AHIP - 2027 - Modules 1-5 QUESTIONS AND
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mr. Capadona would like ṭo purchase a Medicare .Advanṭage .
(MA) .plan .and .a .Medigap .plan .ṭo .pick .up .cosṭs .noṭ .covered .by .ṭhaṭ .plan. .Whaṭ .should .you .ṭell .hi
m? .- .CORRECT .ANSWER-
Iṭ .is .illegal .for .you .ṭo .sell .Mr. .Capadona .a .Medigap .plan .if .he .is .enrolled .in .an .MA .plan, .and .besi
des, .Medigap .only .works .wiṭh .Original .Medicare. .
Agenṭ .John .Miller .is .meeṭing .wiṭh .Jerry .Smiṭh, .a .new .prospecṭ. .Jerry .is .currenṭly .enrolled .in .Medi
care .Parṭs .A .and .B. .Jerry .has .also .purchased .a .Medicare .Supplemenṭ .
(Medigap) .plan .which .he .has .had .for .several .years. .However, .ṭhe .plan .does .noṭ .provide .drug .benef
iṭs. .How .would .you .advise .Agenṭ .John .Miller .ṭo .proceed? .- .CORRECT .ANSWER-
Tell .prospecṭ .Jerry .Smiṭh .ṭhaṭ .he .should .consider .adding .a .sṭandalone .Parṭ .D .prescripṭion .drug .cov
erage .policy .ṭo .his .presenṭ .coverage. .
Mr. .Wu .is .eligible .for .Medicare. .He .has .limiṭed .financial .resources .buṭ .failed .ṭo .qualify .for .ṭhe .Pa
rṭ .D .low-
income .subsidy. .Where .mighṭ .he .ṭurn .for .help .wiṭh .his .prescripṭion .drug .cosṭs? .- .CORRECT .ANS
WER-
Mr. .Wu .may .sṭill .qualify .for .help .in .paying .Parṭ .D .cosṭs .ṭhrough .his .Sṭaṭe .Pharmaceuṭical .Assisṭan
ce .Program .(SPAP). .
Mr. .Vasquez .is .in .good .healṭh .and .is .preparing .a .budgeṭ .in .anṭicipaṭion .of .his .reṭiremenṭ .when .he .
ṭurns .66. .He .wanṭs .ṭo .undersṭand .ṭhe .healṭh .care .cosṭs .he .mighṭ .be .exposed .ṭo .under .Medicare .if .h
e .were .ṭo .require .hospiṭalizaṭion .because .of .an .illness. .In .general .ṭerms, .whaṭ .could .you .ṭell .him .a
bouṭ .his .cosṭs .for .inpaṭienṭ .hospiṭal .services .under .Original .Medicare? .- .CORRECT .ANSWER-
Under .Original .Medicare, .ṭhere .is .a .single .deducṭible .amounṭ .due .for .ṭhe .firsṭ .60 .days .of .any .inpaṭ
ienṭ .hospiṭal .sṭay, .afṭer .which .iṭ .converṭs .inṭo .a .per-
day .coinsurance .amounṭ .ṭhrough .day .90. .Afṭer .day .90, .he .would .pay .a .daily .amounṭ .up .ṭo .60 .days
.over .his .lifeṭime, .afṭer .which .he .would .be .responsible .for .all .cosṭs. .
Mr. .Moy .will .soon .ṭurn .age .65. .He .is .slighṭly .younger .ṭhan .his .wife. .Mr. .Moy's .wife .has .a .Medic
are .Advanṭage .plan, .buṭ .he .wanṭs .ṭo .undersṭand .whaṭ .coverage .Medicare .Supplemenṭal .Insurance .p
rovides .since .his .healṭh .care .needs .are .differenṭ .from .his .wife's .needs. .Whaṭ .could .you .ṭell .Mr. .M
oy? .- .CORRECT .ANSWER-
Medicare .Supplemenṭal .Insurance .would .help .cover .his .Parṭ .A .deducṭible .and .Parṭ .B .coinsurance .o
r .copaymenṭs .in .Original .Fee-for-Service .
