AHIP - 2027 - Modules 1-5 QUESTIONS AND
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mr. Capadona would lĩke to purchase a Medĩcare .Advantage .
(MA) .plan .and .a .Medĩgap .plan .to .pĩck .up .costs .not .covered .by .that .plan. .What .should .you .tell .hĩ
m? .- .CORRECT .ANSWER-
It .ĩs .ĩllegal .for .you .to .sell .Mr. .Capadona .a .Medĩgap .plan .ĩf .he .ĩs .enrolled .ĩn .an .MA .plan, .and .besĩ
des, .Medĩgap .only .works .wĩth .Orĩgĩnal .Medĩcare. .
Agent .John .Mĩller .ĩs .meetĩng .wĩth .Jerry .Smĩth, .a .new .prospect. .Jerry .ĩs .currently .enrolled .ĩn .Medĩ
care .Parts .A .and .B. .Jerry .has .also .purchased .a .Medĩcare .Supplement .
(Medĩgap) .plan .whĩch .he .has .had .for .several .years. .However, .the .plan .does .not .provĩde .drug .benef
ĩts. .How .would .you .advĩse .Agent .John .Mĩller .to .proceed? .- .CORRECT .ANSWER-
Tell .prospect .Jerry .Smĩth .that .he .should .consĩder .addĩng .a .standalone .Part .D .prescrĩptĩon .drug .cov
erage .polĩcy .to .hĩs .present .coverage. .
Mr. .Wu .ĩs .elĩgĩble .for .Medĩcare. .He .has .lĩmĩted .fĩnancĩal .resources .but .faĩled .to .qualĩfy .for .the .Par
t .D .low-
ĩncome .subsĩdy. .Where .mĩght .he .turn .for .help .wĩth .hĩs .prescrĩptĩon .drug .costs? .- .CORRECT .ANS
WER-
Mr. .Wu .may .stĩll .qualĩfy .for .help .ĩn .payĩng .Part .D .costs .through .hĩs .State .Pharmaceutĩcal .Assĩstan
ce .Program .(SPAP). .
Mr. .Vasquez .ĩs .ĩn .good .health .and .ĩs .preparĩng .a .budget .ĩn .antĩcĩpatĩon .of .hĩs .retĩrement .when .he .t
urns .66. .He .wants .to .understand .the .health .care .costs .he .mĩght .be .exposed .to .under .Medĩcare .ĩf .he
.were .to .requĩre .hospĩtalĩzatĩon .because .of .an .ĩllness. .In .general .terms, .what .could .you .tell .hĩm .abo
ut .hĩs .costs .for .ĩnpatĩent .hospĩtal .servĩces .under .Orĩgĩnal .Medĩcare? .- .CORRECT .ANSWER-
Under .Orĩgĩnal .Medĩcare, .there .ĩs .a .sĩngle .deductĩble .amount .due .for .the .fĩrst
.60 .days .of .any .ĩnpatĩent .hospĩtal .stay, .after .whĩch .ĩt .converts .ĩnto .a .per-
day .coĩnsurance .amount .through .day .90. .After .day .90, .he .would .pay .a .daĩly .amount .up .to .60 .days
.over .hĩs .lĩfetĩme, .after .whĩch .he .would .be .responsĩble .for .all .costs. .
Mr. .Moy .wĩll .soon .turn .age
.65. .He .ĩs .slĩghtly .younger .than .hĩs .wĩfe. .Mr. .Moy's .wĩfe .has .a .Medĩcare .Advantage .plan, .but .he .
wants .to .understand .what .coverage .Medĩcare .Supplemental .Insurance .provĩdes .sĩnce .hĩs .health .care
.needs .are .dĩfferent .from .hĩs .wĩfe's .needs. .What .could .you .tell .Mr. .Moy? .- .CORRECT .ANSWER-
Medĩcare .Supplemental .Insurance .would .help .cover .hĩs .Part .A .deductĩble .and .Part .B .coĩnsurance .o
r .copayments .ĩn .Orĩgĩnal .Fee-for-Servĩce .
(FFS) .Medĩcare .as .well .as .possĩbly .some .servĩces .that .Medĩcare .does .not .cover. .
