AHIP Module 1

AHIP Module 1 Question 1: Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and wants to know which services Original Medicare will cover. What can you tell her? Answer: Original Medicare covers ambulance services, among other things. Question 2: Madeline Martinez is turning 65 and has a substantial income from her late husband's estate. She wants to know how this will affect her Medicare enrollment. What should you tell her? Answer: Madeline will pay Part B premiums at a rate higher than the standard lowest rate but lower than the highest rate due to her substantial income. Question 3: Juan Perez is turning 65 and working for Smallcap, Incorporated. He wants to know if he'll be entitled to Medicare and how it will impact his employer-sponsored healthcare coverage. How would you respond? Answer: Juan will be eligible for Medicare once he turns 65, and if he enrolls, Medicare will become the primary payer of his healthcare claims, and Smallcap won't have to continue offering him coverage comparable to those under 65 under its employer-sponsored group health plan. Question 4: Mr. Wu has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs? What could you tell him? Answer: Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Question 5: Mrs. Quinn received a letter informing her that she's been automatically enrolled in Medicare Part B after turning 66. What should you tell her? Answer: Part B primarily covers physician services, and she'll pay a monthly premium, with the exception of many preventive and screening tests, generally having a 20% coinsurance. Question 6: Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What can you tell her about Medigap as an option? Answer: Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. Question 7: Agent John Miller is meeting with Jerry Smith, who has a Medigap plan without drug benefits. How would you advise Agent John Miller to proceed? Answer: Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Question 8: Ms. Moore is concerned that her income will make it impossible for her to qualify for Medicare when she retires at 65. What could you tell her? Answer: 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. Question 9: Mr. Davis is turning 52 and has recently been diagnosed with end-stage renal disease (ESRD). How would you advise him on obtaining coverage under Medicare? Answer: He may sign-up for Medicare at any time, but coverage usually begins on the fourth month after dialysis treatments start. 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? ️c. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. 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? ️c. Part 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. Bauer is 49 years old, but eighteen months ago he was declared disabled 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? ️b. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Anita Magri will turn age 65 in August 2020. 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? ️a. You 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. 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? ️d. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.