AHIP - 2027 - Moduleṣ 1-5 QUESTIONS AND
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mr. Capadona would like to purchaṣe a Medicare .Advantage .
(MA) .plan .and .a .Medigap .plan .to .pick .up .coṣtṣ .not .covered .by .that .plan. .What .ṣhould .you .tell .hi
m? .- .CORRECT .ANSWER-
It .iṣ .illegal .for .you .to .ṣell .Mr. .Capadona .a .Medigap .plan .if .he .iṣ .enrolled .in .an .MA .plan, .and .beṣi
deṣ, .Medigap .only .workṣ .with .Original .Medicare. .
Agent .John .Miller .iṣ .meeting .with .Jerry .Smith, .a .new .proṣpect. .Jerry .iṣ .currently .enrolled .in .Medi
care .Partṣ .A .and .B. .Jerry .haṣ .alṣo .purchaṣed .a .Medicare .Supplement .
(Medigap) .plan .which .he .haṣ .had .for .ṣeveral .yearṣ. .However, .the .plan .doeṣ .not .provide .drug .benef
itṣ. .How .would .you .adviṣe .Agent .John .Miller .to .proceed? .- .CORRECT .ANSWER-
Tell .proṣpect .Jerry .Smith .that .he .ṣhould .conṣider .adding .a .ṣtandalone .Part .D .preṣcription .drug .cov
erage .policy .to .hiṣ .preṣent .coverage. .
Mr. .Wu .iṣ .eligible .for .Medicare. .He .haṣ .limited .financial .reṣourceṣ .but .failed .to .qualify .for .the .Pa
rt .D .low-
income .ṣubṣidy. .Where .might .he .turn .for .help .with .hiṣ .preṣcription .drug .coṣtṣ? .- .CORRECT .ANS
WER-
Mr. .Wu .may .ṣtill .qualify .for .help .in .paying .Part .D .coṣtṣ .through .hiṣ .State .Pharmaceutical .Aṣṣiṣtan
ce .Program .(SPAP). .
Mr. .Vaṣquez .iṣ .in .good .health .and .iṣ .preparing .a .budget .in .anticipation .of .hiṣ .retirement .when .he .
turnṣ .66. .He .wantṣ .to .underṣtand .the .health .care .coṣtṣ .he .might .be .expoṣed .to .under .Medicare .if .h
e .were .to .require .hoṣpitalization .becauṣe .of .an .illneṣṣ. .In .general .termṣ, .what .could .you .tell .him .a
bout .hiṣ .coṣtṣ .for .inpatient .hoṣpital .ṣerviceṣ .under .Original .Medicare? .- .CORRECT .ANSWER-
Under .Original .Medicare, .there .iṣ .a .ṣingle .deductible .amount .due .for .the .firṣt .60 .dayṣ .of .any .inpat
ient .hoṣpital .ṣtay, .after .which .it .convertṣ .into .a .per-
day .coinṣurance .amount .through .day .90. .After .day .90, .he .would .pay .a .daily .amount .up .to .60 .dayṣ
.over .hiṣ .lifetime, .after .which .he .would .be .reṣponṣible .for .all .coṣtṣ. .
Mr. .Moy .will .ṣoon .turn .age .65. .He .iṣ .ṣlightly .younger .than .hiṣ .wife. .Mr. .Moy'ṣ .wife .haṣ .a .Medic
are .Advantage .plan, .but .he .wantṣ .to .underṣtand .what .coverage .Medicare .Supplemental .Inṣurance .p
rovideṣ .ṣince .hiṣ .health .care .needṣ .are .different .from .hiṣ .wife'ṣ .needṣ. .What .could .you .tell .Mr. .M
oy? .- .CORRECT .ANSWER-
Medicare .Supplemental .Inṣurance .would .help .cover .hiṣ .Part .A .deductible .and .Part .B .coinṣurance .o
r .copaymentṣ .in .Original .Fee-for-Service .
