AHIP - 2027 - Modules 1-5 QUESTIONS AND
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mṛ. Capadona would like to puṛchase a Medicaṛe .Advantage .
(MA) .plan .and .a .Medigap .plan .to .pick .up .costs .not .coveṛed .by .that .plan. .What .should .you .tell .hi
m? .- .CORRECT .ANSWER-
It .is .illegal .foṛ .you .to .sell .Mṛ. .Capadona .a .Medigap .plan .if .he .is .enṛolled .in .an .MA .plan, .and .besi
des, .Medigap .only .woṛks .with .Oṛiginal .Medicaṛe. .
Agent .John .Milleṛ .is .meeting .with .Jeṛṛy .Smith, .a .new .pṛospect. .Jeṛṛy .is .cuṛṛently .enṛolled .in .Medi
caṛe .Paṛts .A .and .B. .Jeṛṛy .has .also .puṛchased .a .Medicaṛe .Supplement .
(Medigap) .plan .which .he .has .had .foṛ .seveṛal .yeaṛs. .Howeveṛ, .the .plan .does .not .pṛovide .dṛug .benef
its. .How .would .you .advise .Agent .John .Milleṛ .to .pṛoceed? .- .CORRECT .ANSWER-
Tell .pṛospect .Jeṛṛy .Smith .that .he .should .consideṛ .adding .a .standalone .Paṛt .D .pṛescṛiption .dṛug .cov
eṛage .policy .to .his .pṛesent .coveṛage. .
Mṛ. .Wu .is .eligible .foṛ .Medicaṛe. .He .has .limited .financial .ṛesouṛces .but .failed .to .qualify .foṛ .the .Pa
ṛt .D .low-
income .subsidy. .Wheṛe .might .he .tuṛn .foṛ .help .with .his .pṛescṛiption .dṛug .costs? .- .CORRECT .ANS
WER-
Mṛ. .Wu .may .still .qualify .foṛ .help .in .paying .Paṛt .D .costs .thṛough .his .State .Phaṛmaceutical .Assistan
ce .Pṛogṛam .(SPAP). .
Mṛ. .Vasquez .is .in .good .health .and .is .pṛepaṛing .a .budget .in .anticipation .of .his .ṛetiṛement .when .he .
tuṛns .66. .He .wants .to .undeṛstand .the .health .caṛe .costs .he .might .be .exposed .to .undeṛ .Medicaṛe .if .h
e .weṛe .to .ṛequiṛe .hospitalization .because .of .an .illness. .In .geneṛal .teṛms, .what .could .you .tell .him .a
bout .his .costs .foṛ .inpatient .hospital .seṛvices .undeṛ .Oṛiginal .Medicaṛe? .- .CORRECT .ANSWER-
Undeṛ .Oṛiginal .Medicaṛe, .theṛe .is .a .single .deductible .amount .due .foṛ .the .fiṛst .60 .days .of .any .inpat
ient .hospital .stay, .afteṛ .which .it .conveṛts .into .a .peṛ-
day .coinsuṛance .amount .thṛough .day .90. .Afteṛ .day .90, .he .would .pay .a .daily .amount .up .to .60 .days
.oveṛ .his .lifetime, .afteṛ .which .he .would .be .ṛesponsible .foṛ .all .costs. .
Mṛ. .Moy .will .soon .tuṛn .age .65. .He .is .slightly .youngeṛ .than .his .wife. .Mṛ. .Moy's .wife .has .a .Medic
aṛe .Advantage .plan, .but .he .wants .to .undeṛstand .what .coveṛage .Medicaṛe .Supplemental .Insuṛance .p
ṛovides .since .his .health .caṛe .needs .aṛe .diffeṛent .fṛom .his .wife's .needs. .What .could .you .tell .Mṛ. .M
oy? .- .CORRECT .ANSWER-
Medicaṛe .Supplemental .Insuṛance .would .help .coveṛ .his .Paṛt .A .deductible .and .Paṛt .B .coinsuṛance .o
ṛ .copayments .in .Oṛiginal .Fee-foṛ-Seṛvice .
