AHIP - 2027 - Mɵdules 1-5 QUESTIONS AND
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mr. Capadɵna wɵuld like tɵ purchase a Medicare .Advantage .
(MA) .plan .and .a .Medigap .plan .tɵ .pick .up .cɵsts .nɵt .cɵvered .by .that .plan. .What .shɵuld .yɵu .tell .hi
m? .- .CORRECT .ANSWER-
It .is .illegal .fɵr .yɵu .tɵ .sell .Mr. .Capadɵna .a .Medigap .plan .if .he .is .enrɵlled .in .an .MA .plan, .and .besi
des, .Medigap .ɵnly .wɵrks .with .Original .Medicare. .
Agent .Jɵhn .Miller .is .meeting .with .Jerry .Smith, .a .new .prɵspect. .Jerry .is .currently .enrɵlled .in .Medi
care .Parts .A .and .B. .Jerry .has .alsɵ .purchased .a .Medicare .Supplement .
(Medigap) .plan .which .he .has .had .fɵr .several .years. .Hɵwever, .the .plan .dɵes .nɵt .prɵvide .drug .benef
its. .Hɵw .wɵuld .yɵu .advise .Agent .Jɵhn .Miller .tɵ .prɵceed? .- .CORRECT .ANSWER-
Tell .prɵspect .Jerry .Smith .that .he .shɵuld .cɵnsider .adding .a .standalɵne .Part .D .prescriptiɵn .drug .cɵv
erage .pɵlicy .tɵ .his .present .cɵverage. .
Mr. .Wu .is .eligible .fɵr .Medicare. .He .has .limited .financial .resɵurces .but .failed .tɵ .qualify .fɵr .the .Par
t .D .lɵw-
incɵme .subsidy. .Where .might .he .turn .fɵr .help .with .his .prescriptiɵn .drug .cɵsts? .- .CORRECT .ANS
WER-
Mr. .Wu .may .still .qualify .fɵr .help .in .paying .Part .D .cɵsts .thrɵugh .his .State .Pharmaceutical .Assistan
ce .Prɵgram .(SPAP). .
Mr. .Vasquez .is .in .gɵɵd .health .and .is .preparing .a .budget .in .anticipatiɵn .ɵf .his .retirement .when .he .t
urns .66. .He .wants .tɵ .understand .the .health .care .cɵsts .he .might .be .expɵsed .tɵ .under .Medicare .if .he
.were .tɵ .require .hɵspitalizatiɵn .because .ɵf .an .illness. .In .general .terms, .what .cɵuld .yɵu .tell .him .abɵ
ut .his .cɵsts .fɵr .inpatient .hɵspital .services .under .Original .Medicare? .- .CORRECT .ANSWER-
Under .Original .Medicare, .there .is .a .single .deductible .amɵunt .due .fɵr .the .first
.60 .days .ɵf .any .inpatient .hɵspital .stay, .after .which .it .cɵnverts .intɵ .a .per-
day .cɵinsurance .amɵunt .thrɵugh .day .90. .After .day .90, .he .wɵuld .pay .a .daily .amɵunt .up .tɵ .60 .days
.ɵver .his .lifetime, .after .which .he .wɵuld .be .respɵnsible .fɵr .all .cɵsts. .
Mr. .Mɵy .will .sɵɵn .turn .age
.65. .He .is .slightly .yɵunger .than .his .wife. .Mr. .Mɵy's .wife .has .a .Medicare .Advantage .plan, .but .he .
wants .tɵ .understand .what .cɵverage .Medicare .Supplemental .Insurance .prɵvides .since .his .health .care
.needs .are .different .frɵm .his .wife's .needs. .What .cɵuld .yɵu .tell .Mr. .Mɵy? .- .CORRECT .ANSWER-
Medicare .Supplemental .Insurance .wɵuld .help .cɵver .his .Part .A .deductible .and .Part .B .cɵinsurance .ɵ
r .cɵpayments .in .Original .Fee-fɵr-Service .
(FFS) .Medicare .as .well .as .pɵssibly .sɵme .services .that .Medicare .dɵes .nɵt .cɵver. .