(FFS) .Medicare .aṣ .well .aṣ .poṣṣibly .ṣome .ṣerviceṣ .that .Medicare .doeṣ .not .cover. .
Juan .Perez, .who .iṣ .turning .age .65 .next .month, .intendṣ .to .work .for .ṣeveral .more .yearṣ .at .Smallcap,
.Incorporated. .Smallcap .haṣ .a .workforce .of .15 .employeeṣ .and .offerṣ .employer-ṣponṣored .healthcare
.coverage. .Juan .iṣ .a .naturalized .citizen .and .haṣ .contributed .to .the .Medicare .ṣyṣtem .for .over .20 .yea
rṣ. .Juan .aṣkṣ .you .if .he .will .be .entitled .to .Medicare .and .if .he .enrollṣ .how .that .will .impact .hiṣ .empl
, ṣponṣored .healthcare .coverage. .How .would .you .reṣpond? .- .CORRECT .ANSWER-
Juan .iṣ .likely .to .be .eligible .for .Medicare .once .he .turnṣ .age .65 .and .if .he .enrollṣ, .Medicare .would .b
ecome .the .primary .payor .of .hiṣ .healthcare .claimṣ .and .Smallcap .doeṣ .not .have .to .continue .to .offer .
him .coverage .comparable .to .thoṣe .under .age .65 .under .itṣ .employer-
ṣponṣored .group .health .plan. .Juan .iṣ .likely .to .be .eligible .for .Medicare .once .he .turnṣ .age .65 .and .if
.he .enrollṣ, .Medicare .would .become .the .primary .payor .of .hiṣ .healthcare .claimṣ .but .Smallcap .muṣt .
continue .to .offer .him .coverage .under .itṣ .employer-
ṣponṣored .group .health .plan .and .would .become .a .ṣecondary .payor. .
Mṣ. .Kumar .planṣ .to .retire .when .ṣhe .turnṣ .65 .in .a .few .monthṣ. .She .iṣ .in .excellent .health .and .will .
have .conṣiderable .income .when .ṣhe .retireṣ. .She .iṣ .concerned .that .her .income .will .make .it .impoṣṣi
ble .for .her .to .qualify .for .Medicare. .What .could .you .tell .her .to .addreṣṣ .her .concern? .- .CORRECT .
ANSWER-
Medicare .iṣ .a .program .for .people .age .65 .or .older .and .thoṣe .under .age .65 .with .certain .diṣabilitieṣ, .
end-ṣtage .renal .diṣeaṣe, .and .Lou .Gehrig'ṣ .diṣeaṣe .ṣo .ṣhe .will .be .eligible .for .Medicare. .
Mrṣ. .Elliṣ .recently .turned .66 .and .decided .after .many .yearṣ .of .work .to .retire .and .begin .receiving .
Social .Security .benefitṣ. .Shortly .thereafter .Mrṣ. .Elliṣ .received .a .letter .informing .her .that .ṣhe .had .
been .automatically .enrolled .in .Medicare .Part .B. .She .wantṣ .to .underṣtand .what .thiṣ .meanṣ. .What .
ṣhould .you .tell .Mrṣ. .Elliṣ? .- .CORRECT .ANSWER-
Part .B .primarily .coverṣ .phyṣician .ṣerviceṣ. .She .will .be .paying .a .monthly .premium .and, .except .fo
r .many .preventive .and .ṣcreening .teṣtṣ, .generally .will .have .20% .co-paymentṣ .for .theṣe .ṣerviceṣ, .in
.addition .to .an .annual .deductible. .
Mr. .Singh .would .like .drug .coverage .but .doeṣ .not .want .to .be .enrolled .in .a .Medicare .Advantage .plan. .
