Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped
paying his Part B premium. Mr. Arias is still covered by Part A. He would like to enroll in a
Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? -
ANSWER-He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare
Part B.
Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrolling in a Medicare Advantage plan (Part C). What should you advise her to do before she
can enroll in a Medicare Advantage plan? - ANSWER-To join a Medicare Advantage plan, she
also must enroll in Part B.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him? - ANSWER-In most Medicare Advantage HMOs, Mr.
Kumar must generally obtain his services only from providers within the plan's network (except
in an emergency or where care is unavailable within the network).
Mrs. Robles is considering a Medicare Advantage PPO and has questions about which providers
she can go to for her health care. What should you tell her? - ANSWER-Mrs. Robles can obtain
care from any provider who participates in Original Medicare, but generally will have a higher
cost-sharing amount if she sees a provider who/that is not a part of the PPO network.
Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income level. She wishes
to enroll in an MA MSA plan that she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed several expensive medications.
Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Lester? - ANSWER-Mrs. Lester may enroll in an MA MSA plan and remain in her
current standalone Part D prescription drug plan.
, Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income from his
investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His
friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Dalton would
like to join that plan. What should you tell him? - ANSWER-SNPs limit enrollment to certain
subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would
not be able to enroll in the SNP.
Mr. Anderson wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? - ANSWER-You would
need to ask Mr. Anderson if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS
plan's service area.
Herber Noble is turning 65 next month, Herber legally entered the United States over twenty
years ago but is not a citizen. Since his entry into the country, Herber has worked at Smallcap
Incorporated and contributed to the Medicare system. Herber suffers from diabetes. He will
soon retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How
would you respond? - ANSWER-Herber is eligible to enroll in Medicare Advantage as long as he
is entitled to Part A and enrolled in Part B. Herber should go to the Social Security website to
enroll in Medicare Part A and B if he has not done so already. Once he is enrolled, he can choose
a Medicare Advantage plan.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? -
ANSWER-Jose, a grandfather who was granted asylum and has worked in the United States for
many years.
Mrs. Castro has just turned 65, is in excellent health and has a relatively high income. She uses
no medications and sees no reason to spend money on a Medicare prescription drug plan if she
does not need the coverage. She currently does not have creditable coverage. What could you
tell her about the implications of such a decision? - ANSWER-If she does not sign up for a
Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a
later date, her premium will be permanently increased by 1% of the national average premium
for every month that she was not covered.
paying his Part B premium. Mr. Arias is still covered by Part A. He would like to enroll in a
Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? -
ANSWER-He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare
Part B.
Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrolling in a Medicare Advantage plan (Part C). What should you advise her to do before she
can enroll in a Medicare Advantage plan? - ANSWER-To join a Medicare Advantage plan, she
also must enroll in Part B.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him? - ANSWER-In most Medicare Advantage HMOs, Mr.
Kumar must generally obtain his services only from providers within the plan's network (except
in an emergency or where care is unavailable within the network).
Mrs. Robles is considering a Medicare Advantage PPO and has questions about which providers
she can go to for her health care. What should you tell her? - ANSWER-Mrs. Robles can obtain
care from any provider who participates in Original Medicare, but generally will have a higher
cost-sharing amount if she sees a provider who/that is not a part of the PPO network.
Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income level. She wishes
to enroll in an MA MSA plan that she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed several expensive medications.
Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Lester? - ANSWER-Mrs. Lester may enroll in an MA MSA plan and remain in her
current standalone Part D prescription drug plan.
, Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income from his
investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His
friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Dalton would
like to join that plan. What should you tell him? - ANSWER-SNPs limit enrollment to certain
subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would
not be able to enroll in the SNP.
Mr. Anderson wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? - ANSWER-You would
need to ask Mr. Anderson if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS
plan's service area.
Herber Noble is turning 65 next month, Herber legally entered the United States over twenty
years ago but is not a citizen. Since his entry into the country, Herber has worked at Smallcap
Incorporated and contributed to the Medicare system. Herber suffers from diabetes. He will
soon retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How
would you respond? - ANSWER-Herber is eligible to enroll in Medicare Advantage as long as he
is entitled to Part A and enrolled in Part B. Herber should go to the Social Security website to
enroll in Medicare Part A and B if he has not done so already. Once he is enrolled, he can choose
a Medicare Advantage plan.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? -
ANSWER-Jose, a grandfather who was granted asylum and has worked in the United States for
many years.
Mrs. Castro has just turned 65, is in excellent health and has a relatively high income. She uses
no medications and sees no reason to spend money on a Medicare prescription drug plan if she
does not need the coverage. She currently does not have creditable coverage. What could you
tell her about the implications of such a decision? - ANSWER-If she does not sign up for a
Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a
later date, her premium will be permanently increased by 1% of the national average premium
for every month that she was not covered.