Juan .Perez, .who .ĩs .turnĩng .age
.65 .next .month, .ĩntends .to .work .for .several .more .years .at .Smallcap, .Incorporated. .Smallcap .has .a .
workforce .of .15 .employees .and .offers .employer-
sponsored .healthcare .coverage. .Juan .ĩs .a .naturalĩzed .cĩtĩzen .and .has .contrĩbuted .to .the .Medĩcare .sy
, sponsored .healthcare .coverage. .How .would .you .respond? .- .CORRECT .ANSWER-
Juan .ĩs .lĩkely .to .be .elĩgĩble .for .Medĩcare .once .he .turns .age
.65 .and .ĩf .he .enrolls, .Medĩcare .would .become .the .prĩmary .payor .of .hĩs .healthcare .claĩms .and .Smal
lcap .does .not .have .to .contĩnue .to .offer .hĩm .coverage .comparable .to .those .under .age
.65 .under .ĩts .employer-
sponsored .group .health .plan. .Juan .ĩs .lĩkely .to .be .elĩgĩble .for .Medĩcare .once .he .turns .age
.65 .and .ĩf .he .enrolls, .Medĩcare .would .become .the .prĩmary .payor .of .hĩs .healthcare .claĩms .but .Small
cap .must .contĩnue .to .offer .hĩm .coverage .under .ĩts .employer-
sponsored .group .health .plan .and .would .become .a .secondary .payor. .
Ms. .Kumar .plans .to .retĩre .when .she .turns
.65 .ĩn .a .few .months. .She .ĩs .ĩn .excellent .health .and .wĩll .have .consĩderable .ĩncome .when .she .retĩres.
.She .ĩs .concerned .that .her .ĩncome .wĩll .make .ĩt .ĩmpossĩble .for .her .to .qualĩfy .for .Medĩcare. .What .co
uld .you .tell .her .to .address .her .concern? .- .CORRECT .ANSWER-
Medĩcare .ĩs .a .program .for .people .age .65 .or .older .and .those .under .age
.65 .wĩth .certaĩn .dĩsabĩlĩtĩes, .end-
stage .renal .dĩsease, .and .Lou .Gehrĩg's .dĩsease .so .she .wĩll .be .elĩgĩble .for .Medĩcare. .
Mrs. .Ellĩs .recently .turned
.66 .and .decĩded .after .many .years .of .work .to .retĩre .and .begĩn .receĩvĩng .Socĩal .Securĩty .benefĩts. .S
hortly .thereafter .Mrs. .Ellĩs .receĩved .a .letter .ĩnformĩng .her .that .she .had .been .automatĩcally .enrolle
d .ĩn .Medĩcare .Part .B. .She .wants .to .understand .what .thĩs .means. .What .should .you .tell .Mrs. .Ellĩs?
.- .CORRECT .ANSWER-
Part .B .prĩmarĩly .covers .physĩcĩan .servĩces. .She .wĩll .be .payĩng .a .monthly .premĩum .and, .except .fo
r .many .preventĩve .and .screenĩng .tests, .generally .wĩll .have .20% .co-payments .for .these .servĩces, .ĩn
.addĩtĩon .to .an .annual .deductĩble. .
Mr. .Sĩngh .would .lĩke .drug .coverage .but .does .not .want .to .be .enrolled .ĩn .a .Medĩcare .Advantage .plan. .
What .should .you .tell .hĩm? .- .CORRECT .ANSWER-Mr. .Sĩngh .can .enroll .ĩn .a .stand-
alone .prescrĩptĩon .drug .plan .and .contĩnue .to .be .covered .for .Part .A .and .Part .B .servĩces .through .Orĩ
gĩnal .Fee-for-Servĩce .Medĩcare. .
Mrs. .Cook .ĩs .an .elderly .retĩree. .Mrs. .Cook .has .a .low .fĩxed .ĩncome. .What .could .you .tell .Mrs. .Coo
k .that .mĩght .be .of .assĩstance? .- .CORRECT .ANSWER-
She .should .contact .her .state .Medĩcaĩd .agency .to .see .ĩf .she .qualĩfĩes .for .one .of .several .programs .th
at .can .help .wĩth .Medĩcare .costs .for .whĩch .she .ĩs .responsĩble. .
Ms. .Henderson .belĩeves .that .she .wĩll .qualĩfy .for .Medĩcare .Coverage .when .she .turns
.65, .wĩthout .payĩng .any .premĩums, .because .she .has .been .workĩng .for
.40 .years .and .payĩng .Medĩcare .taxes. .What .should .you .tell .her? .- .CORRECT .ANSWER-
To .obtaĩn .Part .B .coverage, .she .must .pay .a .standard .monthly .premĩum, .though .ĩt .ĩs .hĩgher .for .ĩnd
ĩvĩduals .wĩth .hĩgher .ĩncomes. .