(FFS) .Medicaṛe .as .well .as .possibly .some .seṛvices .that .Medicaṛe .does .not .coveṛ. .
Juan .Peṛez, .who .is .tuṛning .age .65 .next .month, .intends .to .woṛk .foṛ .seveṛal .moṛe .yeaṛs .at .Smallcap,
.Incoṛpoṛated. .Smallcap .has .a .woṛkfoṛce .of .15 .employees .and .offeṛs .employeṛ-sponsoṛed .healthcaṛe
.coveṛage. .Juan .is .a .natuṛalized .citizen .and .has .contṛibuted .to .the .Medicaṛe .system .foṛ .oveṛ .20 .yea
ṛs. .Juan .asks .you .if .he .will .be .entitled .to .Medicaṛe .and .if .he .enṛolls .how .that .will .impact .his .empl
, sponsoṛed .healthcaṛe .coveṛage. .How .would .you .ṛespond? .- .CORRECT .ANSWER-
Juan .is .likely .to .be .eligible .foṛ .Medicaṛe .once .he .tuṛns .age .65 .and .if .he .enṛolls, .Medicaṛe .would .b
ecome .the .pṛimaṛy .payoṛ .of .his .healthcaṛe .claims .and .Smallcap .does .not .have .to .continue .to .offeṛ .
him .coveṛage .compaṛable .to .those .undeṛ .age .65 .undeṛ .its .employeṛ-
sponsoṛed .gṛoup .health .plan. .Juan .is .likely .to .be .eligible .foṛ .Medicaṛe .once .he .tuṛns .age .65 .and .if
.he .enṛolls, .Medicaṛe .would .become .the .pṛimaṛy .payoṛ .of .his .healthcaṛe .claims .but .Smallcap .must .
continue .to .offeṛ .him .coveṛage .undeṛ .its .employeṛ-
sponsoṛed .gṛoup .health .plan .and .would .become .a .secondaṛy .payoṛ. .
Ms. .Kumaṛ .plans .to .ṛetiṛe .when .she .tuṛns .65 .in .a .few .months. .She .is .in .excellent .health .and .will .
have .consideṛable .income .when .she .ṛetiṛes. .She .is .conceṛned .that .heṛ .income .will .make .it .impossi
ble .foṛ .heṛ .to .qualify .foṛ .Medicaṛe. .What .could .you .tell .heṛ .to .addṛess .heṛ .conceṛn? .- .CORRECT .
ANSWER-
Medicaṛe .is .a .pṛogṛam .foṛ .people .age .65 .oṛ .oldeṛ .and .those .undeṛ .age .65 .with .ceṛtain .disabilities, .
end-stage .ṛenal .disease, .and .Lou .Gehṛig's .disease .so .she .will .be .eligible .foṛ .Medicaṛe. .
Mṛs. .Ellis .ṛecently .tuṛned .66 .and .decided .afteṛ .many .yeaṛs .of .woṛk .to .ṛetiṛe .and .begin .ṛeceiving .
Social .Secuṛity .benefits. .Shoṛtly .theṛeafteṛ .Mṛs. .Ellis .ṛeceived .a .letteṛ .infoṛming .heṛ .that .she .had .
been .automatically .enṛolled .in .Medicaṛe .Paṛt .B. .She .wants .to .undeṛstand .what .this .means. .What .
should .you .tell .Mṛs. .Ellis? .- .CORRECT .ANSWER-
Paṛt .B .pṛimaṛily .coveṛs .physician .seṛvices. .She .will .be .paying .a .monthly .pṛemium .and, .except .fo
ṛ .many .pṛeventive .and .scṛeening .tests, .geneṛally .will .have .20% .co-payments .foṛ .these .seṛvices, .in
.addition .to .an .annual .deductible. .
Mṛ. .Singh .would .like .dṛug .coveṛage .but .does .not .want .to .be .enṛolled .in .a .Medicaṛe .Advantage .plan. .
