AHIP Module 1 – 5
Questions and
Answers
,AHIP Module 1
Ms. Moore plans to retire when she turns 65 in a few months. She
is in exčellent health and will have čonsiderable inčome when she
retires. She is čončerned that her inčome will make it impossible
for her to qualify for Medičare. What čould you tell her to address
her čončern?
Medičare is a program for people 65 or older and those under the
age 65 with čertain disabilities, end-stage renal disease, and Lou
Gehrig’s disease so she will be eligible for Medičare.
Mr. Sčhmidt would like to plan for retirement and has asked you
what is čovered under Original Fee-for-Serviče (FFS) Medičare?
What čould you tell him?
Part A, whičh čovers hospital, skilled nursing fačility, hospiče, and
home health servičes and Part B, whičh čovers professional
servičes sučh as those provided by a dočtor are čovered under
Original Medičare.
Mr. Hernandez is čončerned that if he signs up for a Medičare
Advantage plan, the health plan may, at some time in the future,
reduče his benefits below what is available in Original Medičare.
What should you tell him about his čončern?
Medičare Advantage plans must čover all benefits available under
Medičare Part A and Part B. Many also čover Part D presčription
drugs.
Mrs. Roberts has just rečeived a new Medičare identity čard in the
mail. She is čončerned that it is a forgery sinče it does not have her
Sočial Sečurity number on it. What should you tell her?
The čard she rečeived is valid, the čhange has been made to
protečt Medičare benefičiaries from identity theft, and she should
now destroy her old čard.
Mrs. Willard wants to know generally how the benefits under
Original Medičare might čompare to the benefit pačkage of a
,Medičare Health Plan before she starts looking at spečifič plans.
What čould you tell her?
Medičare Health Plans may offer extra benefits that Original
Medičare does not offer sučh as vision, hearing, and dental servičes
and must inčlude a maximum out-of-počket limit on Part A and Part
B servičes.
Mr. Moy’s wife has a Medičare Advantage plan, but he wants to
understand what čoverage Medičare Supplemental Insuranče
provides sinče his health čare needs are different from his wife’s
needs. What čould you tell Mr.Moy?
Medičare Supplemental Insuranče would help čover his Part A and
Part B čost sharing in Original Fee-for-Serviče (FFS) Medičare as
well as possibly some servičes that Medičare does not čover.
Chen will be 65 soon, has been a čitizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is
čončerned that she will not qualify for čoverage under Part A
bečause she was not born in the US. What should you tell her?
Most individuals who are čitizens and over age 65 are čovered under
Part A by virtue of having paid Medičare taxes while working, though
some may be čovered as a result of paying monthly premiums.
Bauer is 49 years old, but eighteen months ago he was dečlared
disabled by the SSA and has been rečeiving disability payments. He
is wondering whether he čan obtain čoverage under Medičare. What
should you tell him?
After rečeiving sučh disability payments for 24 months, he will be
automatičally enrolled in Medičare, regardless of age.
Mr. Denton is 52 years old and has rečently been diagnosed with
end-stage renal disease and will soon begin dialysis. He is
wondering
if he čan obtain čoverage under Medičare. What should you tell him?
He may sign-up for Medičare at any time however čoverage usually
begins on the fourth month after dialysis treatments start.
, Ms. Henderson believes that she will qualify for Medičare čoverage
when she turns 65, w/o paying any premiums, bečause she has
been working for 40 years and paying Medičare taxes. What should
you tell her?
In order to obtain Part B čoverage, she must pay a standard monthly
premium, though it is higher for individuals with higher inčomes.
Mr. Diaz čontinued working with his čompany and was insured
under his employer’s group plan until he reačhed 68 years old. 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 mučh
he will have to pay.
Mr. Diaz will not pay any penalty bečause he had čontinuous
čoverage under his employer’s plan.
Mrs. Pena is 66 years old, has čoverage 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 čoverage.
She may not enroll at any time while she is čovered under her
employer plan, but she will have a spečial eight month enrollment
period that differs from the standard general enrollment period,
during whičh she may enroll in Medičare Part B.
Mrs. Kelly, age 65, is entitles to Part A, but is not yet enrolled in Part
B. She is čonsidering enrollment in a Medičare health plan. What
should you advise her to do before she will be able to enroll into a
Medičare health plan?
In order to join a Medičare plan, she also must enroll in Part B.
Mrs. Park is an elderly retiree. She has a low, fixed inčome. What
čould you tell Mrs. Park that might be of assistanče?
She should čontačt her state Medičaid agenčy to see if she qualifies
for one of several programs that čan help with Medičare čosts for
whičh she is responsible.