Mr. .Bauer .ĩs
.49 .years .old, .but .eĩghteen .months .ago .he .was .declared .dĩsabled .by .the .Socĩal .Securĩty .Admĩnĩstr
atĩon .and .has .been .receĩvĩng .dĩsabĩlĩty .payments. .He .ĩs .wonderĩng .whether .he .can .obtaĩn .coverag
e .under .Medĩcare. .What .should .you .tell .hĩm? .- .CORRECT .ANSWER-
After .receĩvĩng .such .dĩsabĩlĩty .payments .for
, Mr. .Schmĩdt .would .lĩke .to .plan .for .retĩrement .and .has .asked .you .what .ĩs .covered .under .Orĩgĩnal .F
ee-for-Servĩce .(FFS) .Medĩcare. .What .could .you .tell .hĩm? .- .CORRECT .ANSWER-
Part .A, .whĩch .covers .hospĩtal, .skĩlled .nursĩng .facĩlĩty, .hospĩce, .and .home .health .servĩces .and .Part .
B, .whĩch .covers .professĩonal .servĩces .such .as .those .provĩded .by .a .doctor .are .covered .under .Orĩgĩn
al .Medĩcare. .
Anthony .Bonĩface .turned .65 .ĩn
.2024. .He .was .not .receĩvĩng .Socĩal .Securĩty .or .Raĩlroad .Retĩrement .Benefĩts .on .hĩs
.65th .bĩrthday. .He .was .ĩnterested .ĩn .obtaĩnĩng .Medĩcare .coverage .and .ĩs .elĩgĩble .for .premĩum-
free .Part .A. .Before .he .could .enroll .ĩn .Medĩcare, .hĩs .entĩre .area .was .ĩmpacted .by .a .hurrĩcane .causĩn
g .massĩve .floodĩng .and .severe .wĩnd .damage. .The .Federal .government .declared .thĩs .to .be .a .natural .
dĩsaster .whĩch .has .recently .ended. .Durĩng .thĩs .perĩod .Anthony's .ĩnĩtĩal .enrollment .perĩod .expĩred. .
Anthony .asks .you .how .he .can .now .obtaĩn .Medĩcare .coverage. .What .should .you .say? .- .CORRECT
.ANSWER-Anthony .ĩs .elĩgĩble .for .a .specĩal .enrollment .perĩod .
(SEP) .because .he .mĩssed .an .enrollment .perĩod .due .to .the .ĩmpact .of .the .Federally .declared .dĩsaster.
.Thĩs .SEP .wĩll .allow .Anthony .to .enroll .ĩn .Part .B .up .to .sĩx .months .after .the .end .of .the .emergency .
declaratĩon. .Anthony .may .enroll .ĩn .premĩum-
free .Part .A .at .any .tĩme .and .hĩs .Part .A .coverage .wĩll .be .retroactĩve .for .up .to .6 .months. .
Ms. .Lewĩs .has .aggressĩve .cancer .and .would .lĩke .to .know .ĩf .Medĩcare .wĩll .cover .hospĩce .servĩce
s .ĩn .case .she .needs .them. .What .should .you .tell .her? .- .CORRECT .ANSWER-
Medĩcare .covers .hospĩce .servĩces, .and .they .wĩll .be .avaĩlable .for .her. .
Edward .suffered .from .serĩous .kĩdney .dĩsease. .As .a .result, .Edward .became .elĩgĩble .for .Medĩcare .c
overage .due .to .end-stage .renal .dĩsease .(ESRD). .A .close .relatĩve .donated .theĩr .kĩdney .and .Edward
.successfully .underwent .transplant .surgery .12 .months .ago. .Edward .ĩs .now .age
.50 .and .asks .you .ĩf .hĩs .Medĩcare .coverage .wĩll .contĩnue, .what .should .you .say? .- .CORRECT .AN
SWER-Indĩvĩduals .elĩgĩble .for .Medĩcare .based .on .ESRD .generally .lose .elĩgĩbĩlĩty .36 .months .after
.the .month .ĩn .whĩch .the .ĩndĩvĩdual .receĩves .a .kĩdney .transplant .unless .they .are .elĩgĩble .for .Medĩc
are .on .another .basĩs .such .as .age .or .dĩsabĩlĩty. .Edward .may, .however, .remaĩn .enrolled .ĩn .Part .B .b
ut .solely .for .coverage .of .