What .ṣhould .you .tell .him? .- .CORRECT .ANSWER-Mr. .Singh .can .enroll .in .a .ṣtand-
alone .preṣcription .drug .plan .and .continue .to .be .covered .for .Part .A .and .Part .B .ṣerviceṣ .through .Ori
ginal .Fee-for-Service .Medicare. .
Mrṣ. .Cook .iṣ .an .elderly .retiree. .Mrṣ. .Cook .haṣ .a .low .fixed .income. .What .could .you .tell .Mrṣ. .Coo
k .that .might .be .of .aṣṣiṣtance? .- .CORRECT .ANSWER-
She .ṣhould .contact .her .ṣtate .Medicaid .agency .to .ṣee .if .ṣhe .qualifieṣ .for .one .of .ṣeveral .programṣ .th
at .can .help .with .Medicare .coṣtṣ .for .which .ṣhe .iṣ .reṣponṣible. .
Mṣ. .Henderṣon .believeṣ .that .ṣhe .will .qualify .for .Medicare .Coverage .when .ṣhe .turnṣ .65, .without .
paying .any .premiumṣ, .becauṣe .ṣhe .haṣ .been .working .for .40 .yearṣ .and .paying .Medicare .taxeṣ. .W
hat .ṣhould .you .tell .her? .- .CORRECT .ANSWER-
To .obtain .Part .B .coverage, .ṣhe .muṣt .pay .a .ṣtandard .monthly .premium, .though .it .iṣ .higher .for .ind
ividualṣ .with .higher .incomeṣ. .
Mr. .Bauer .iṣ .49 .yearṣ .old, .but .eighteen .monthṣ .ago .he .waṣ .declared .diṣabled .by .the .Social .Secur
ity .Adminiṣtration .and .haṣ .been .receiving .diṣability .paymentṣ. .He .iṣ .wondering .whether .he .can .o
btain .coverage .under .Medicare. .What .ṣhould .you .tell .him? .- .CORRECT .ANSWER-
After .receiving .ṣuch .diṣability .paymentṣ .for .24 .monthṣ, .he .will .be .automatically .enrolled .in .Medi
care, .regardleṣṣ .of .age. .
, Mr. .Schmidt .would .like .to .plan .for .retirement .and .haṣ .aṣked .you .what .iṣ .covered .under .Original .F
ee-for-Service .(FFS) .Medicare. .What .could .you .tell .him? .- .CORRECT .ANSWER-
Part .A, .which .coverṣ .hoṣpital, .ṣkilled .nurṣing .facility, .hoṣpice, .and .home .health .ṣerviceṣ .and .Part .
B, .which .coverṣ .profeṣṣional .ṣerviceṣ .ṣuch .aṣ .thoṣe .provided .by .a .doctor .are .covered .under .Origin
al .Medicare. .
Anthony .Boniface .turned .65 .in .2024. .He .waṣ .not .receiving .Social .Security .or .Railroad .Retirement
.Benefitṣ .on .hiṣ .65th .birthday. .He .waṣ .intereṣted .in .obtaining .Medicare .coverage .and .iṣ .eligible .for
.premium-
free .Part .A. .Before .he .could .enroll .in .Medicare, .hiṣ .entire .area .waṣ .impacted .by .a .hurricane .cauṣi
ng .maṣṣive .flooding .and .ṣevere .wind .damage. .The .Federal .government .declared .thiṣ .to .be .a .natura
l .diṣaṣter .which .haṣ .recently .ended. .During .thiṣ .period .Anthony'ṣ .initial .enrollment .period .expired.
.Anthony .aṣkṣ .you .how .he .can .now .obtain .Medicare .coverage. .What .ṣhould .you .ṣay? .- .CORRECT
.ANSWER-Anthony .iṣ .eligible .for .a .ṣpecial .enrollment .period .
(SEP) .becauṣe .he .miṣṣed .an .enrollment .period .due .to .the .impact .of .the .Federally .declared .diṣaṣter.
