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Module 1
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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?
Question 1Answer
a.
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.
b.
Medigap plans that cover costs not paid for by an MA plan are available only in Massachusetts,
Minnesota, and Wisconsin.
c.
Medigap policies designed to cover costs not paid for by an MA plan can be purchased, but only
if the MA plan’s design is considered to be the “defined standard benefit.”
d.
You will help Mr. Capadona to select a Medigap plan that is designed to cover gaps in Medicare
Advantage.
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Mr. Singh would like drug coverage but does not want to be enrolled in
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a Medicare Advantage plan. What should you tell him?
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Question 2Answer
a.
Mr. Singh must leave Original Medicare to receive drug coverage.
b.
Part D prescription drug coverage can only be obtained by enrollment into a Medicare
Advantage plan that also covers Part A and Part B services.
c.
Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage
through some means other than a Medicare Advantage plan.
d.
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part
A and Part B services through Original Fee-for-Service Medicare.
Mildred Savage enrolled in Allcare Medicare Advantage plan several
years ago. Mildred recently learned that she is suffering from
inoperable cancer and has just a few months to live. She would like to
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spend these final months in hospice care. Mildred’s family asks you
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whether hospice benefits will be paid for under the Allcare Medicare
Advantage plan. What should you say?
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Question 10Answer
a.
Hospice benefits will be paid for under Mildred’s Allcare Medicare Advantage plan which must
cover all Medicare Part A and Part B benefits.
b.
Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be
paid for by Original Medicare under Part A and Allcare will continue to pay for any non-hospice
services.
c.
Hospice benefits are not covered under Medicare and must be paid for using private funds.
d.
Hospice benefits will be available to Mildred but they will be paid for by Original Medicare
under Part B.
Mr. Bauer is 49 years old, but eighteen months ago he was declared
disabled by the Social Security Administration and has been receiving
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disability payments. He is wondering whether he can obtain coverage
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under Medicare. What should you tell him?
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Question 13Answer
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Individuals who become eligible for such disability payments only have to wait 12 months
before they can apply for coverage under Medicare.
b.
He became eligible for Medicare when his disability eligibility determination was first made.
c.
After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
d.
Individuals receiving such disability payments from the Social Security Administration continue
to receive those payments but only become eligible for Medicare upon reaching age 65.
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Ms. Henderson believes that she will qualify for Medicare Coverage
when she turns 65, without paying any premiums, because she has
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been working for 40 years and paying Medicare taxes. What should you
tell her?
Question 15Answer
a.
She is correct because she will be covered under Part A, without paying premiums and she has
worked for 40 years so she will not have to pay Part B premiums.
b.
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
c.
Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Advantage
plan.
d.
She is correct that she will not have to pay a premium because State programs cover the cost of
Part B premiums for all Medicare beneficiaries.
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Edward suffered from serious kidney disease. As a result, Edward
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became eligible for Medicare coverage due to end-stage renal disease
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(ESRD). A close relative donated their kidney and Edward successfully
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underwent transplant surgery 12 months ago. Edward is now age 50
and asks you if his Medicare coverage will continue, what should you
say?
Question 3Answer
a.
Individuals eligible for Medicare based on ESRD generally lose eligibility 48 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in Part E
(Medigap) but solely for coverage of immunosuppressive drugs if he has no other health care
coverage that would cover the drugs.
b.
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward should apply for Medicaid if he has no other
health care coverage that would cover the drugs regardless of his income level or assets.
c.
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
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month in which the individual receives a kidney transplant unless they are eligible for Medicare
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on another basis such as age or disability. Edward may, however, remain enrolled in Part B but
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solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
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d.
Individuals eligible for Medicare based on ESRD generally lose eligibility 24 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in Part A but
solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
Madeline Martinez was widowed several years ago. Her husband
worked for many years and contributed into the Medicare system. He
also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked
part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should
you tell her?
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Question 4Answer
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a.
You should tell Madeline that she will need to pay premiums for Part A because of her short
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work history. You should also tell Madeline that she will pay Part B premiums at the highest rate
because her income over the last several years has exceeded $100,000.
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b.
You should tell Madeline that she will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband’s long work record and participation in the Medicare
system. You should also tell Madeline that she will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due her substantial income.
c.
You should tell Madeline that she will be able to enroll in both Medicare Part A and Part B
without paying monthly premiums due to her husband’s long work record and participation in
the Medicare system.
d.
You should tell Madeline that she will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband’s long work record and participation in the Medicare
system. You should also tell Madeline that she will pay Part B premiums at the highest rate
because her income over the last several years has exceeded $100,000.