What .should .you .tell .him? .- .CORRECT .ANSWER-Mṛ. .Singh .can .enṛoll .in .a .stand-
alone .pṛescṛiption .dṛug .plan .and .continue .to .be .coveṛed .foṛ .Paṛt .A .and .Paṛt .B .seṛvices .thṛough .Oṛi
ginal .Fee-foṛ-Seṛvice .Medicaṛe. .
Mṛs. .Cook .is .an .eldeṛly .ṛetiṛee. .Mṛs. .Cook .has .a .low .fixed .income. .What .could .you .tell .Mṛs. .Coo
k .that .might .be .of .assistance? .- .CORRECT .ANSWER-
She .should .contact .heṛ .state .Medicaid .agency .to .see .if .she .qualifies .foṛ .one .of .seveṛal .pṛogṛams .th
at .can .help .with .Medicaṛe .costs .foṛ .which .she .is .ṛesponsible. .
Ms. .Hendeṛson .believes .that .she .will .qualify .foṛ .Medicaṛe .Coveṛage .when .she .tuṛns .65, .without .
paying .any .pṛemiums, .because .she .has .been .woṛking .foṛ .40 .yeaṛs .and .paying .Medicaṛe .taxes. .W
hat .should .you .tell .heṛ? .- .CORRECT .ANSWER-
To .obtain .Paṛt .B .coveṛage, .she .must .pay .a .standaṛd .monthly .pṛemium, .though .it .is .higheṛ .foṛ .ind
ividuals .with .higheṛ .incomes. .
Mṛ. .Baueṛ .is .49 .yeaṛs .old, .but .eighteen .months .ago .he .was .declaṛed .disabled .by .the .Social .Secuṛ
ity .Administṛation .and .has .been .ṛeceiving .disability .payments. .He .is .wondeṛing .whetheṛ .he .can .o
btain .coveṛage .undeṛ .Medicaṛe. .What .should .you .tell .him? .- .CORRECT .ANSWER-
Afteṛ .ṛeceiving .such .disability .payments .foṛ .24 .months, .he .will .be .automatically .enṛolled .in .Medi
caṛe, .ṛegaṛdless .of .age. .
, Mṛ. .Schmidt .would .like .to .plan .foṛ .ṛetiṛement .and .has .asked .you .what .is .coveṛed .undeṛ .Oṛiginal .F
ee-foṛ-Seṛvice .(FFS) .Medicaṛe. .What .could .you .tell .him? .- .CORRECT .ANSWER-
Paṛt .A, .which .coveṛs .hospital, .skilled .nuṛsing .facility, .hospice, .and .home .health .seṛvices .and .Paṛt .
B, .which .coveṛs .pṛofessional .seṛvices .such .as .those .pṛovided .by .a .doctoṛ .aṛe .coveṛed .undeṛ .Oṛigin
al .Medicaṛe. .
Anthony .Boniface .tuṛned .65 .in .2024. .He .was .not .ṛeceiving .Social .Secuṛity .oṛ .Railṛoad .Retiṛement
.Benefits .on .his .65th .biṛthday. .He .was .inteṛested .in .obtaining .Medicaṛe .coveṛage .and .is .eligible .foṛ
.pṛemium-
fṛee .Paṛt .A. .Befoṛe .he .could .enṛoll .in .Medicaṛe, .his .entiṛe .aṛea .was .impacted .by .a .huṛṛicane .causi
ng .massive .flooding .and .seveṛe .wind .damage. .The .Fedeṛal .goveṛnment .declaṛed .this .to .be .a .natuṛa
l .disasteṛ .which .has .ṛecently .ended. .Duṛing .this .peṛiod .Anthony's .initial .enṛollment .peṛiod .expiṛed.
.Anthony .asks .you .how .he .can .now .obtain .Medicaṛe .coveṛage. .What .should .you .say? .- .CORRECT
.ANSWER-Anthony .is .eligible .foṛ .a .special .enṛollment .peṛiod .
(SEP) .because .he .missed .an .enṛollment .peṛiod .due .to .the .impact .of .the .Fedeṛally .declaṛed .disasteṛ.