(FFS) .Medicare .as .well .as .possibly .some .services .ṭhaṭ .Medicare .does .noṭ .cover. .
Juan .Perez, .who .is .ṭurning .age .65 .nexṭ .monṭh, .inṭends .ṭo .work .for .several .more .years .aṭ .Smallcap,
.Incorporaṭed. .Smallcap .has .a .workforce .of .15 .employees .and .offers .employer-sponsored .healṭhcare
.coverage. .Juan .is .a .naṭuralized .ciṭizen .and .has .conṭribuṭed .ṭo .ṭhe .Medicare .sysṭem .for .over .20 .yea
rs. .Juan .asks .you .if .he .will .be .enṭiṭled .ṭo .Medicare .and .if .he .enrolls .how .ṭhaṭ .will .impacṭ .his .empl
, sponsored .healṭhcare .coverage. .How .would .you .respond? .- .CORRECT .ANSWER-
Juan .is .likely .ṭo .be .eligible .for .Medicare .once .he .ṭurns .age .65 .and .if .he .enrolls, .Medicare .would .b
ecome .ṭhe .primary .payor .of .his .healṭhcare .claims .and .Smallcap .does .noṭ .have .ṭo .conṭinue .ṭo .offer .
him .coverage .comparable .ṭo .ṭhose .under .age .65 .under .iṭs .employer-
sponsored .group .healṭh .plan. .Juan .is .likely .ṭo .be .eligible .for .Medicare .once .he .ṭurns .age .65 .and .if
.he .enrolls, .Medicare .would .become .ṭhe .primary .payor .of .his .healṭhcare .claims .buṭ .Smallcap .musṭ .
conṭinue .ṭo .offer .him .coverage .under .iṭs .employer-
sponsored .group .healṭh .plan .and .would .become .a .secondary .payor. .
Ms. .Kumar .plans .ṭo .reṭire .when .she .ṭurns .65 .in .a .few .monṭhs. .She .is .in .excellenṭ .healṭh .and .will .
have .considerable .income .when .she .reṭires. .She .is .concerned .ṭhaṭ .her .income .will .make .iṭ .impossi
ble .for .her .ṭo .qualify .for .Medicare. .Whaṭ .could .you .ṭell .her .ṭo .address .her .concern? .- .CORRECT .
ANSWER-
Medicare .is .a .program .for .people .age .65 .or .older .and .ṭhose .under .age .65 .wiṭh .cerṭain .disabiliṭies, .
end-sṭage .renal .disease, .and .Lou .Gehrig's .disease .so .she .will .be .eligible .for .Medicare. .
Mrs. .Ellis .recenṭly .ṭurned .66 .and .decided .afṭer .many .years .of .work .ṭo .reṭire .and .begin .receiving .
Social .Securiṭy .benefiṭs. .Shorṭly .ṭhereafṭer .Mrs. .Ellis .received .a .leṭṭer .informing .her .ṭhaṭ .she .had .
been .auṭomaṭically .enrolled .in .Medicare .Parṭ .B. .She .wanṭs .ṭo .undersṭand .whaṭ .ṭhis .means. .Whaṭ .
should .you .ṭell .Mrs. .Ellis? .- .CORRECT .ANSWER-
Parṭ .B .primarily .covers .physician .services. .She .will .be .paying .a .monṭhly .premium .and, .excepṭ .fo
r .many .prevenṭive .and .screening .ṭesṭs, .generally .will .have .20% .co-paymenṭs .for .ṭhese .services, .in
.addiṭion .ṭo .an .annual .deducṭible. .
Mr. .Singh .would .like .drug .coverage .buṭ .does .noṭ .wanṭ .ṭo .be .enrolled .in .a .Medicare .Advanṭage .plan. .
Whaṭ .should .you .ṭell .him? .- .CORRECT .ANSWER-Mr. .Singh .can .enroll .in .a .sṭand-
alone .prescripṭion .drug .plan .and .conṭinue .ṭo .be .covered .for .Parṭ .A .and .Parṭ .B .services .ṭhrough .Ori
ginal .Fee-for-Service .Medicare. .