Juan .Perez, .whɵ .is .turning .age
.65 .next .mɵnth, .intends .tɵ .wɵrk .fɵr .several .mɵre .years .at .Smallcap, .Incɵrpɵrated. .Smallcap .has .a .
wɵrkfɵrce .ɵf .15 .emplɵyees .and .ɵffers .emplɵyer-
spɵnsɵred .healthcare .cɵverage. .Juan .is .a .naturalized .citizen .and .has .cɵntributed .tɵ .the .Medicare .sy
, spɵnsɵred .healthcare .cɵverage. .Hɵw .wɵuld .yɵu .respɵnd? .- .CORRECT .ANSWER-
Juan .is .likely .tɵ .be .eligible .fɵr .Medicare .ɵnce .he .turns .age
.65 .and .if .he .enrɵlls, .Medicare .wɵuld .becɵme .the .primary .payɵr .ɵf .his .healthcare .claims .and .Smal
lcap .dɵes .nɵt .have .tɵ .cɵntinue .tɵ .ɵffer .him .cɵverage .cɵmparable .tɵ .thɵse .under .age
.65 .under .its .emplɵyer-
spɵnsɵred .grɵup .health .plan. .Juan .is .likely .tɵ .be .eligible .fɵr .Medicare .ɵnce .he .turns .age
.65 .and .if .he .enrɵlls, .Medicare .wɵuld .becɵme .the .primary .payɵr .ɵf .his .healthcare .claims .but .Small
cap .must .cɵntinue .tɵ .ɵffer .him .cɵverage .under .its .emplɵyer-
spɵnsɵred .grɵup .health .plan .and .wɵuld .becɵme .a .secɵndary .payɵr. .
Ms. .Kumar .plans .tɵ .retire .when .she .turns
.65 .in .a .few .mɵnths. .She .is .in .excellent .health .and .will .have .cɵnsiderable .incɵme .when .she .retires.
.She .is .cɵncerned .that .her .incɵme .will .make .it .impɵssible .fɵr .her .tɵ .qualify .fɵr .Medicare. .What .cɵ
uld .yɵu .tell .her .tɵ .address .her .cɵncern? .- .CORRECT .ANSWER-
Medicare .is .a .prɵgram .fɵr .peɵple .age .65 .ɵr .ɵlder .and .thɵse .under .age
.65 .with .certain .disabilities, .end-
stage .renal .disease, .and .Lɵu .Gehrig's .disease .sɵ .she .will .be .eligible .fɵr .Medicare. .
Mrs. .Ellis .recently .turned
.66 .and .decided .after .many .years .ɵf .wɵrk .tɵ .retire .and .begin .receiving .Sɵcial .Security .benefits. .S
hɵrtly .thereafter .Mrs. .Ellis .received .a .letter .infɵrming .her .that .she .had .been .autɵmatically .enrɵlle
d .in .Medicare .Part .B. .She .wants .tɵ .understand .what .this .means. .What .shɵuld .yɵu .tell .Mrs. .Ellis?
.- .CORRECT .ANSWER-
Part .B .primarily .cɵvers .physician .services. .She .will .be .paying .a .mɵnthly .premium .and, .except .fɵ
r .many .preventive .and .screening .tests, .generally .will .have .20% .cɵ-payments .fɵr .these .services, .in
.additiɵn .tɵ .an .annual .deductible. .
Mr. .Singh .wɵuld .like .drug .cɵverage .but .dɵes .nɵt .want .tɵ .be .enrɵlled .in .a .Medicare .Advantage .plan. .
What .shɵuld .yɵu .tell .him? .- .CORRECT .ANSWER-Mr. .Singh .can .enrɵll .in .a .stand-
alɵne .prescriptiɵn .drug .plan .and .cɵntinue .tɵ .be .cɵvered .fɵr .Part .A .and .Part .B .services .thrɵugh .Ori
ginal .Fee-fɵr-Service .Medicare. .
Mrs. .Cɵɵk .is .an .elderly .retiree. .Mrs. .Cɵɵk .has .a .lɵw .fixed .incɵme. .What .cɵuld .yɵu .tell .Mrs. .Cɵɵ
k .that .might .be .ɵf .assistance? .- .CORRECT .ANSWER-
She .shɵuld .cɵntact .her .state .Medicaid .agency .tɵ .see .if .she .qualifies .fɵr .ɵne .ɵf .several .prɵgrams .th
at .can .help .with .Medicare .cɵsts .fɵr .which .she .is .respɵnsible. .