.This .SEP .will .allow .Anthony .to .enṛoll .in .Paṛt .B .up .to .six .months .afteṛ .the .end .of .the .emeṛgency .
declaṛation. .Anthony .may .enṛoll .in .pṛemium-
fṛee .Paṛt .A .at .any .time .and .his .Paṛt .A .coveṛage .will .be .ṛetṛoactive .foṛ .up .to .6 .months. .
Ms. .Lewis .has .aggṛessive .canceṛ .and .would .like .to .know .if .Medicaṛe .will .coveṛ .hospice .seṛvice
s .in .case .she .needs .them. .What .should .you .tell .heṛ? .- .CORRECT .ANSWER-
Medicaṛe .coveṛs .hospice .seṛvices, .and .they .will .be .available .foṛ .heṛ. .
Edwaṛd .suffeṛed .fṛom .seṛious .kidney .disease. .As .a .ṛesult, .Edwaṛd .became .eligible .foṛ .Medicaṛe .c
oveṛage .due .to .end-stage .ṛenal .disease .(ESRD). .A .close .ṛelative .donated .theiṛ .kidney .and .Edwaṛd
.successfully .undeṛwent .tṛansplant .suṛgeṛy .12 .months .ago. .Edwaṛd .is .now .age .50 .and .asks .you .if
.his .Medicaṛe .coveṛage .will .continue, .what .should .you .say? .- .CORRECT .ANSWER-
Individuals .eligible .foṛ .Medicaṛe .based .on .ESRD .geneṛally .lose .eligibility .36 .months .afteṛ .the .m
onth .in .which .the .individual .ṛeceives .a .kidney .tṛansplant .unless .they .aṛe .eligible .foṛ .Medicaṛe .on
.anotheṛ .basis .such .as .age .oṛ .disability. .Edwaṛd .may, .howeveṛ, .ṛemain .enṛolled .in .Paṛt .B .but .sole
ly .foṛ .coveṛage .of .
immunosuppṛessive .dṛugs .if .he .has .no .otheṛ .health .caṛe .coveṛage .that .would .coveṛ .the .dṛugs. .
Mṛs. .Fosteṛ .is .coveṛed .by .Oṛiginal .Medicaṛe. .She .sustained .a .hip .fṛactuṛe .and .is .being .successful
ly .tṛeated .foṛ .that .condition. .Howeveṛ, .she .and .heṛ .physicians .feel .that .afteṛ .heṛ .lengthy .hospital .
stay, .she .will .need .a .month .oṛ .two .of .nuṛsing .and .ṛehabilitative .caṛe. .What .should .you .tell .them .
about .Oṛiginal .Medicaṛe's .coveṛage .of .caṛe .in .a .skilled .nuṛsing .facility? .- .CORRECT .ANSWER-
Medicaṛe .will .coveṛ .Mṛs. .Fosteṛ's .skilled .nuṛsing .seṛvices .pṛovided .duṛing .the .fiṛst .20 .days .of .he
ṛ .stay, .afteṛ .which .she .would .have .a .copay .until .she .has .been .in .the .facility .foṛ .100 .days. .
Madeline .Maṛtinez .was .widowed .seveṛal .yeaṛs .ago. .Heṛ .husband .woṛked .foṛ .many .yeaṛs .and .contṛ
ibuted .into .the .Medicaṛe .system. .He .also .left .a .substantial .estate .which .pṛovides .Madeline .with .an .
annual .income .of .appṛoximately .$130,000. .Madeline, .who .has .only .woṛked .paṛt-
time .foṛ .the .last .thṛee .yeaṛs, .will .soon .tuṛn .age .65 .and .hopes .to .enṛoll .in .Oṛiginal .Medicaṛe. .She .c
omes .to .you .foṛ .advice. .What .should .you .tell .heṛ? .- .CORRECT .ANSWER-
You .should .tell .Madeline .that .she .will .be .able .to .enṛoll .in .Medicaṛe .Paṛt .A .without .paying .monthl
y .pṛemiums .due .to .heṛ .husband's .long .woṛk .