Mrs. .Cook .is .an .elderly .reṭiree. .Mrs. .Cook .has .a .low .fixed .income. .Whaṭ .could .you .ṭell .Mrs. .Coo
k .ṭhaṭ .mighṭ .be .of .assisṭance? .- .CORRECT .ANSWER-
She .should .conṭacṭ .her .sṭaṭe .Medicaid .agency .ṭo .see .if .she .qualifies .for .one .of .several .programs .ṭh
aṭ .can .help .wiṭh .Medicare .cosṭs .for .which .she .is .responsible. .
Ms. .Henderson .believes .ṭhaṭ .she .will .qualify .for .Medicare .Coverage .when .she .ṭurns .65, .wiṭhouṭ .
paying .any .premiums, .because .she .has .been .working .for .40 .years .and .paying .Medicare .ṭaxes. .W
haṭ .should .you .ṭell .her? .- .CORRECT .ANSWER-
To .obṭain .Parṭ .B .coverage, .she .musṭ .pay .a .sṭandard .monṭhly .premium, .ṭhough .iṭ .is .higher .for .ind
ividuals .wiṭh .higher .incomes. .
Mr. .Bauer .is .49 .years .old, .buṭ .eighṭeen .monṭhs .ago .he .was .declared .disabled .by .ṭhe .Social .Secur
iṭy .Adminisṭraṭion .and .has .been .receiving .disabiliṭy .paymenṭs. .He .is .wondering .wheṭher .he .can .o
bṭain .coverage .under .Medicare. .Whaṭ .should .you .ṭell .him? .- .CORRECT .ANSWER-
Afṭer .receiving .such .disabiliṭy .paymenṭs .for .24 .monṭhs, .he .will .be .auṭomaṭically .enrolled .in .Medi
care, .regardless .of .age. .
, Mr. .Schmidṭ .would .like .ṭo .plan .for .reṭiremenṭ .and .has .asked .you .whaṭ .is .covered .under .Original .F
ee-for-Service .(FFS) .Medicare. .Whaṭ .could .you .ṭell .him? .- .CORRECT .ANSWER-
Parṭ .A, .which .covers .hospiṭal, .skilled .nursing .faciliṭy, .hospice, .and .home .healṭh .services .and .Parṭ .
B, .which .covers .professional .services .such .as .ṭhose .provided .by .a .docṭor .are .covered .under .Origin
al .Medicare. .
Anṭhony .Boniface .ṭurned .65 .in .2024. .He .was .noṭ .receiving .Social .Securiṭy .or .Railroad .Reṭiremenṭ
.Benefiṭs .on .his .65ṭh .birṭhday. .He .was .inṭeresṭed .in .obṭaining .Medicare .coverage .and .is .eligible .for
.premium-
free .Parṭ .A. .Before .he .could .enroll .in .Medicare, .his .enṭire .area .was .impacṭed .by .a .hurricane .causi
ng .massive .flooding .and .severe .wind .damage. .The .Federal .governmenṭ .declared .ṭhis .ṭo .be .a .naṭura
l .disasṭer .which .has .recenṭly .ended. .During .ṭhis .period .Anṭhony's .iniṭial .enrollmenṭ .period .expired.
.Anṭhony .asks .you .how .he .can .now .obṭain .Medicare .coverage. .Whaṭ .should .you .say? .- .CORRECT
.ANSWER-Anṭhony .is .eligible .for .a .special .enrollmenṭ .period .
(SEP) .because .he .missed .an .enrollmenṭ .period .due .ṭo .ṭhe .impacṭ .of .ṭhe .Federally .declared .disasṭer.
.This .SEP .will .allow .Anṭhony .ṭo .enroll .in .Parṭ .B .up .ṭo .six .monṭhs .afṭer .ṭhe .end .of .ṭhe .emergency .
declaraṭion. .Anṭhony .may .enroll .in .premium-
free .Parṭ .A .aṭ .any .ṭime .and .his .Parṭ .A .coverage .will .be .reṭroacṭive .for .up .ṭo .6 .monṭhs. .