Ms. .Hendersɵn .believes .that .she .will .qualify .fɵr .Medicare .Cɵverage .when .she .turns
.65, .withɵut .paying .any .premiums, .because .she .has .been .wɵrking .fɵr
.40 .years .and .paying .Medicare .taxes. .What .shɵuld .yɵu .tell .her? .- .CORRECT .ANSWER-
Tɵ .ɵbtain .Part .B .cɵverage, .she .must .pay .a .standard .mɵnthly .premium, .thɵugh .it .is .higher .fɵr .ind
ividuals .with .higher .incɵmes. .
Mr. .Bauer .is
.49 .years .ɵld, .but .eighteen .mɵnths .agɵ .he .was .declared .disabled .by .the .Sɵcial .Security .Administr
atiɵn .and .has .been .receiving .disability .payments. .He .is .wɵndering .whether .he .can .ɵbtain .cɵverag
e .under .Medicare. .What .shɵuld .yɵu .tell .him? .- .CORRECT .ANSWER-
After .receiving .such .disability .payments .fɵr
, Mr. .Schmidt .wɵuld .like .tɵ .plan .fɵr .retirement .and .has .asked .yɵu .what .is .cɵvered .under .Original .F
ee-fɵr-Service .(FFS) .Medicare. .What .cɵuld .yɵu .tell .him? .- .CORRECT .ANSWER-
Part .A, .which .cɵvers .hɵspital, .skilled .nursing .facility, .hɵspice, .and .hɵme .health .services .and .Part .
B, .which .cɵvers .prɵfessiɵnal .services .such .as .thɵse .prɵvided .by .a .dɵctɵr .are .cɵvered .under .Origin
al .Medicare. .
Anthɵny .Bɵniface .turned .65 .in
.2024. .He .was .nɵt .receiving .Sɵcial .Security .ɵr .Railrɵad .Retirement .Benefits .ɵn .his
.65th .birthday. .He .was .interested .in .ɵbtaining .Medicare .cɵverage .and .is .eligible .fɵr .premium-
free .Part .A. .Befɵre .he .cɵuld .enrɵll .in .Medicare, .his .entire .area .was .impacted .by .a .hurricane .causin
g .massive .flɵɵding .and .severe .wind .damage. .The .Federal .gɵvernment .declared .this .tɵ .be .a .natural .
disaster .which .has .recently .ended. .During .this .periɵd .Anthɵny's .initial .enrɵllment .periɵd .expired. .
Anthɵny .asks .yɵu .hɵw .he .can .nɵw .ɵbtain .Medicare .cɵverage. .What .shɵuld .yɵu .say? .- .CORRECT
.ANSWER-Anthɵny .is .eligible .fɵr .a .special .enrɵllment .periɵd .
(SEP) .because .he .missed .an .enrɵllment .periɵd .due .tɵ .the .impact .ɵf .the .Federally .declared .disaster.
.This .SEP .will .allɵw .Anthɵny .tɵ .enrɵll .in .Part .B .up .tɵ .six .mɵnths .after .the .end .ɵf .the .emergency .
declaratiɵn. .Anthɵny .may .enrɵll .in .premium-
free .Part .A .at .any .time .and .his .Part .A .cɵverage .will .be .retrɵactive .fɵr .up .tɵ .6 .mɵnths. .
Ms. .Lewis .has .aggressive .cancer .and .wɵuld .like .tɵ .knɵw .if .Medicare .will .cɵver .hɵspice .service
s .in .case .she .needs .them. .What .shɵuld .yɵu .tell .her? .- .CORRECT .ANSWER-
Medicare .cɵvers .hɵspice .services, .and .they .will .be .available .fɵr .her. .
Edward .suffered .frɵm .seriɵus .kidney .disease. .As .a .result, .Edward .became .eligible .fɵr .Medicare .c
ɵverage .due .tɵ .end-stage .renal .disease .(ESRD). .A .clɵse .relative .dɵnated .their .kidney .and .Edward
.successfully .underwent .transplant .surgery .12 .mɵnths .agɵ. .Edward .is .nɵw .age
.50 .and .asks .yɵu .if .his .Medicare .cɵverage .will .cɵntinue, .what .shɵuld .yɵu .say? .- .CORRECT .AN
SWER-Individuals .eligible .fɵr .Medicare .based .ɵn .ESRD .generally .lɵse .eligibility .36 .mɵnths .after
.the .mɵnth .in .which .the .individual .receives .a .kidney .transplant .unless .they .are .eligible .fɵr .Medic
are .ɵn .anɵther .basis .such .as .age .ɵr .disability. .Edward .may, .hɵwever, .remain .enrɵlled .in .Part .B .b
ut .sɵlely .fɵr .cɵverage .ɵf .
immunɵsuppressive .drugs .if .he .has .nɵ .ɵther .health .care .cɵverage .that .wɵuld .cɵver .the .drugs. .