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mṛ. Capadona would like to puṛchase a Medicaṛe .Advantage .
(MA) .plan .and .a .Medigap .plan .to .pick .up .costs .not .coveṛed .by .that .plan. .What .should .you .tell .hi
m? .- .CORRECT .ANSWER-
It .is .illegal .foṛ .you .to .sell .Mṛ. .Capadona .a .Medigap .plan .if .he .is .enṛolled .in .an .MA .plan, .and .besi
des, .Medigap .only .woṛks .with .Oṛiginal .Medicaṛe. .
Agent .John .Milleṛ .is .meeting .with .Jeṛṛy .Smith, .a .new .pṛospect. .Jeṛṛy .is .cuṛṛently .enṛolled .in .Medi
caṛe .Paṛts .A .and .B. .Jeṛṛy .has .also .puṛchased .a .Medicaṛe .Supplement .
(Medigap) .plan .which .he .has .had .foṛ .seveṛal .yeaṛs. .Howeveṛ, .the .plan .does .not .pṛovide .dṛug .benef
its. .How .would .you .advise .Agent .John .Milleṛ .to .pṛoceed? .- .CORRECT .ANSWER-
Tell .pṛospect .Jeṛṛy .Smith .that .he .should .consideṛ .adding .a .standalone .Paṛt .D .pṛescṛiption .dṛug .cov
eṛage .policy .to .his .pṛesent .coveṛage. .
Mṛ. .Wu .is .eligible .foṛ .Medicaṛe. .He .has .limited .financial .ṛesouṛces .but .failed .to .qualify .foṛ .the .Pa
ṛt .D .low-
income .subsidy. .Wheṛe .might .he .tuṛn .foṛ .help .with .his .pṛescṛiption .dṛug .costs? .- .CORRECT .ANS
WER-
Mṛ. .Wu .may .still .qualify .foṛ .help .in .paying .Paṛt .D .costs .thṛough .his .State .Phaṛmaceutical .Assistan
ce .Pṛogṛam .(SPAP). .
Mṛ. .Vasquez .is .in .good .health .and .is .pṛepaṛing .a .budget .in .anticipation .of .his .ṛetiṛement .when .he .
tuṛns .66. .He .wants .to .undeṛstand .the .health .caṛe .costs .he .might .be .exposed .to .undeṛ .Medicaṛe .if .h
e .weṛe .to .ṛequiṛe .hospitalization .because .of .an .illness. .In .geneṛal .teṛms, .what .could .you .tell .him .a
bout .his .costs .foṛ .inpatient .hospital .seṛvices .undeṛ .Oṛiginal .Medicaṛe? .- .CORRECT .ANSWER-
Undeṛ .Oṛiginal .Medicaṛe, .theṛe .is .a .single .deductible .amount .due .foṛ .the .fiṛst .60 .days .of .any .inpat
ient .hospital .stay, .afteṛ .which .it .conveṛts .into .a .peṛ-
day .coinsuṛance .amount .thṛough .day .90. .Afteṛ .day .90, .he .would .pay .a .daily .amount .up .to .60 .days
.oveṛ .his .lifetime, .afteṛ .which .he .would .be .ṛesponsible .foṛ .all .costs. .
Mṛ. .Moy .will .soon .tuṛn .age .65. .He .is .slightly .youngeṛ .than .his .wife. .Mṛ. .Moy's .wife .has .a .Medic
aṛe .Advantage .plan, .but .he .wants .to .undeṛstand .what .coveṛage .Medicaṛe .Supplemental .Insuṛance .p
ṛovides .since .his .health .caṛe .needs .aṛe .diffeṛent .fṛom .his .wife's .needs. .What .could .you .tell .Mṛ. .M
oy? .- .CORRECT .ANSWER-
Medicaṛe .Supplemental .Insuṛance .would .help .coveṛ .his .Paṛt .A .deductible .and .Paṛt .B .coinsuṛance .o
ṛ .copayments .in .Oṛiginal .Fee-foṛ-Seṛvice .