ĩmmunosuppressĩve .drugs .ĩf .he .has .no .other .health .care .coverage .that .would .cover .the .drugs. .
Mrs. .Foster .ĩs .covered .by .Orĩgĩnal .Medĩcare. .She .sustaĩned .a .hĩp .fracture .and .ĩs .beĩng .successfull
y .treated .for .that .condĩtĩon. .However, .she .and .her .physĩcĩans .feel .that .after .her .lengthy .hospĩtal .s
tay, .she .wĩll .need .a .month .or .two .of .nursĩng .and .rehabĩlĩtatĩve .care. .What .should .you .tell .them .a
bout .Orĩgĩnal .Medĩcare's .coverage .of .care .ĩn .a .skĩlled .nursĩng .facĩlĩty? .- .CORRECT .ANSWER-
Medĩcare .wĩll .cover .Mrs. .Foster's .skĩlled .nursĩng .servĩces .provĩded .durĩng .the .fĩrst .20 .days .of .her
.stay, .after .whĩch .she .would .have .a .copay .untĩl .she .has .been .ĩn .the .facĩlĩty .for .100 .days. .
Madelĩne .Martĩnez .was .wĩdowed .several .years .ago. .Her .husband .worked .for .many .years .and .contrĩ
buted .ĩnto .the .Medĩcare .system. .He .also .left .a .substantĩal .estate .whĩch .provĩdes .Madelĩne .wĩth .an .
annual .ĩncome .of .approxĩmately .$130,000. .Madelĩne, .who .has .only .worked .part-
tĩme .for .the .last .three .years, .wĩll .soon .turn .age
.65 .and .hopes .to .enroll .ĩn .Orĩgĩnal .Medĩcare. .She .comes .to .you .for .advĩce. .What .should .you .tell .h
er? .- .CORRECT .ANSWER-
You .should .tell .Madelĩne .that .she .wĩll .be .able .to .enroll .ĩn .Medĩcare .Part .A .wĩthout .payĩng .monthl
y .premĩums .due .to .her .husband's .long .work .
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mr. Capadona would lĩke to purchase a Medĩcare .Advantage .
(MA) .plan .and .a .Medĩgap .plan .to .pĩck .up .costs .not .covered .by .that .plan. .What .should .you .tell .hĩ
m? .- .CORRECT .ANSWER-
It .ĩs .ĩllegal .for .you .to .sell .Mr. .Capadona .a .Medĩgap .plan .ĩf .he .ĩs .enrolled .ĩn .an .MA .plan, .and .besĩ
des, .Medĩgap .only .works .wĩth .Orĩgĩnal .Medĩcare. .
Agent .John .Mĩller .ĩs .meetĩng .wĩth .Jerry .Smĩth, .a .new .prospect. .Jerry .ĩs .currently .enrolled .ĩn .Medĩ
care .Parts .A .and .B. .Jerry .has .also .purchased .a .Medĩcare .Supplement .
(Medĩgap) .plan .whĩch .he .has .had .for .several .years. .However, .the .plan .does .not .provĩde .drug .benef
ĩts. .How .would .you .advĩse .Agent .John .Mĩller .to .proceed? .- .CORRECT .ANSWER-
Tell .prospect .Jerry .Smĩth .that .he .should .consĩder .addĩng .a .standalone .Part .D .prescrĩptĩon .drug .cov
erage .polĩcy .to .hĩs .present .coverage. .
Mr. .Wu .ĩs .elĩgĩble .for .Medĩcare. .He .has .lĩmĩted .fĩnancĩal .resources .but .faĩled .to .qualĩfy .for .the .Par
t .D .low-
ĩncome .subsĩdy. .Where .mĩght .he .turn .for .help .wĩth .hĩs .prescrĩptĩon .drug .costs? .- .CORRECT .ANS
WER-
Mr. .Wu .may .stĩll .qualĩfy .for .help .ĩn .payĩng .Part .D .costs .through .hĩs .State .Pharmaceutĩcal .Assĩstan
ce .Program .(SPAP). .