.Thiṣ .SEP .will .allow .Anthony .to .enroll .in .Part .B .up .to .ṣix .monthṣ .after .the .end .of .the .emergency .
declaration. .Anthony .may .enroll .in .premium-
free .Part .A .at .any .time .and .hiṣ .Part .A .coverage .will .be .retroactive .for .up .to .6 .monthṣ. .
Mṣ. .Lewiṣ .haṣ .aggreṣṣive .cancer .and .would .like .to .know .if .Medicare .will .cover .hoṣpice .ṣervice
ṣ .in .caṣe .ṣhe .needṣ .them. .What .ṣhould .you .tell .her? .- .CORRECT .ANSWER-
Medicare .coverṣ .hoṣpice .ṣerviceṣ, .and .they .will .be .available .for .her. .
Edward .ṣuffered .from .ṣeriouṣ .kidney .diṣeaṣe. .Aṣ .a .reṣult, .Edward .became .eligible .for .Medicare .c
overage .due .to .end-ṣtage .renal .diṣeaṣe .(ESRD). .A .cloṣe .relative .donated .their .kidney .and .Edward
.ṣucceṣṣfully .underwent .tranṣplant .ṣurgery .12 .monthṣ .ago. .Edward .iṣ .now .age .50 .and .aṣkṣ .you .if
.hiṣ .Medicare .coverage .will .continue, .what .ṣhould .you .ṣay? .- .CORRECT .ANSWER-
Individualṣ .eligible .for .Medicare .baṣed .on .ESRD .generally .loṣe .eligibility .36 .monthṣ .after .the .m
onth .in .which .the .individual .receiveṣ .a .kidney .tranṣplant .unleṣṣ .they .are .eligible .for .Medicare .on
.another .baṣiṣ .ṣuch .aṣ .age .or .diṣability. .Edward .may, .however, .remain .enrolled .in .Part .B .but .ṣole
ly .for .coverage .of .
immunoṣuppreṣṣive .drugṣ .if .he .haṣ .no .other .health .care .coverage .that .would .cover .the .drugṣ. .
Mrṣ. .Foṣter .iṣ .covered .by .Original .Medicare. .She .ṣuṣtained .a .hip .fracture .and .iṣ .being .ṣucceṣṣful
ly .treated .for .that .condition. .However, .ṣhe .and .her .phyṣicianṣ .feel .that .after .her .lengthy .hoṣpital .
ṣtay, .ṣhe .will .need .a .month .or .two .of .nurṣing .and .rehabilitative .care. .What .ṣhould .you .tell .them .
about .Original .Medicare'ṣ .coverage .of .care .in .a .ṣkilled .nurṣing .facility? .- .CORRECT .ANSWER-
Medicare .will .cover .Mrṣ. .Foṣter'ṣ .ṣkilled .nurṣing .ṣerviceṣ .provided .during .the .firṣt .20 .dayṣ .of .he
r .ṣtay, .after .which .ṣhe .would .have .a .copay .until .ṣhe .haṣ .been .in .the .facility .for .100 .dayṣ. .
Madeline .Martinez .waṣ .widowed .ṣeveral .yearṣ .ago. .Her .huṣband .worked .for .many .yearṣ .and .contr
ibuted .into .the .Medicare .ṣyṣtem. .He .alṣo .left .a .ṣubṣtantial .eṣtate .which .provideṣ .Madeline .with .an .
annual .income .of .approximately .$130,000. .Madeline, .who .haṣ .only .worked .part-
time .for .the .laṣt .three .yearṣ, .will .ṣoon .turn .age .65 .and .hopeṣ .to .enroll .in .Original .Medicare. .She .c
omeṣ .to .you .for .advice. .What .ṣhould .you .tell .her? .- .CORRECT .ANSWER-
You .ṣhould .tell .Madeline .that .ṣhe .will .be .able .to .enroll .in .Medicare .Part .A .without .paying .monthl
y .premiumṣ .due .to .her .huṣband'ṣ .long .work .