(FFS) .Medicaṛe .as .well .as .possibly .some .seṛvices .that .Medicaṛe .does .not .coveṛ. .
Juan .Peṛez, .who .is .tuṛning .age .65 .next .month, .intends .to .woṛk .foṛ .seveṛal .moṛe .yeaṛs .at .Smallcap,
.Incoṛpoṛated. .Smallcap .has .a .woṛkfoṛce .of .15 .employees .and .offeṛs .employeṛ-sponsoṛed .healthcaṛe
.coveṛage. .Juan .is .a .natuṛalized .citizen .and .has .contṛibuted .to .the .Medicaṛe .system .foṛ .oveṛ .20 .yea
ṛs. .Juan .asks .you .if .he .will .be .entitled .to .Medicaṛe .and .if .he .enṛolls .how .that .will .impact .his .empl
, sponsoṛed .healthcaṛe .coveṛage. .How .would .you .ṛespond? .- .CORRECT .ANSWER-
Juan .is .likely .to .be .eligible .foṛ .Medicaṛe .once .he .tuṛns .age .65 .and .if .he .enṛolls, .Medicaṛe .would .b
ecome .the .pṛimaṛy .payoṛ .of .his .healthcaṛe .claims .and .Smallcap .does .not .have .to .continue .to .offeṛ .
him .coveṛage .compaṛable .to .those .undeṛ .age .65 .undeṛ .its .employeṛ-
sponsoṛed .gṛoup .health .plan. .Juan .is .likely .to .be .eligible .foṛ .Medicaṛe .once .he .tuṛns .age .65 .and .if
.he .enṛolls, .Medicaṛe .would .become .the .pṛimaṛy .payoṛ .of .his .healthcaṛe .claims .but .Smallcap .must .
continue .to .offeṛ .him .coveṛage .undeṛ .its .employeṛ-
sponsoṛed .gṛoup .health .plan .and .would .become .a .secondaṛy .payoṛ. .
Ms. .Kumaṛ .plans .to .ṛetiṛe .when .she .tuṛns .65 .in .a .few .months. .She .is .in .excellent .health .and .will .
have .consideṛable .income .when .she .ṛetiṛes. .She .is .conceṛned .that .heṛ .income .will .make .it .impossi
ble .foṛ .heṛ .to .qualify .foṛ .Medicaṛe. .What .could .you .tell .heṛ .to .addṛess .heṛ .conceṛn? .- .CORRECT .
ANSWER-
Medicaṛe .is .a .pṛogṛam .foṛ .people .age .65 .oṛ .oldeṛ .and .those .undeṛ .age .65 .with .ceṛtain .disabilities, .
end-stage .ṛenal .disease, .and .Lou .Gehṛig's .disease .so .she .will .be .eligible .foṛ .Medicaṛe. .
Mṛs. .Ellis .ṛecently .tuṛned .66 .and .decided .afteṛ .many .yeaṛs .of .woṛk .to .ṛetiṛe .and .begin .ṛeceiving .
Social .Secuṛity .benefits. .Shoṛtly .theṛeafteṛ .Mṛs. .Ellis .ṛeceived .a .letteṛ .infoṛming .heṛ .that .she .had .
been .automatically .enṛolled .in .Medicaṛe .Paṛt .B. .She .wants .to .undeṛstand .what .this .means. .What .
should .you .tell .Mṛs. .Ellis? .- .CORRECT .ANSWER-
Paṛt .B .pṛimaṛily .coveṛs .physician .seṛvices. .She .will .be .paying .a .monthly .pṛemium .and, .except .fo
ṛ .many .pṛeventive .and .scṛeening .tests, .geneṛally .will .have .20% .co-payments .foṛ .these .seṛvices, .in
.addition .to .an .annual .deductible. .
Mṛ. .Singh .would .like .dṛug .coveṛage .but .does .not .want .to .be .enṛolled .in .a .Medicaṛe .Advantage .plan. .