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Module 1
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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?
Question 1Answer
a.
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.
b.
Medigap plans that cover costs not paid for by an MA plan are available only in Massachusetts,
Minnesota, and Wisconsin.
c.
Medigap policies designed to cover costs not paid for by an MA plan can be purchased, but only
if the MA plan’s design is considered to be the “defined standard benefit.”
d.
You will help Mr. Capadona to select a Medigap plan that is designed to cover gaps in Medicare
Advantage.
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Mr. Singh would like drug coverage but does not want to be enrolled in
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a Medicare Advantage plan. What should you tell him?
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Question 2Answer
a.
Mr. Singh must leave Original Medicare to receive drug coverage.
b.
Part D prescription drug coverage can only be obtained by enrollment into a Medicare
Advantage plan that also covers Part A and Part B services.
c.
Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage
through some means other than a Medicare Advantage plan.
d.
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part
A and Part B services through Original Fee-for-Service Medicare.
Mildred Savage enrolled in Allcare Medicare Advantage plan several
years ago. Mildred recently learned that she is suffering from
inoperable cancer and has just a few months to live. She would like to
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spend these final months in hospice care. Mildred’s family asks you
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whether hospice benefits will be paid for under the Allcare Medicare
Advantage plan. What should you say?
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Question 10Answer
a.
Hospice benefits will be paid for under Mildred’s Allcare Medicare Advantage plan which must
cover all Medicare Part A and Part B benefits.
b.
Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be
paid for by Original Medicare under Part A and Allcare will continue to pay for any non-hospice
services.
c.
Hospice benefits are not covered under Medicare and must be paid for using private funds.
d.
Hospice benefits will be available to Mildred but they will be paid for by Original Medicare
under Part B.
Mr. Bauer is 49 years old, but eighteen months ago he was declared
disabled by the Social Security Administration and has been receiving
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disability payments. He is wondering whether he can obtain coverage
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under Medicare. What should you tell him?
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Question 13Answer
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Individuals who become eligible for such disability payments only have to wait 12 months
before they can apply for coverage under Medicare.
b.
He became eligible for Medicare when his disability eligibility determination was first made.
c.
After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
d.
Individuals receiving such disability payments from the Social Security Administration continue
to receive those payments but only become eligible for Medicare upon reaching age 65.
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Ms. Henderson believes that she will qualify for Medicare Coverage
when she turns 65, without paying any premiums, because she has
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been working for 40 years and paying Medicare taxes. What should you
tell her?
Question 15Answer
a.
She is correct because she will be covered under Part A, without paying premiums and she has
worked for 40 years so she will not have to pay Part B premiums.
b.
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
c.
Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Advantage
plan.
d.
She is correct that she will not have to pay a premium because State programs cover the cost of
Part B premiums for all Medicare beneficiaries.
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Edward suffered from serious kidney disease. As a result, Edward
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became eligible for Medicare coverage due to end-stage renal disease
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(ESRD). A close relative donated their kidney and Edward successfully
Ed
underwent transplant surgery 12 months ago. Edward is now age 50
and asks you if his Medicare coverage will continue, what should you
say?
Question 3Answer
a.
Individuals eligible for Medicare based on ESRD generally lose eligibility 48 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in Part E
(Medigap) but solely for coverage of immunosuppressive drugs if he has no other health care
coverage that would cover the drugs.
b.
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward should apply for Medicaid if he has no other
health care coverage that would cover the drugs regardless of his income level or assets.
c.
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
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month in which the individual receives a kidney transplant unless they are eligible for Medicare
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on another basis such as age or disability. Edward may, however, remain enrolled in Part B but
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solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
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d.
Individuals eligible for Medicare based on ESRD generally lose eligibility 24 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in Part A but
solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
Madeline Martinez was widowed several years ago. Her husband
worked for many years and contributed into the Medicare system. He
also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked
part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should
you tell her?
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Question 4Answer
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a.
You should tell Madeline that she will need to pay premiums for Part A because of her short
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work history. You should also tell Madeline that she will pay Part B premiums at the highest rate
because her income over the last several years has exceeded $100,000.
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b.
You should tell Madeline that she will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband’s long work record and participation in the Medicare
system. You should also tell Madeline that she will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due her substantial income.
c.
You should tell Madeline that she will be able to enroll in both Medicare Part A and Part B
without paying monthly premiums due to her husband’s long work record and participation in
the Medicare system.
d.
You should tell Madeline that she will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband’s long work record and participation in the Medicare
system. You should also tell Madeline that she will pay Part B premiums at the highest rate
because her income over the last several years has exceeded $100,000.
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