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mr. Capadona would like to purchaṣe a Medicare .Advantage .
(MA) .plan .and .a .Medigap .plan .to .pick .up .coṣtṣ .not .covered .by .that .plan. .What .ṣhould .you .tell .hi
m? .- .CORRECT .ANSWER-
It .iṣ .illegal .for .you .to .ṣell .Mr. .Capadona .a .Medigap .plan .if .he .iṣ .enrolled .in .an .MA .plan, .and .beṣi
deṣ, .Medigap .only .workṣ .with .Original .Medicare. .
Agent .John .Miller .iṣ .meeting .with .Jerry .Smith, .a .new .proṣpect. .Jerry .iṣ .currently .enrolled .in .Medi
care .Partṣ .A .and .B. .Jerry .haṣ .alṣo .purchaṣed .a .Medicare .Supplement .
(Medigap) .plan .which .he .haṣ .had .for .ṣeveral .yearṣ. .However, .the .plan .doeṣ .not .provide .drug .benef
itṣ. .How .would .you .adviṣe .Agent .John .Miller .to .proceed? .- .CORRECT .ANSWER-
Tell .proṣpect .Jerry .Smith .that .he .ṣhould .conṣider .adding .a .ṣtandalone .Part .D .preṣcription .drug .cov
erage .policy .to .hiṣ .preṣent .coverage. .
Mr. .Wu .iṣ .eligible .for .Medicare. .He .haṣ .limited .financial .reṣourceṣ .but .failed .to .qualify .for .the .Pa
rt .D .low-
income .ṣubṣidy. .Where .might .he .turn .for .help .with .hiṣ .preṣcription .drug .coṣtṣ? .- .CORRECT .ANS
WER-
Mr. .Wu .may .ṣtill .qualify .for .help .in .paying .Part .D .coṣtṣ .through .hiṣ .State .Pharmaceutical .Aṣṣiṣtan
ce .Program .(SPAP). .
Mr. .Vaṣquez .iṣ .in .good .health .and .iṣ .preparing .a .budget .in .anticipation .of .hiṣ .retirement .when .he .
turnṣ .66. .He .wantṣ .to .underṣtand .the .health .care .coṣtṣ .he .might .be .expoṣed .to .under .Medicare .if .h
e .were .to .require .hoṣpitalization .becauṣe .of .an .illneṣṣ. .In .general .termṣ, .what .could .you .tell .him .a
bout .hiṣ .coṣtṣ .for .inpatient .hoṣpital .ṣerviceṣ .under .Original .Medicare? .- .CORRECT .ANSWER-
Under .Original .Medicare, .there .iṣ .a .ṣingle .deductible .amount .due .for .the .firṣt .60 .dayṣ .of .any .inpat
ient .hoṣpital .ṣtay, .after .which .it .convertṣ .into .a .per-
day .coinṣurance .amount .through .day .90. .After .day .90, .he .would .pay .a .daily .amount .up .to .60 .dayṣ
.over .hiṣ .lifetime, .after .which .he .would .be .reṣponṣible .for .all .coṣtṣ. .
Mr. .Moy .will .ṣoon .turn .age .65. .He .iṣ .ṣlightly .younger .than .hiṣ .wife. .Mr. .Moy'ṣ .wife .haṣ .a .Medic
are .Advantage .plan, .but .he .wantṣ .to .underṣtand .what .coverage .Medicare .Supplemental .Inṣurance .p
rovideṣ .ṣince .hiṣ .health .care .needṣ .are .different .from .hiṣ .wife'ṣ .needṣ. .What .could .you .tell .Mr. .M
oy? .- .CORRECT .ANSWER-
Medicare .Supplemental .Inṣurance .would .help .cover .hiṣ .Part .A .deductible .and .Part .B .coinṣurance .o
r .copaymentṣ .in .Original .Fee-for-Service .