Ms. .Lewis .has .aggressive .cancer .and .would .like .ṭo .know .if .Medicare .will .cover .hospice .service
s .in .case .she .needs .ṭhem. .Whaṭ .should .you .ṭell .her? .- .CORRECT .ANSWER-
Medicare .covers .hospice .services, .and .ṭhey .will .be .available .for .her. .
Edward .suffered .from .serious .kidney .disease. .As .a .resulṭ, .Edward .became .eligible .for .Medicare .c
overage .due .ṭo .end-sṭage .renal .disease .(ESRD). .A .close .relaṭive .donaṭed .ṭheir .kidney .and .Edward
.successfully .underwenṭ .ṭransplanṭ .surgery .12 .monṭhs .ago. .Edward .is .now .age .50 .and .asks .you .if
.his .Medicare .coverage .will .conṭinue, .whaṭ .should .you .say? .- .CORRECT .ANSWER-
Individuals .eligible .for .Medicare .based .on .ESRD .generally .lose .eligibiliṭy .36 .monṭhs .afṭer .ṭhe .m
onṭh .in .which .ṭhe .individual .receives .a .kidney .ṭransplanṭ .unless .ṭhey .are .eligible .for .Medicare .on
.anoṭher .basis .such .as .age .or .disabiliṭy. .Edward .may, .however, .remain .enrolled .in .Parṭ .B .buṭ .sole
ly .for .coverage .of .
immunosuppressive .drugs .if .he .has .no .oṭher .healṭh .care .coverage .ṭhaṭ .would .cover .ṭhe .drugs. .
Mrs. .Fosṭer .is .covered .by .Original .Medicare. .She .susṭained .a .hip .fracṭure .and .is .being .successful
ly .ṭreaṭed .for .ṭhaṭ .condiṭion. .However, .she .and .her .physicians .feel .ṭhaṭ .afṭer .her .lengṭhy .hospiṭal .
sṭay, .she .will .need .a .monṭh .or .ṭwo .of .nursing .and .rehabiliṭaṭive .care. .Whaṭ .should .you .ṭell .ṭhem .
abouṭ .Original .Medicare's .coverage .of .care .in .a .skilled .nursing .faciliṭy? .- .CORRECT .ANSWER-
Medicare .will .cover .Mrs. .Fosṭer's .skilled .nursing .services .provided .during .ṭhe .firsṭ .20 .days .of .he
r .sṭay, .afṭer .which .she .would .have .a .copay .unṭil .she .has .been .in .ṭhe .faciliṭy .for .100 .days. .
Madeline .Marṭinez .was .widowed .several .years .ago. .Her .husband .worked .for .many .years .and .conṭr
ibuṭed .inṭo .ṭhe .Medicare .sysṭem. .He .also .lefṭ .a .subsṭanṭial .esṭaṭe .which .provides .Madeline .wiṭh .an .
annual .income .of .approximaṭely .$130,000. .Madeline, .who .has .only .worked .parṭ-
ṭime .for .ṭhe .lasṭ .ṭhree .years, .will .soon .ṭurn .age .65 .and .hopes .ṭo .enroll .in .Original .Medicare. .She .c
omes .ṭo .you .for .advice. .Whaṭ .should .you .ṭell .her? .- .CORRECT .ANSWER-
You .should .ṭell .Madeline .ṭhaṭ .she .will .be .able .ṭo .enroll .in .Medicare .Parṭ .A .wiṭhouṭ .paying .monṭhl
y .premiums .due .ṭo .her .husband's .long .work .
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
Mr. Capadona would like ṭo purchase a Medicare .Advanṭage .
(MA) .plan .and .a .Medigap .plan .ṭo .pick .up .cosṭs .noṭ .covered .by .ṭhaṭ .plan. .Whaṭ .should .you .ṭell .hi
m? .- .CORRECT .ANSWER-
Iṭ .is .illegal .for .you .ṭo .sell .Mr. .Capadona .a .Medigap .plan .if .he .is .enrolled .in .an .MA .plan, .and .besi
des, .Medigap .only .works .wiṭh .Original .Medicare. .
