AHIP 2023 EXAM (ACTUAL TEST)

Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) andwill 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. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored healthcarecoverage. 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? - Juan is likely to be eligible forMedicare 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. 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? - Medicare Supplemental Insurance would help cover his Part A andPart B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next year. She heardshe 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 differsfrom the standard general enrollment period, during which she may enroll in Medicare Part B. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paidtaxes 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? - Most individuals who arecitizens 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. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides nodrug coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her? - Mrs. Gonzalez cannot purchase aMedigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. 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 itemsand services. What should you tell her? - Medicare does not cover massage therapy, or, in general,glasses or dentures. Mr. Patel is in good health and is preparing a budgetin 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 wereto 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? - Under Original Medicare, there is a single deductible amount due for thefirst 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance 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. 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. Whatshould you tell her? - To obtain Part B coverage, she must pay a standard monthly premium, thoughit is higher for individuals with higher incomes. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer'sretiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you whatcosts he would generally expect to encounter when enrolling into a standard MedicarePart D prescription drug plan. What should you tell him? - He generally would pay a monthly premium, annual deductible, and perprescription cost-sharing. 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? - Medicare 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