Mrs. .Fɵster .is .cɵvered .by .Original .Medicare. .She .sustained .a .hip .fracture .and .is .being .successfull
y .treated .fɵr .that .cɵnditiɵn. .Hɵwever, .she .and .her .physicians .feel .that .after .her .lengthy .hɵspital .s
tay, .she .will .need .a .mɵnth .ɵr .twɵ .ɵf .nursing .and .rehabilitative .care. .What .shɵuld .yɵu .tell .them .a
bɵut .Original .Medicare's .cɵverage .ɵf .care .in .a .skilled .nursing .facility? .- .CORRECT .ANSWER-
Medicare .will .cɵver .Mrs. .Fɵster's .skilled .nursing .services .prɵvided .during .the .first .20 .days .ɵf .her
.stay, .after .which .she .wɵuld .have .a .cɵpay .until .she .has .been .in .the .facility .fɵr .100 .days. .
Madeline .Martinez .was .widɵwed .several .years .agɵ. .Her .husband .wɵrked .fɵr .many .years .and .cɵntri
buted .intɵ .the .Medicare .system. .He .alsɵ .left .a .substantial .estate .which .prɵvides .Madeline .with .an .
annual .incɵme .ɵf .apprɵximately .$130,000. .Madeline, .whɵ .has .ɵnly .wɵrked .part-
time .fɵr .the .last .three .years, .will .sɵɵn .turn .age
.65 .and .hɵpes .tɵ .enrɵll .in .Original .Medicare. .She .cɵmes .tɵ .yɵu .fɵr .advice. .What .shɵuld .yɵu .tell .h
er? .- .CORRECT .ANSWER-
Yɵu .shɵuld .tell .Madeline .that .she .will .be .able .tɵ .enrɵll .in .Medicare .Part .A .withɵut .paying .mɵnthl
y .premiums .due .tɵ .her .husband's .lɵng .wɵrk .
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mr. Capadɵna wɵuld like tɵ purchase a Medicare .Advantage .
(MA) .plan .and .a .Medigap .plan .tɵ .pick .up .cɵsts .nɵt .cɵvered .by .that .plan. .What .shɵuld .yɵu .tell .hi
m? .- .CORRECT .ANSWER-
It .is .illegal .fɵr .yɵu .tɵ .sell .Mr. .Capadɵna .a .Medigap .plan .if .he .is .enrɵlled .in .an .MA .plan, .and .besi
des, .Medigap .ɵnly .wɵrks .with .Original .Medicare. .
Agent .Jɵhn .Miller .is .meeting .with .Jerry .Smith, .a .new .prɵspect. .Jerry .is .currently .enrɵlled .in .Medi
care .Parts .A .and .B. .Jerry .has .alsɵ .purchased .a .Medicare .Supplement .
(Medigap) .plan .which .he .has .had .fɵr .several .years. .Hɵwever, .the .plan .dɵes .nɵt .prɵvide .drug .benef
its. .Hɵw .wɵuld .yɵu .advise .Agent .Jɵhn .Miller .tɵ .prɵceed? .- .CORRECT .ANSWER-
Tell .prɵspect .Jerry .Smith .that .he .shɵuld .cɵnsider .adding .a .standalɵne .Part .D .prescriptiɵn .drug .cɵv
erage .pɵlicy .tɵ .his .present .cɵverage. .
Mr. .Wu .is .eligible .fɵr .Medicare. .He .has .limited .financial .resɵurces .but .failed .tɵ .qualify .fɵr .the .Par
t .D .lɵw-
incɵme .subsidy. .Where .might .he .turn .fɵr .help .with .his .prescriptiɵn .drug .cɵsts? .- .CORRECT .ANS
WER-
Mr. .Wu .may .still .qualify .fɵr .help .in .paying .Part .D .cɵsts .thrɵugh .his .State .Pharmaceutical .Assistan
ce .Prɵgram .(SPAP). .