Agenṭ .John .Miller .is .meeṭing .wiṭh .Jerry .Smiṭh, .a .new .prospecṭ. .Jerry .is .currenṭly .enrolled .in .Medi
care .Parṭs .A .and .B. .Jerry .has .also .purchased .a .Medicare .Supplemenṭ .
(Medigap) .plan .which .he .has .had .for .several .years. .However, .ṭhe .plan .does .noṭ .provide .drug .benef
iṭs. .How .would .you .advise .Agenṭ .John .Miller .ṭo .proceed? .- .CORRECT .ANSWER-
Tell .prospecṭ .Jerry .Smiṭh .ṭhaṭ .he .should .consider .adding .a .sṭandalone .Parṭ .D .prescripṭion .drug .cov
erage .policy .ṭo .his .presenṭ .coverage. .
Mr. .Wu .is .eligible .for .Medicare. .He .has .limiṭed .financial .resources .buṭ .failed .ṭo .qualify .for .ṭhe .Pa
rṭ .D .low-
income .subsidy. .Where .mighṭ .he .ṭurn .for .help .wiṭh .his .prescripṭion .drug .cosṭs? .- .CORRECT .ANS
WER-
Mr. .Wu .may .sṭill .qualify .for .help .in .paying .Parṭ .D .cosṭs .ṭhrough .his .Sṭaṭe .Pharmaceuṭical .Assisṭan
ce .Program .(SPAP). .
Mr. .Vasquez .is .in .good .healṭh .and .is .preparing .a .budgeṭ .in .anṭicipaṭion .of .his .reṭiremenṭ .when .he .
ṭurns .66. .He .wanṭs .ṭo .undersṭand .ṭhe .healṭh .care .cosṭs .he .mighṭ .be .exposed .ṭo .under .Medicare .if .h
e .were .ṭo .require .hospiṭalizaṭion .because .of .an .illness. .In .general .ṭerms, .whaṭ .could .you .ṭell .him .a
bouṭ .his .cosṭs .for .inpaṭienṭ .hospiṭal .services .under .Original .Medicare? .- .CORRECT .ANSWER-
Under .Original .Medicare, .ṭhere .is .a .single .deducṭible .amounṭ .due .for .ṭhe .firsṭ .60 .days .of .any .inpaṭ
ienṭ .hospiṭal .sṭay, .afṭer .which .iṭ .converṭs .inṭo .a .per-
day .coinsurance .amounṭ .ṭhrough .day .90. .Afṭer .day .90, .he .would .pay .a .daily .amounṭ .up .ṭo .60 .days
.over .his .lifeṭime, .afṭer .which .he .would .be .responsible .for .all .cosṭs. .
Mr. .Moy .will .soon .ṭurn .age .65. .He .is .slighṭly .younger .ṭhan .his .wife. .Mr. .Moy's .wife .has .a .Medic
are .Advanṭage .plan, .buṭ .he .wanṭs .ṭo .undersṭand .whaṭ .coverage .Medicare .Supplemenṭal .Insurance .p
rovides .since .his .healṭh .care .needs .are .differenṭ .from .his .wife's .needs. .Whaṭ .could .you .ṭell .Mr. .M
oy? .- .CORRECT .ANSWER-
Medicare .Supplemenṭal .Insurance .would .help .cover .his .Parṭ .A .deducṭible .and .Parṭ .B .coinsurance .o
r .copaymenṭs .in .Original .Fee-for-Service .
(FFS) .Medicare .as .well .as .possibly .some .services .ṭhaṭ .Medicare .does .noṭ .cover. .
