AHIP TRAINING Module 1

AHIP TRAINING Module 1 Question 1: Mrs. Chen, a 65-year-old citizen who has been a US resident for 12 years, is concerned that she won't qualify for Part A coverage because she wasn't born in the US. What can you tell her? Answer: Most 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. Question 2: Mr. Bauer, a 49-year-old individual with a disability, wonders if he can obtain coverage under Medicare. How long must he wait before he can enroll in Medicare? Answer: He will be automatically enrolled in Medicare after receiving disability payments for 24 months. Question 3: Mr. Davis, a 49-year-old individual with a disability, wants to purchase a Medicare Advantage (MA) or Part D prescription drug plan. Can he do so? Answer: No, he cannot purchase a MA or Part D plan because he has not received SSA or Railroad Retirement Board disability benefits for 24 months. Question 4: Mrs. Henderson believes she will qualify for Medicare coverage without paying premiums because she has worked for 40 years and paid Medicare taxes. What can you tell her about Part B premiums? Answer: She will need to pay a standard monthly premium for Part B coverage, although it may be higher for individuals with higher income. Question 5: Mr. Diaz continues to work with his company and is insured under his employer's group plan until he reaches age 68. What can you tell him about Part B premiums? Answer: He will not pay any penalty because he had continuous coverage under his employer's plan. Question 6: Mrs. Peña is 66 years old and has an employer plan. She will retire next year and wants to know when she can enroll in Part B. What can you tell her? Answer: She 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. Question 7: Mrs. Kelly is entitled to Part A but not yet enrolled in Part B and is considering enrollment in a Medicare health plan. What should you advise her to do before enrolling in a Medicare health plan? Answer: She must also enroll in Part B before enrolling in a Medicare health plan. Question 8: Tomá has limited income and resources. What could you tell her that might be of assistance? Answer: She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs. Question 9: Mr. Yu has limited income and resources and wonders what kind of financial assistance might be available to him if he qualifies. What could you tell him? Answer: He 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. Question 10: Mr. Patel is preparing for retirement and wants to understand the healthcare costs he might incur under Medicare if he requires hospitalization due to an illness. What can you tell him about Original Medicare's coverage of inpatient hospital services? Answer: Under 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. RAINEY is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? (Medicare inpatient services) ️Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. QUIGLEY 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. (Medicare premiums and deductibles) ️Part 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-pays for these services, in addition to an annual deductible. BUCK has several family members who did from different cancers. He wants to know if Medicare covers cancer screening. (Medicare covers or not) ️Medicare 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. TURNER is comparing her employer's retiree ins. to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? (Medicare covers or not) ️Original Medicare covers ambulance services. BADEAU 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. (Medicare covers or not) ️Medicare DOES NOT cover acupuncture, or, in general, glasses or dentures. SINGH would like drug coverage, but does not want to be enrolled into a health plan.