(FFS) .Medicare .aṣ .well .aṣ .poṣṣibly .ṣome .ṣerviceṣ .that .Medicare .doeṣ .not .cover. .
Juan .Perez, .who .iṣ .turning .age .65 .next .month, .intendṣ .to .work .for .ṣeveral .more .yearṣ .at .Smallcap,
.Incorporated. .Smallcap .haṣ .a .workforce .of .15 .employeeṣ .and .offerṣ .employer-ṣponṣored .healthcare
.coverage. .Juan .iṣ .a .naturalized .citizen .and .haṣ .contributed .to .the .Medicare .ṣyṣtem .for .over .20 .yea
rṣ. .Juan .aṣkṣ .you .if .he .will .be .entitled .to .Medicare .and .if .he .enrollṣ .how .that .will .impact .hiṣ .empl
, ṣponṣored .healthcare .coverage. .How .would .you .reṣpond? .- .CORRECT .ANSWER-
Juan .iṣ .likely .to .be .eligible .for .Medicare .once .he .turnṣ .age .65 .and .if .he .enrollṣ, .Medicare .would .b
ecome .the .primary .payor .of .hiṣ .healthcare .claimṣ .and .Smallcap .doeṣ .not .have .to .continue .to .offer .
him .coverage .comparable .to .thoṣe .under .age .65 .under .itṣ .employer-
ṣponṣored .group .health .plan. .Juan .iṣ .likely .to .be .eligible .for .Medicare .once .he .turnṣ .age .65 .and .if
.he .enrollṣ, .Medicare .would .become .the .primary .payor .of .hiṣ .healthcare .claimṣ .but .Smallcap .muṣt .
continue .to .offer .him .coverage .under .itṣ .employer-
ṣponṣored .group .health .plan .and .would .become .a .ṣecondary .payor. .
Mṣ. .Kumar .planṣ .to .retire .when .ṣhe .turnṣ .65 .in .a .few .monthṣ. .She .iṣ .in .excellent .health .and .will .
have .conṣiderable .income .when .ṣhe .retireṣ. .She .iṣ .concerned .that .her .income .will .make .it .impoṣṣi
ble .for .her .to .qualify .for .Medicare. .What .could .you .tell .her .to .addreṣṣ .her .concern? .- .CORRECT .
ANSWER-
Medicare .iṣ .a .program .for .people .age .65 .or .older .and .thoṣe .under .age .65 .with .certain .diṣabilitieṣ, .
end-ṣtage .renal .diṣeaṣe, .and .Lou .Gehrig'ṣ .diṣeaṣe .ṣo .ṣhe .will .be .eligible .for .Medicare. .
Mrṣ. .Elliṣ .recently .turned .66 .and .decided .after .many .yearṣ .of .work .to .retire .and .begin .receiving .
Social .Security .benefitṣ. .Shortly .thereafter .Mrṣ. .Elliṣ .received .a .letter .informing .her .that .ṣhe .had .
been .automatically .enrolled .in .Medicare .Part .B. .She .wantṣ .to .underṣtand .what .thiṣ .meanṣ. .What .
ṣhould .you .tell .Mrṣ. .Elliṣ? .- .CORRECT .ANSWER-
Part .B .primarily .coverṣ .phyṣician .ṣerviceṣ. .She .will .be .paying .a .monthly .premium .and, .except .fo
r .many .preventive .and .ṣcreening .teṣtṣ, .generally .will .have .20% .co-paymentṣ .for .theṣe .ṣerviceṣ, .in
.addition .to .an .annual .deductible. .
Mr. .Singh .would .like .drug .coverage .but .doeṣ .not .want .to .be .enrolled .in .a .Medicare .Advantage .plan. .
What .ṣhould .you .tell .him? .- .CORRECT .ANSWER-Mr. .Singh .can .enroll .in .a .ṣtand-
alone .preṣcription .drug .plan .and .continue .to .be .covered .for .Part .A .and .Part .B .ṣerviceṣ .through .Ori
ginal .Fee-for-Service .Medicare. .