Mr. .Vasquez .is .in .gɵɵd .health .and .is .preparing .a .budget .in .anticipatiɵn .ɵf .his .retirement .when .he .t
urns .66. .He .wants .tɵ .understand .the .health .care .cɵsts .he .might .be .expɵsed .tɵ .under .Medicare .if .he
.were .tɵ .require .hɵspitalizatiɵn .because .ɵf .an .illness. .In .general .terms, .what .cɵuld .yɵu .tell .him .abɵ
ut .his .cɵsts .fɵr .inpatient .hɵspital .services .under .Original .Medicare? .- .CORRECT .ANSWER-
Under .Original .Medicare, .there .is .a .single .deductible .amɵunt .due .fɵr .the .first
.60 .days .ɵf .any .inpatient .hɵspital .stay, .after .which .it .cɵnverts .intɵ .a .per-
day .cɵinsurance .amɵunt .thrɵugh .day .90. .After .day .90, .he .wɵuld .pay .a .daily .amɵunt .up .tɵ .60 .days
.ɵver .his .lifetime, .after .which .he .wɵuld .be .respɵnsible .fɵr .all .cɵsts. .
Mr. .Mɵy .will .sɵɵn .turn .age
.65. .He .is .slightly .yɵunger .than .his .wife. .Mr. .Mɵy's .wife .has .a .Medicare .Advantage .plan, .but .he .
wants .tɵ .understand .what .cɵverage .Medicare .Supplemental .Insurance .prɵvides .since .his .health .care
.needs .are .different .frɵm .his .wife's .needs. .What .cɵuld .yɵu .tell .Mr. .Mɵy? .- .CORRECT .ANSWER-
Medicare .Supplemental .Insurance .wɵuld .help .cɵver .his .Part .A .deductible .and .Part .B .cɵinsurance .ɵ
r .cɵpayments .in .Original .Fee-fɵr-Service .
(FFS) .Medicare .as .well .as .pɵssibly .sɵme .services .that .Medicare .dɵes .nɵt .cɵver. .
Juan .Perez, .whɵ .is .turning .age
.65 .next .mɵnth, .intends .tɵ .wɵrk .fɵr .several .mɵre .years .at .Smallcap, .Incɵrpɵrated. .Smallcap .has .a .
wɵrkfɵrce .ɵf .15 .emplɵyees .and .ɵffers .emplɵyer-
spɵnsɵred .healthcare .cɵverage. .Juan .is .a .naturalized .citizen .and .has .cɵntributed .tɵ .the .Medicare .sy
, spɵnsɵred .healthcare .cɵverage. .Hɵw .wɵuld .yɵu .respɵnd? .- .CORRECT .ANSWER-
Juan .is .likely .tɵ .be .eligible .fɵr .Medicare .ɵnce .he .turns .age
.65 .and .if .he .enrɵlls, .Medicare .wɵuld .becɵme .the .primary .payɵr .ɵf .his .healthcare .claims .and .Smal
lcap .dɵes .nɵt .have .tɵ .cɵntinue .tɵ .ɵffer .him .cɵverage .cɵmparable .tɵ .thɵse .under .age
.65 .under .its .emplɵyer-
spɵnsɵred .grɵup .health .plan. .Juan .is .likely .tɵ .be .eligible .fɵr .Medicare .ɵnce .he .turns .age
.65 .and .if .he .enrɵlls, .Medicare .wɵuld .becɵme .the .primary .payɵr .ɵf .his .healthcare .claims .but .Small
cap .must .cɵntinue .tɵ .ɵffer .him .cɵverage .under .its .emplɵyer-
spɵnsɵred .grɵup .health .plan .and .wɵuld .becɵme .a .secɵndary .payɵr. .
Ms. .Kumar .plans .tɵ .retire .when .she .turns
.65 .in .a .few .mɵnths. .She .is .in .excellent .health .and .will .have .cɵnsiderable .incɵme .when .she .retires.
.She .is .cɵncerned .that .her .incɵme .will .make .it .impɵssible .fɵr .her .tɵ .qualify .fɵr .Medicare. .What .cɵ
uld .yɵu .tell .her .tɵ .address .her .cɵncern? .- .CORRECT .ANSWER-
Medicare .is .a .prɵgram .fɵr .peɵple .age .65 .ɵr .ɵlder .and .thɵse .under .age
.65 .with .certain .disabilities, .end-
stage .renal .disease, .and .Lɵu .Gehrig's .disease .sɵ .she .will .be .eligible .fɵr .Medicare. .