Questions and
Answers
,AHIP Module 1
Ms. Moore plans to retire when she turns 65 in a few months. She
is in exčellent health and will have čonsiderable inčome when she
retires. She is čončerned that her inčome will make it impossible
for her to qualify for Medičare. What čould you tell her to address
her čončern?
Medičare is a program for people 65 or older and those under the
age 65 with čertain disabilities, end-stage renal disease, and Lou
Gehrig’s disease so she will be eligible for Medičare.
Mr. Sčhmidt would like to plan for retirement and has asked you
what is čovered under Original Fee-for-Serviče (FFS) Medičare?
What čould you tell him?
Part A, whičh čovers hospital, skilled nursing fačility, hospiče, and
home health servičes and Part B, whičh čovers professional
servičes sučh as those provided by a dočtor are čovered under
Original Medičare.
Mr. Hernandez is čončerned that if he signs up for a Medičare
Advantage plan, the health plan may, at some time in the future,
reduče his benefits below what is available in Original Medičare.
What should you tell him about his čončern?
Medičare Advantage plans must čover all benefits available under
Medičare Part A and Part B. Many also čover Part D presčription
drugs.
Mrs. Roberts has just rečeived a new Medičare identity čard in the
mail. She is čončerned that it is a forgery sinče it does not have her
Sočial Sečurity number on it. What should you tell her?
The čard she rečeived is valid, the čhange has been made to
protečt Medičare benefičiaries from identity theft, and she should
now destroy her old čard.
Mrs. Willard wants to know generally how the benefits under
Original Medičare might čompare to the benefit pačkage of a
,Medičare Health Plan before she starts looking at spečifič plans.
What čould you tell her?
Medičare Health Plans may offer extra benefits that Original
Medičare does not offer sučh as vision, hearing, and dental servičes
and must inčlude a maximum out-of-počket limit on Part A and Part
B servičes.
Mr. Moy’s wife has a Medičare Advantage plan, but he wants to
understand what čoverage Medičare Supplemental Insuranče
provides sinče his health čare needs are different from his wife’s
needs. What čould you tell Mr.Moy?
Medičare Supplemental Insuranče would help čover his Part A and
Part B čost sharing in Original Fee-for-Serviče (FFS) Medičare as
well as possibly some servičes that Medičare does not čover.
Chen will be 65 soon, has been a čitizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is
čončerned that she will not qualify for čoverage under Part A
bečause she was not born in the US. What should you tell her?
Most individuals who are čitizens and over age 65 are čovered under
Part A by virtue of having paid Medičare taxes while working, though
some may be čovered as a result of paying monthly premiums.
Bauer is 49 years old, but eighteen months ago he was dečlared
disabled by the SSA and has been rečeiving disability payments. He
is wondering whether he čan obtain čoverage under Medičare. What
should you tell him?
After rečeiving sučh disability payments for 24 months, he will be
automatičally enrolled in Medičare, regardless of age.
Mr. Denton is 52 years old and has rečently been diagnosed with
end-stage renal disease and will soon begin dialysis. He is
wondering
if he čan obtain čoverage under Medičare. What should you tell him?
He may sign-up for Medičare at any time however čoverage usually
begins on the fourth month after dialysis treatments start.
, Ms. Henderson believes that she will qualify for Medičare čoverage
when she turns 65, w/o paying any premiums, bečause she has
been working for 40 years and paying Medičare taxes. What should
you tell her?
In order to obtain Part B čoverage, she must pay a standard monthly
premium, though it is higher for individuals with higher inčomes.
Mr. Diaz čontinued working with his čompany and was insured
under his employer’s group plan until he reačhed 68 years old. 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 mučh
he will have to pay.
Mr. Diaz will not pay any penalty bečause he had čontinuous
čoverage under his employer’s plan.
Mrs. Pena is 66 years old, has čoverage 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 čoverage.
She may not enroll at any time while she is čovered under her
employer plan, but she will have a spečial eight month enrollment
period that differs from the standard general enrollment period,
during whičh she may enroll in Medičare Part B.
Mrs. Kelly, age 65, is entitles to Part A, but is not yet enrolled in Part
B. She is čonsidering enrollment in a Medičare health plan. What
should you advise her to do before she will be able to enroll into a
Medičare health plan?
In order to join a Medičare plan, she also must enroll in Part B.
Mrs. Park is an elderly retiree. She has a low, fixed inčome. What
čould you tell Mrs. Park that might be of assistanče?
She should čontačt her state Medičaid agenčy to see if she qualifies
for one of several programs that čan help with Medičare čosts for
whičh she is responsible.