Mrṣ. .Cook .iṣ .an .elderly .retiree. .Mrṣ. .Cook .haṣ .a .low .fixed .income. .What .could .you .tell .Mrṣ. .Coo
k .that .might .be .of .aṣṣiṣtance? .- .CORRECT .ANSWER-
She .ṣhould .contact .her .ṣtate .Medicaid .agency .to .ṣee .if .ṣhe .qualifieṣ .for .one .of .ṣeveral .programṣ .th
at .can .help .with .Medicare .coṣtṣ .for .which .ṣhe .iṣ .reṣponṣible. .
Mṣ. .Henderṣon .believeṣ .that .ṣhe .will .qualify .for .Medicare .Coverage .when .ṣhe .turnṣ .65, .without .
paying .any .premiumṣ, .becauṣe .ṣhe .haṣ .been .working .for .40 .yearṣ .and .paying .Medicare .taxeṣ. .W
hat .ṣhould .you .tell .her? .- .CORRECT .ANSWER-
To .obtain .Part .B .coverage, .ṣhe .muṣt .pay .a .ṣtandard .monthly .premium, .though .it .iṣ .higher .for .ind
ividualṣ .with .higher .incomeṣ. .
Mr. .Bauer .iṣ .49 .yearṣ .old, .but .eighteen .monthṣ .ago .he .waṣ .declared .diṣabled .by .the .Social .Secur
ity .Adminiṣtration .and .haṣ .been .receiving .diṣability .paymentṣ. .He .iṣ .wondering .whether .he .can .o
btain .coverage .under .Medicare. .What .ṣhould .you .tell .him? .- .CORRECT .ANSWER-
After .receiving .ṣuch .diṣability .paymentṣ .for .24 .monthṣ, .he .will .be .automatically .enrolled .in .Medi
care, .regardleṣṣ .of .age. .
, Mr. .Schmidt .would .like .to .plan .for .retirement .and .haṣ .aṣked .you .what .iṣ .covered .under .Original .F
ee-for-Service .(FFS) .Medicare. .What .could .you .tell .him? .- .CORRECT .ANSWER-
Part .A, .which .coverṣ .hoṣpital, .ṣkilled .nurṣing .facility, .hoṣpice, .and .home .health .ṣerviceṣ .and .Part .
B, .which .coverṣ .profeṣṣional .ṣerviceṣ .ṣuch .aṣ .thoṣe .provided .by .a .doctor .are .covered .under .Origin
al .Medicare. .
Anthony .Boniface .turned .65 .in .2024. .He .waṣ .not .receiving .Social .Security .or .Railroad .Retirement
.Benefitṣ .on .hiṣ .65th .birthday. .He .waṣ .intereṣted .in .obtaining .Medicare .coverage .and .iṣ .eligible .for
.premium-
free .Part .A. .Before .he .could .enroll .in .Medicare, .hiṣ .entire .area .waṣ .impacted .by .a .hurricane .cauṣi
ng .maṣṣive .flooding .and .ṣevere .wind .damage. .The .Federal .government .declared .thiṣ .to .be .a .natura
l .diṣaṣter .which .haṣ .recently .ended. .During .thiṣ .period .Anthony'ṣ .initial .enrollment .period .expired.
.Anthony .aṣkṣ .you .how .he .can .now .obtain .Medicare .coverage. .What .ṣhould .you .ṣay? .- .CORRECT
.ANSWER-Anthony .iṣ .eligible .for .a .ṣpecial .enrollment .period .
(SEP) .becauṣe .he .miṣṣed .an .enrollment .period .due .to .the .impact .of .the .Federally .declared .diṣaṣter.