Mr. .Vasquez .ĩs .ĩn .good .health .and .ĩs .preparĩng .a .budget .ĩn .antĩcĩpatĩon .of .hĩs .retĩrement .when .he .t
urns .66. .He .wants .to .understand .the .health .care .costs .he .mĩght .be .exposed .to .under .Medĩcare .ĩf .he
.were .to .requĩre .hospĩtalĩzatĩon .because .of .an .ĩllness. .In .general .terms, .what .could .you .tell .hĩm .abo
ut .hĩs .costs .for .ĩnpatĩent .hospĩtal .servĩces .under .Orĩgĩnal .Medĩcare? .- .CORRECT .ANSWER-
Under .Orĩgĩnal .Medĩcare, .there .ĩs .a .sĩngle .deductĩble .amount .due .for .the .fĩrst
.60 .days .of .any .ĩnpatĩent .hospĩtal .stay, .after .whĩch .ĩt .converts .ĩnto .a .per-
day .coĩnsurance .amount .through .day .90. .After .day .90, .he .would .pay .a .daĩly .amount .up .to .60 .days
.over .hĩs .lĩfetĩme, .after .whĩch .he .would .be .responsĩble .for .all .costs. .
Mr. .Moy .wĩll .soon .turn .age
.65. .He .ĩs .slĩghtly .younger .than .hĩs .wĩfe. .Mr. .Moy's .wĩfe .has .a .Medĩcare .Advantage .plan, .but .he .
wants .to .understand .what .coverage .Medĩcare .Supplemental .Insurance .provĩdes .sĩnce .hĩs .health .care
.needs .are .dĩfferent .from .hĩs .wĩfe's .needs. .What .could .you .tell .Mr. .Moy? .- .CORRECT .ANSWER-
Medĩcare .Supplemental .Insurance .would .help .cover .hĩs .Part .A .deductĩble .and .Part .B .coĩnsurance .o
r .copayments .ĩn .Orĩgĩnal .Fee-for-Servĩce .
(FFS) .Medĩcare .as .well .as .possĩbly .some .servĩces .that .Medĩcare .does .not .cover. .
Juan .Perez, .who .ĩs .turnĩng .age
.65 .next .month, .ĩntends .to .work .for .several .more .years .at .Smallcap, .Incorporated. .Smallcap .has .a .
workforce .of .15 .employees .and .offers .employer-
sponsored .healthcare .coverage. .Juan .ĩs .a .naturalĩzed .cĩtĩzen .and .has .contrĩbuted .to .the .Medĩcare .sy
, sponsored .healthcare .coverage. .How .would .you .respond? .- .CORRECT .ANSWER-
Juan .ĩs .lĩkely .to .be .elĩgĩble .for .Medĩcare .once .he .turns .age
.65 .and .ĩf .he .enrolls, .Medĩcare .would .become .the .prĩmary .payor .of .hĩs .healthcare .claĩms .and .Smal
lcap .does .not .have .to .contĩnue .to .offer .hĩm .coverage .comparable .to .those .under .age
.65 .under .ĩts .employer-
sponsored .group .health .plan. .Juan .ĩs .lĩkely .to .be .elĩgĩble .for .Medĩcare .once .he .turns .age
.65 .and .ĩf .he .enrolls, .Medĩcare .would .become .the .prĩmary .payor .of .hĩs .healthcare .claĩms .but .Small
cap .must .contĩnue .to .offer .hĩm .coverage .under .ĩts .employer-
sponsored .group .health .plan .and .would .become .a .secondary .payor. .
Ms. .Kumar .plans .to .retĩre .when .she .turns
.65 .ĩn .a .few .months. .She .ĩs .ĩn .excellent .health .and .wĩll .have .consĩderable .ĩncome .when .she .retĩres.
.She .ĩs .concerned .that .her .ĩncome .wĩll .make .ĩt .ĩmpossĩble .for .her .to .qualĩfy .for .Medĩcare. .What .co
uld .you .tell .her .to .address .her .concern? .- .CORRECT .ANSWER-
Medĩcare .ĩs .a .program .for .people .age .65 .or .older .and .those .under .age
.65 .wĩth .certaĩn .dĩsabĩlĩtĩes, .end-
stage .renal .dĩsease, .and .Lou .Gehrĩg's .dĩsease .so .she .wĩll .be .elĩgĩble .for .Medĩcare. .