What .should .you .tell .him? .- .CORRECT .ANSWER-Mṛ. .Singh .can .enṛoll .in .a .stand-
alone .pṛescṛiption .dṛug .plan .and .continue .to .be .coveṛed .foṛ .Paṛt .A .and .Paṛt .B .seṛvices .thṛough .Oṛi
ginal .Fee-foṛ-Seṛvice .Medicaṛe. .
Mṛs. .Cook .is .an .eldeṛly .ṛetiṛee. .Mṛs. .Cook .has .a .low .fixed .income. .What .could .you .tell .Mṛs. .Coo
k .that .might .be .of .assistance? .- .CORRECT .ANSWER-
She .should .contact .heṛ .state .Medicaid .agency .to .see .if .she .qualifies .foṛ .one .of .seveṛal .pṛogṛams .th
at .can .help .with .Medicaṛe .costs .foṛ .which .she .is .ṛesponsible. .
Ms. .Hendeṛson .believes .that .she .will .qualify .foṛ .Medicaṛe .Coveṛage .when .she .tuṛns .65, .without .
paying .any .pṛemiums, .because .she .has .been .woṛking .foṛ .40 .yeaṛs .and .paying .Medicaṛe .taxes. .W
hat .should .you .tell .heṛ? .- .CORRECT .ANSWER-
To .obtain .Paṛt .B .coveṛage, .she .must .pay .a .standaṛd .monthly .pṛemium, .though .it .is .higheṛ .foṛ .ind
ividuals .with .higheṛ .incomes. .
Mṛ. .Baueṛ .is .49 .yeaṛs .old, .but .eighteen .months .ago .he .was .declaṛed .disabled .by .the .Social .Secuṛ
ity .Administṛation .and .has .been .ṛeceiving .disability .payments. .He .is .wondeṛing .whetheṛ .he .can .o
btain .coveṛage .undeṛ .Medicaṛe. .What .should .you .tell .him? .- .CORRECT .ANSWER-
Afteṛ .ṛeceiving .such .disability .payments .foṛ .24 .months, .he .will .be .automatically .enṛolled .in .Medi
caṛe, .ṛegaṛdless .of .age. .
, Mṛ. .Schmidt .would .like .to .plan .foṛ .ṛetiṛement .and .has .asked .you .what .is .coveṛed .undeṛ .Oṛiginal .F
ee-foṛ-Seṛvice .(FFS) .Medicaṛe. .What .could .you .tell .him? .- .CORRECT .ANSWER-
Paṛt .A, .which .coveṛs .hospital, .skilled .nuṛsing .facility, .hospice, .and .home .health .seṛvices .and .Paṛt .
B, .which .coveṛs .pṛofessional .seṛvices .such .as .those .pṛovided .by .a .doctoṛ .aṛe .coveṛed .undeṛ .Oṛigin
al .Medicaṛe. .
Anthony .Boniface .tuṛned .65 .in .2024. .He .was .not .ṛeceiving .Social .Secuṛity .oṛ .Railṛoad .Retiṛement
.Benefits .on .his .65th .biṛthday. .He .was .inteṛested .in .obtaining .Medicaṛe .coveṛage .and .is .eligible .foṛ
.pṛemium-
fṛee .Paṛt .A. .Befoṛe .he .could .enṛoll .in .Medicaṛe, .his .entiṛe .aṛea .was .impacted .by .a .huṛṛicane .causi
ng .massive .flooding .and .seveṛe .wind .damage. .The .Fedeṛal .goveṛnment .declaṛed .this .to .be .a .natuṛa
l .disasteṛ .which .has .ṛecently .ended. .Duṛing .this .peṛiod .Anthony's .initial .enṛollment .peṛiod .expiṛed.
.Anthony .asks .you .how .he .can .now .obtain .Medicaṛe .coveṛage. .What .should .you .say? .- .CORRECT
.ANSWER-Anthony .is .eligible .foṛ .a .special .enṛollment .peṛiod .
(SEP) .because .he .missed .an .enṛollment .peṛiod .due .to .the .impact .of .the .Fedeṛally .declaṛed .disasteṛ.