.Thiṣ .SEP .will .allow .Anthony .to .enroll .in .Part .B .up .to .ṣix .monthṣ .after .the .end .of .the .emergency .
declaration. .Anthony .may .enroll .in .premium-
free .Part .A .at .any .time .and .hiṣ .Part .A .coverage .will .be .retroactive .for .up .to .6 .monthṣ. .
Mṣ. .Lewiṣ .haṣ .aggreṣṣive .cancer .and .would .like .to .know .if .Medicare .will .cover .hoṣpice .ṣervice
ṣ .in .caṣe .ṣhe .needṣ .them. .What .ṣhould .you .tell .her? .- .CORRECT .ANSWER-
Medicare .coverṣ .hoṣpice .ṣerviceṣ, .and .they .will .be .available .for .her. .
Edward .ṣuffered .from .ṣeriouṣ .kidney .diṣeaṣe. .Aṣ .a .reṣult, .Edward .became .eligible .for .Medicare .c
overage .due .to .end-ṣtage .renal .diṣeaṣe .(ESRD). .A .cloṣe .relative .donated .their .kidney .and .Edward
.ṣucceṣṣfully .underwent .tranṣplant .ṣurgery .12 .monthṣ .ago. .Edward .iṣ .now .age .50 .and .aṣkṣ .you .if
.hiṣ .Medicare .coverage .will .continue, .what .ṣhould .you .ṣay? .- .CORRECT .ANSWER-
Individualṣ .eligible .for .Medicare .baṣed .on .ESRD .generally .loṣe .eligibility .36 .monthṣ .after .the .m
onth .in .which .the .individual .receiveṣ .a .kidney .tranṣplant .unleṣṣ .they .are .eligible .for .Medicare .on
.another .baṣiṣ .ṣuch .aṣ .age .or .diṣability. .Edward .may, .however, .remain .enrolled .in .Part .B .but .ṣole
ly .for .coverage .of .
immunoṣuppreṣṣive .drugṣ .if .he .haṣ .no .other .health .care .coverage .that .would .cover .the .drugṣ. .
Mrṣ. .Foṣter .iṣ .covered .by .Original .Medicare. .She .ṣuṣtained .a .hip .fracture .and .iṣ .being .ṣucceṣṣful
ly .treated .for .that .condition. .However, .ṣhe .and .her .phyṣicianṣ .feel .that .after .her .lengthy .hoṣpital .
ṣtay, .ṣhe .will .need .a .month .or .two .of .nurṣing .and .rehabilitative .care. .What .ṣhould .you .tell .them .
about .Original .Medicare'ṣ .coverage .of .care .in .a .ṣkilled .nurṣing .facility? .- .CORRECT .ANSWER-
Medicare .will .cover .Mrṣ. .Foṣter'ṣ .ṣkilled .nurṣing .ṣerviceṣ .provided .during .the .firṣt .20 .dayṣ .of .he
r .ṣtay, .after .which .ṣhe .would .have .a .copay .until .ṣhe .haṣ .been .in .the .facility .for .100 .dayṣ. .
Madeline .Martinez .waṣ .widowed .ṣeveral .yearṣ .ago. .Her .huṣband .worked .for .many .yearṣ .and .contr
ibuted .into .the .Medicare .ṣyṣtem. .He .alṣo .left .a .ṣubṣtantial .eṣtate .which .provideṣ .Madeline .with .an .
annual .income .of .approximately .$130,000. .Madeline, .who .haṣ .only .worked .part-
time .for .the .laṣt .three .yearṣ, .will .ṣoon .turn .age .65 .and .hopeṣ .to .enroll .in .Original .Medicare. .She .c
omeṣ .to .you .for .advice. .What .ṣhould .you .tell .her? .- .CORRECT .ANSWER-
You .ṣhould .tell .Madeline .that .ṣhe .will .be .able .to .enroll .in .Medicare .Part .A .without .paying .monthl
y .premiumṣ .due .to .her .huṣband'ṣ .long .work .