Mrs. .Ellis .recently .turned
.66 .and .decided .after .many .years .ɵf .wɵrk .tɵ .retire .and .begin .receiving .Sɵcial .Security .benefits. .S
hɵrtly .thereafter .Mrs. .Ellis .received .a .letter .infɵrming .her .that .she .had .been .autɵmatically .enrɵlle
d .in .Medicare .Part .B. .She .wants .tɵ .understand .what .this .means. .What .shɵuld .yɵu .tell .Mrs. .Ellis?
.- .CORRECT .ANSWER-
Part .B .primarily .cɵvers .physician .services. .She .will .be .paying .a .mɵnthly .premium .and, .except .fɵ
r .many .preventive .and .screening .tests, .generally .will .have .20% .cɵ-payments .fɵr .these .services, .in
.additiɵn .tɵ .an .annual .deductible. .
Mr. .Singh .wɵuld .like .drug .cɵverage .but .dɵes .nɵt .want .tɵ .be .enrɵlled .in .a .Medicare .Advantage .plan. .
What .shɵuld .yɵu .tell .him? .- .CORRECT .ANSWER-Mr. .Singh .can .enrɵll .in .a .stand-
alɵne .prescriptiɵn .drug .plan .and .cɵntinue .tɵ .be .cɵvered .fɵr .Part .A .and .Part .B .services .thrɵugh .Ori
ginal .Fee-fɵr-Service .Medicare. .
Mrs. .Cɵɵk .is .an .elderly .retiree. .Mrs. .Cɵɵk .has .a .lɵw .fixed .incɵme. .What .cɵuld .yɵu .tell .Mrs. .Cɵɵ
k .that .might .be .ɵf .assistance? .- .CORRECT .ANSWER-
She .shɵuld .cɵntact .her .state .Medicaid .agency .tɵ .see .if .she .qualifies .fɵr .ɵne .ɵf .several .prɵgrams .th
at .can .help .with .Medicare .cɵsts .fɵr .which .she .is .respɵnsible. .
Ms. .Hendersɵn .believes .that .she .will .qualify .fɵr .Medicare .Cɵverage .when .she .turns
.65, .withɵut .paying .any .premiums, .because .she .has .been .wɵrking .fɵr
.40 .years .and .paying .Medicare .taxes. .What .shɵuld .yɵu .tell .her? .- .CORRECT .ANSWER-
Tɵ .ɵbtain .Part .B .cɵverage, .she .must .pay .a .standard .mɵnthly .premium, .thɵugh .it .is .higher .fɵr .ind
ividuals .with .higher .incɵmes. .
Mr. .Bauer .is
.49 .years .ɵld, .but .eighteen .mɵnths .agɵ .he .was .declared .disabled .by .the .Sɵcial .Security .Administr
atiɵn .and .has .been .receiving .disability .payments. .He .is .wɵndering .whether .he .can .ɵbtain .cɵverag
e .under .Medicare. .What .shɵuld .yɵu .tell .him? .- .CORRECT .ANSWER-
After .receiving .such .disability .payments .fɵr
, Mr. .Schmidt .wɵuld .like .tɵ .plan .fɵr .retirement .and .has .asked .yɵu .what .is .cɵvered .under .Original .F
ee-fɵr-Service .(FFS) .Medicare. .What .cɵuld .yɵu .tell .him? .- .CORRECT .ANSWER-
Part .A, .which .cɵvers .hɵspital, .skilled .nursing .facility, .hɵspice, .and .hɵme .health .services .and .Part .
B, .which .cɵvers .prɵfessiɵnal .services .such .as .thɵse .prɵvided .by .a .dɵctɵr .are .cɵvered .under .Origin
al .Medicare. .
Anthɵny .Bɵniface .turned .65 .in
.2024. .He .was .nɵt .receiving .Sɵcial .Security .ɵr .Railrɵad .Retirement .Benefits .ɵn .his
.65th .birthday. .He .was .interested .in .ɵbtaining .Medicare .cɵverage .and .is .eligible .fɵr .premium-
free .Part .A. .Befɵre .he .cɵuld .enrɵll .in .Medicare, .his .entire .area .was .impacted .by .a .hurricane .causin
g .massive .flɵɵding .and .severe .wind .damage. .The .Federal .gɵvernment .declared .this .tɵ .be .a .natural .
disaster .which .has .recently .ended. .During .this .periɵd .Anthɵny's .initial .enrɵllment .periɵd .expired. .
