AHIP ALL MODULES|| 100 QUESTIONS
AND ANSWERS (GRADED A)
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. What should you tell her? - ANSWER-To obtain Part B coverage, she
must pay a standard monthly premium, though it is higher for individuals with higher
incomes.
Mr. Patel is in good health and is preparing a budget in 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 were to 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? - 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 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.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
employer-sponsored healthcare coverage. 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? - ANSWER-Juan is likely to be eligible
for Medicare 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.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not provide
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.
Mrs. Peňa 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? - 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 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.
, Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap
plan to pick up costs not covered by that plan. What should you tell him? - ANSWER-It
is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan,
and besides, Medigap only works with Original Medicare.
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? - 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.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - ANSWER-
Medicare covers the 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.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed
her Medicare Summary Notice (MSN) and disagrees with a determination that partially
denied one of her claims for services. What advice would you give her? - ANSWER-
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date
she received the MSN in the mail.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park 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 for which she is responsible.
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? -
ANSWER-After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age
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? - ANSWER-He may sign-up for Medicare at any
time however coverage usually begins on the fourth month after dialysis treatments
start.
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 items and services. What should you tell her? - ANSWER-Medicare does
not cover massage therapy, or, in general, glasses or dentures.
AND ANSWERS (GRADED A)
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. What should you tell her? - ANSWER-To obtain Part B coverage, she
must pay a standard monthly premium, though it is higher for individuals with higher
incomes.
Mr. Patel is in good health and is preparing a budget in 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 were to 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? - 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 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.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
employer-sponsored healthcare coverage. 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? - ANSWER-Juan is likely to be eligible
for Medicare 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.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not provide
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.
Mrs. Peňa 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? - 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 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.
, Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap
plan to pick up costs not covered by that plan. What should you tell him? - ANSWER-It
is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan,
and besides, Medigap only works with Original Medicare.
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? - 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.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - ANSWER-
Medicare covers the 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.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed
her Medicare Summary Notice (MSN) and disagrees with a determination that partially
denied one of her claims for services. What advice would you give her? - ANSWER-
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date
she received the MSN in the mail.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park 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 for which she is responsible.
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? -
ANSWER-After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age
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? - ANSWER-He may sign-up for Medicare at any
time however coverage usually begins on the fourth month after dialysis treatments
start.
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 items and services. What should you tell her? - ANSWER-Medicare does
not cover massage therapy, or, in general, glasses or dentures.
