correct answersShe can enroll in the PPO, but she will
not be able to purchase a stand-alone Medicare Part D prescription drug plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does
not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone
prescription drug plan. What should you tell her?correct answersShe could enroll in a
PFFS plan and a stand-alone Medicare prescription drug plan.
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ie
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Ed
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Ed
ie
ird
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
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for the Part D low-income subsidy. Where might he turn for help with his prescription
drug costs?correct answersMr. Wu may still qualify for help in paying Part D costs
Ed
through his State Pharmaceutical Assistance Program.
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?correct answersPart D covers prescription drugs
and she should look at her premiums, formulary, and cost-sharing among other factors
to see if they have changed.
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?correct answersMr. Diaz will not pay any
penalty because he had continuous coverage under his employer's plan.
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?correct answersMedigap plans help beneficiaries cover Original Medicare
benefits, but they coordinate with Original Medicare coverage.
e
ie
di
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
ird
would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met? What could you tell her?correct answersOriginal Medicare
uB
covers ambulance services.
Ed
Anita Magri will turn age 65 in August 2022. 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?correct answersYou 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.
Mrs. 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?correct answersPart 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.
ie
ird
ie
uB
ird
Ed
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Ed
, Ed
ie
ird
What impact, if any, have recent regulatory changes had upon Medigap plans?correct
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answersThe Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Ed
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?correct answersMedicare 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.
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefits package of a Medicare Advantage Plan before she starts
looking at specific plans. What could you tell her?correct answersMedicare Advantage
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. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access
to services since she receives some assistance for her health care costs from the State.
What should you tell her?correct answersMedicaid may provide additional benefits, but
e
ie
Medicaid will only pay for these services if they are furnished by Medicaid participating
di
providers.
ird
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What
uB
should she be aware of when considering enrollment in a Medicare Advantage (MA)
plan?correct answersShe can submit any bills she has for co-payments under Medicare
Ed
to the state's Medicaid program and they will always be fully covered.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise
her to do before she will be able to enroll in a Medicare Advantage plan?correct
answersTo join a Medicare Advantage plan, she also must enroll in Part B.
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?correct answersShe can enroll in the PPO, but she will
not be able to purchase a stand-alone Medicare Part D prescription drug plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does
not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone
prescription drug plan. What should you tell her?correct answersShe could enroll in a
PFFS plan and a stand-alone Medicare prescription drug plan.
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ird
ie
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ird
Ed
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Ed