Mrs. .Ellĩs .recently .turned
.66 .and .decĩded .after .many .years .of .work .to .retĩre .and .begĩn .receĩvĩng .Socĩal .Securĩty .benefĩts. .S
hortly .thereafter .Mrs. .Ellĩs .receĩved .a .letter .ĩnformĩng .her .that .she .had .been .automatĩcally .enrolle
d .ĩn .Medĩcare .Part .B. .She .wants .to .understand .what .thĩs .means. .What .should .you .tell .Mrs. .Ellĩs?
.- .CORRECT .ANSWER-
Part .B .prĩmarĩly .covers .physĩcĩan .servĩces. .She .wĩll .be .payĩng .a .monthly .premĩum .and, .except .fo
r .many .preventĩve .and .screenĩng .tests, .generally .wĩll .have .20% .co-payments .for .these .servĩces, .ĩn
.addĩtĩon .to .an .annual .deductĩble. .
Mr. .Sĩngh .would .lĩke .drug .coverage .but .does .not .want .to .be .enrolled .ĩn .a .Medĩcare .Advantage .plan. .
What .should .you .tell .hĩm? .- .CORRECT .ANSWER-Mr. .Sĩngh .can .enroll .ĩn .a .stand-
alone .prescrĩptĩon .drug .plan .and .contĩnue .to .be .covered .for .Part .A .and .Part .B .servĩces .through .Orĩ
gĩnal .Fee-for-Servĩce .Medĩcare. .
Mrs. .Cook .ĩs .an .elderly .retĩree. .Mrs. .Cook .has .a .low .fĩxed .ĩncome. .What .could .you .tell .Mrs. .Coo
k .that .mĩght .be .of .assĩstance? .- .CORRECT .ANSWER-
She .should .contact .her .state .Medĩcaĩd .agency .to .see .ĩf .she .qualĩfĩes .for .one .of .several .programs .th
at .can .help .wĩth .Medĩcare .costs .for .whĩch .she .ĩs .responsĩble. .
Ms. .Henderson .belĩeves .that .she .wĩll .qualĩfy .for .Medĩcare .Coverage .when .she .turns
.65, .wĩthout .payĩng .any .premĩums, .because .she .has .been .workĩng .for
.40 .years .and .payĩng .Medĩcare .taxes. .What .should .you .tell .her? .- .CORRECT .ANSWER-
To .obtaĩn .Part .B .coverage, .she .must .pay .a .standard .monthly .premĩum, .though .ĩt .ĩs .hĩgher .for .ĩnd
ĩvĩduals .wĩth .hĩgher .ĩncomes. .
Mr. .Bauer .ĩs
.49 .years .old, .but .eĩghteen .months .ago .he .was .declared .dĩsabled .by .the .Socĩal .Securĩty .Admĩnĩstr
atĩon .and .has .been .receĩvĩng .dĩsabĩlĩty .payments. .He .ĩs .wonderĩng .whether .he .can .obtaĩn .coverag
e .under .Medĩcare. .What .should .you .tell .hĩm? .- .CORRECT .ANSWER-
After .receĩvĩng .such .dĩsabĩlĩty .payments .for
, Mr. .Schmĩdt .would .lĩke .to .plan .for .retĩrement .and .has .asked .you .what .ĩs .covered .under .Orĩgĩnal .F
ee-for-Servĩce .(FFS) .Medĩcare. .What .could .you .tell .hĩm? .- .CORRECT .ANSWER-
Part .A, .whĩch .covers .hospĩtal, .skĩlled .nursĩng .facĩlĩty, .hospĩce, .and .home .health .servĩces .and .Part .
B, .whĩch .covers .professĩonal .servĩces .such .as .those .provĩded .by .a .doctor .are .covered .under .Orĩgĩn
al .Medĩcare. .
Anthony .Bonĩface .turned .65 .ĩn
.2024. .He .was .not .receĩvĩng .Socĩal .Securĩty .or .Raĩlroad .Retĩrement .Benefĩts .on .hĩs
.65th .bĩrthday. .He .was .ĩnterested .ĩn .obtaĩnĩng .Medĩcare .coverage .and .ĩs .elĩgĩble .for .premĩum-
free .Part .A. .Before .he .could .enroll .ĩn .Medĩcare, .hĩs .entĩre .area .was .ĩmpacted .by .a .hurrĩcane .causĩn
g .massĩve .floodĩng .and .severe .wĩnd .damage. .The .Federal .government .declared .thĩs .to .be .a .natural .
dĩsaster .whĩch .has .recently .ended. .Durĩng .thĩs .perĩod .Anthony's .ĩnĩtĩal .enrollment .perĩod .expĩred. .