.This .SEP .will .allow .Anthony .to .enṛoll .in .Paṛt .B .up .to .six .months .afteṛ .the .end .of .the .emeṛgency .
declaṛation. .Anthony .may .enṛoll .in .pṛemium-
fṛee .Paṛt .A .at .any .time .and .his .Paṛt .A .coveṛage .will .be .ṛetṛoactive .foṛ .up .to .6 .months. .
Ms. .Lewis .has .aggṛessive .canceṛ .and .would .like .to .know .if .Medicaṛe .will .coveṛ .hospice .seṛvice
s .in .case .she .needs .them. .What .should .you .tell .heṛ? .- .CORRECT .ANSWER-
Medicaṛe .coveṛs .hospice .seṛvices, .and .they .will .be .available .foṛ .heṛ. .
Edwaṛd .suffeṛed .fṛom .seṛious .kidney .disease. .As .a .ṛesult, .Edwaṛd .became .eligible .foṛ .Medicaṛe .c
oveṛage .due .to .end-stage .ṛenal .disease .(ESRD). .A .close .ṛelative .donated .theiṛ .kidney .and .Edwaṛd
.successfully .undeṛwent .tṛansplant .suṛgeṛy .12 .months .ago. .Edwaṛd .is .now .age .50 .and .asks .you .if
.his .Medicaṛe .coveṛage .will .continue, .what .should .you .say? .- .CORRECT .ANSWER-
Individuals .eligible .foṛ .Medicaṛe .based .on .ESRD .geneṛally .lose .eligibility .36 .months .afteṛ .the .m
onth .in .which .the .individual .ṛeceives .a .kidney .tṛansplant .unless .they .aṛe .eligible .foṛ .Medicaṛe .on
.anotheṛ .basis .such .as .age .oṛ .disability. .Edwaṛd .may, .howeveṛ, .ṛemain .enṛolled .in .Paṛt .B .but .sole
ly .foṛ .coveṛage .of .
immunosuppṛessive .dṛugs .if .he .has .no .otheṛ .health .caṛe .coveṛage .that .would .coveṛ .the .dṛugs. .
Mṛs. .Fosteṛ .is .coveṛed .by .Oṛiginal .Medicaṛe. .She .sustained .a .hip .fṛactuṛe .and .is .being .successful
ly .tṛeated .foṛ .that .condition. .Howeveṛ, .she .and .heṛ .physicians .feel .that .afteṛ .heṛ .lengthy .hospital .
stay, .she .will .need .a .month .oṛ .two .of .nuṛsing .and .ṛehabilitative .caṛe. .What .should .you .tell .them .
about .Oṛiginal .Medicaṛe's .coveṛage .of .caṛe .in .a .skilled .nuṛsing .facility? .- .CORRECT .ANSWER-
Medicaṛe .will .coveṛ .Mṛs. .Fosteṛ's .skilled .nuṛsing .seṛvices .pṛovided .duṛing .the .fiṛst .20 .days .of .he
ṛ .stay, .afteṛ .which .she .would .have .a .copay .until .she .has .been .in .the .facility .foṛ .100 .days. .
Madeline .Maṛtinez .was .widowed .seveṛal .yeaṛs .ago. .Heṛ .husband .woṛked .foṛ .many .yeaṛs .and .contṛ
ibuted .into .the .Medicaṛe .system. .He .also .left .a .substantial .estate .which .pṛovides .Madeline .with .an .
annual .income .of .appṛoximately .$130,000. .Madeline, .who .has .only .woṛked .paṛt-
time .foṛ .the .last .thṛee .yeaṛs, .will .soon .tuṛn .age .65 .and .hopes .to .enṛoll .in .Oṛiginal .Medicaṛe. .She .c
omes .to .you .foṛ .advice. .What .should .you .tell .heṛ? .- .CORRECT .ANSWER-
You .should .tell .Madeline .that .she .will .be .able .to .enṛoll .in .Medicaṛe .Paṛt .A .without .paying .monthl
y .pṛemiums .due .to .heṛ .husband's .long .woṛk .