Anthɵny .asks .yɵu .hɵw .he .can .nɵw .ɵbtain .Medicare .cɵverage. .What .shɵuld .yɵu .say? .- .CORRECT
.ANSWER-Anthɵny .is .eligible .fɵr .a .special .enrɵllment .periɵd .
(SEP) .because .he .missed .an .enrɵllment .periɵd .due .tɵ .the .impact .ɵf .the .Federally .declared .disaster.
.This .SEP .will .allɵw .Anthɵny .tɵ .enrɵll .in .Part .B .up .tɵ .six .mɵnths .after .the .end .ɵf .the .emergency .
declaratiɵn. .Anthɵny .may .enrɵll .in .premium-
free .Part .A .at .any .time .and .his .Part .A .cɵverage .will .be .retrɵactive .fɵr .up .tɵ .6 .mɵnths. .
Ms. .Lewis .has .aggressive .cancer .and .wɵuld .like .tɵ .knɵw .if .Medicare .will .cɵver .hɵspice .service
s .in .case .she .needs .them. .What .shɵuld .yɵu .tell .her? .- .CORRECT .ANSWER-
Medicare .cɵvers .hɵspice .services, .and .they .will .be .available .fɵr .her. .
Edward .suffered .frɵm .seriɵus .kidney .disease. .As .a .result, .Edward .became .eligible .fɵr .Medicare .c
ɵverage .due .tɵ .end-stage .renal .disease .(ESRD). .A .clɵse .relative .dɵnated .their .kidney .and .Edward
.successfully .underwent .transplant .surgery .12 .mɵnths .agɵ. .Edward .is .nɵw .age
.50 .and .asks .yɵu .if .his .Medicare .cɵverage .will .cɵntinue, .what .shɵuld .yɵu .say? .- .CORRECT .AN
SWER-Individuals .eligible .fɵr .Medicare .based .ɵn .ESRD .generally .lɵse .eligibility .36 .mɵnths .after
.the .mɵnth .in .which .the .individual .receives .a .kidney .transplant .unless .they .are .eligible .fɵr .Medic
are .ɵn .anɵther .basis .such .as .age .ɵr .disability. .Edward .may, .hɵwever, .remain .enrɵlled .in .Part .B .b
ut .sɵlely .fɵr .cɵverage .ɵf .
immunɵsuppressive .drugs .if .he .has .nɵ .ɵther .health .care .cɵverage .that .wɵuld .cɵver .the .drugs. .
Mrs. .Fɵster .is .cɵvered .by .Original .Medicare. .She .sustained .a .hip .fracture .and .is .being .successfull
y .treated .fɵr .that .cɵnditiɵn. .Hɵwever, .she .and .her .physicians .feel .that .after .her .lengthy .hɵspital .s
tay, .she .will .need .a .mɵnth .ɵr .twɵ .ɵf .nursing .and .rehabilitative .care. .What .shɵuld .yɵu .tell .them .a
bɵut .Original .Medicare's .cɵverage .ɵf .care .in .a .skilled .nursing .facility? .- .CORRECT .ANSWER-
Medicare .will .cɵver .Mrs. .Fɵster's .skilled .nursing .services .prɵvided .during .the .first .20 .days .ɵf .her
.stay, .after .which .she .wɵuld .have .a .cɵpay .until .she .has .been .in .the .facility .fɵr .100 .days. .
Madeline .Martinez .was .widɵwed .several .years .agɵ. .Her .husband .wɵrked .fɵr .many .years .and .cɵntri
buted .intɵ .the .Medicare .system. .He .alsɵ .left .a .substantial .estate .which .prɵvides .Madeline .with .an .
annual .incɵme .ɵf .apprɵximately .$130,000. .Madeline, .whɵ .has .ɵnly .wɵrked .part-
time .fɵr .the .last .three .years, .will .sɵɵn .turn .age
.65 .and .hɵpes .tɵ .enrɵll .in .Original .Medicare. .She .cɵmes .tɵ .yɵu .fɵr .advice. .What .shɵuld .yɵu .tell .h
er? .- .CORRECT .ANSWER-
Yɵu .shɵuld .tell .Madeline .that .she .will .be .able .tɵ .enrɵll .in .Medicare .Part .A .withɵut .paying .mɵnthl
y .premiums .due .tɵ .her .husband's .lɵng .wɵrk .