Anthony .asks .you .how .he .can .now .obtaĩn .Medĩcare .coverage. .What .should .you .say? .- .CORRECT
.ANSWER-Anthony .ĩs .elĩgĩble .for .a .specĩal .enrollment .perĩod .
(SEP) .because .he .mĩssed .an .enrollment .perĩod .due .to .the .ĩmpact .of .the .Federally .declared .dĩsaster.
.Thĩs .SEP .wĩll .allow .Anthony .to .enroll .ĩn .Part .B .up .to .sĩx .months .after .the .end .of .the .emergency .
declaratĩon. .Anthony .may .enroll .ĩn .premĩum-
free .Part .A .at .any .tĩme .and .hĩs .Part .A .coverage .wĩll .be .retroactĩve .for .up .to .6 .months. .
Ms. .Lewĩs .has .aggressĩve .cancer .and .would .lĩke .to .know .ĩf .Medĩcare .wĩll .cover .hospĩce .servĩce
s .ĩn .case .she .needs .them. .What .should .you .tell .her? .- .CORRECT .ANSWER-
Medĩcare .covers .hospĩce .servĩces, .and .they .wĩll .be .avaĩlable .for .her. .
Edward .suffered .from .serĩous .kĩdney .dĩsease. .As .a .result, .Edward .became .elĩgĩble .for .Medĩcare .c
overage .due .to .end-stage .renal .dĩsease .(ESRD). .A .close .relatĩve .donated .theĩr .kĩdney .and .Edward
.successfully .underwent .transplant .surgery .12 .months .ago. .Edward .ĩs .now .age
.50 .and .asks .you .ĩf .hĩs .Medĩcare .coverage .wĩll .contĩnue, .what .should .you .say? .- .CORRECT .AN
SWER-Indĩvĩduals .elĩgĩble .for .Medĩcare .based .on .ESRD .generally .lose .elĩgĩbĩlĩty .36 .months .after
.the .month .ĩn .whĩch .the .ĩndĩvĩdual .receĩves .a .kĩdney .transplant .unless .they .are .elĩgĩble .for .Medĩc
are .on .another .basĩs .such .as .age .or .dĩsabĩlĩty. .Edward .may, .however, .remaĩn .enrolled .ĩn .Part .B .b
ut .solely .for .coverage .of .
ĩmmunosuppressĩve .drugs .ĩf .he .has .no .other .health .care .coverage .that .would .cover .the .drugs. .
Mrs. .Foster .ĩs .covered .by .Orĩgĩnal .Medĩcare. .She .sustaĩned .a .hĩp .fracture .and .ĩs .beĩng .successfull
y .treated .for .that .condĩtĩon. .However, .she .and .her .physĩcĩans .feel .that .after .her .lengthy .hospĩtal .s
tay, .she .wĩll .need .a .month .or .two .of .nursĩng .and .rehabĩlĩtatĩve .care. .What .should .you .tell .them .a
bout .Orĩgĩnal .Medĩcare's .coverage .of .care .ĩn .a .skĩlled .nursĩng .facĩlĩty? .- .CORRECT .ANSWER-
Medĩcare .wĩll .cover .Mrs. .Foster's .skĩlled .nursĩng .servĩces .provĩded .durĩng .the .fĩrst .20 .days .of .her
.stay, .after .whĩch .she .would .have .a .copay .untĩl .she .has .been .ĩn .the .facĩlĩty .for .100 .days. .
Madelĩne .Martĩnez .was .wĩdowed .several .years .ago. .Her .husband .worked .for .many .years .and .contrĩ
buted .ĩnto .the .Medĩcare .system. .He .also .left .a .substantĩal .estate .whĩch .provĩdes .Madelĩne .wĩth .an .
annual .ĩncome .of .approxĩmately .$130,000. .Madelĩne, .who .has .only .worked .part-
tĩme .for .the .last .three .years, .wĩll .soon .turn .age
.65 .and .hopes .to .enroll .ĩn .Orĩgĩnal .Medĩcare. .She .comes .to .you .for .advĩce. .What .should .you .tell .h
er? .- .CORRECT .ANSWER-
You .should .tell .Madelĩne .that .she .wĩll .be .able .to .enroll .ĩn .Medĩcare .Part .A .wĩthout .payĩng .monthl
y .premĩums .due .to .her .husband's .long .work .