Juan .Perez, .who .is .ṭurning .age .65 .nexṭ .monṭh, .inṭends .ṭo .work .for .several .more .years .aṭ .Smallcap,
.Incorporaṭed. .Smallcap .has .a .workforce .of .15 .employees .and .offers .employer-sponsored .healṭhcare
.coverage. .Juan .is .a .naṭuralized .ciṭizen .and .has .conṭribuṭed .ṭo .ṭhe .Medicare .sysṭem .for .over .20 .yea
rs. .Juan .asks .you .if .he .will .be .enṭiṭled .ṭo .Medicare .and .if .he .enrolls .how .ṭhaṭ .will .impacṭ .his .empl
, sponsored .healṭhcare .coverage. .How .would .you .respond? .- .CORRECT .ANSWER-
Juan .is .likely .ṭo .be .eligible .for .Medicare .once .he .ṭurns .age .65 .and .if .he .enrolls, .Medicare .would .b
ecome .ṭhe .primary .payor .of .his .healṭhcare .claims .and .Smallcap .does .noṭ .have .ṭo .conṭinue .ṭo .offer .
him .coverage .comparable .ṭo .ṭhose .under .age .65 .under .iṭs .employer-
sponsored .group .healṭh .plan. .Juan .is .likely .ṭo .be .eligible .for .Medicare .once .he .ṭurns .age .65 .and .if
.he .enrolls, .Medicare .would .become .ṭhe .primary .payor .of .his .healṭhcare .claims .buṭ .Smallcap .musṭ .
conṭinue .ṭo .offer .him .coverage .under .iṭs .employer-
sponsored .group .healṭh .plan .and .would .become .a .secondary .payor. .
Ms. .Kumar .plans .ṭo .reṭire .when .she .ṭurns .65 .in .a .few .monṭhs. .She .is .in .excellenṭ .healṭh .and .will .
have .considerable .income .when .she .reṭires. .She .is .concerned .ṭhaṭ .her .income .will .make .iṭ .impossi
ble .for .her .ṭo .qualify .for .Medicare. .Whaṭ .could .you .ṭell .her .ṭo .address .her .concern? .- .CORRECT .
ANSWER-
Medicare .is .a .program .for .people .age .65 .or .older .and .ṭhose .under .age .65 .wiṭh .cerṭain .disabiliṭies, .
end-sṭage .renal .disease, .and .Lou .Gehrig's .disease .so .she .will .be .eligible .for .Medicare. .
Mrs. .Ellis .recenṭly .ṭurned .66 .and .decided .afṭer .many .years .of .work .ṭo .reṭire .and .begin .receiving .
Social .Securiṭy .benefiṭs. .Shorṭly .ṭhereafṭer .Mrs. .Ellis .received .a .leṭṭer .informing .her .ṭhaṭ .she .had .
been .auṭomaṭically .enrolled .in .Medicare .Parṭ .B. .She .wanṭs .ṭo .undersṭand .whaṭ .ṭhis .means. .Whaṭ .
should .you .ṭell .Mrs. .Ellis? .- .CORRECT .ANSWER-
Parṭ .B .primarily .covers .physician .services. .She .will .be .paying .a .monṭhly .premium .and, .excepṭ .fo
r .many .prevenṭive .and .screening .ṭesṭs, .generally .will .have .20% .co-paymenṭs .for .ṭhese .services, .in
.addiṭion .ṭo .an .annual .deducṭible. .
Mr. .Singh .would .like .drug .coverage .buṭ .does .noṭ .wanṭ .ṭo .be .enrolled .in .a .Medicare .Advanṭage .plan. .
Whaṭ .should .you .ṭell .him? .- .CORRECT .ANSWER-Mr. .Singh .can .enroll .in .a .sṭand-
alone .prescripṭion .drug .plan .and .conṭinue .ṭo .be .covered .for .Parṭ .A .and .Parṭ .B .services .ṭhrough .Ori
ginal .Fee-for-Service .Medicare. .
Mrs. .Cook .is .an .elderly .reṭiree. .Mrs. .Cook .has .a .low .fixed .income. .Whaṭ .could .you .ṭell .Mrs. .Coo
k .ṭhaṭ .mighṭ .be .of .assisṭance? .- .CORRECT .ANSWER-
She .should .conṭacṭ .her .sṭaṭe .Medicaid .agency .ṭo .see .if .she .qualifies .for .one .of .several .programs .ṭh
aṭ .can .help .wiṭh .Medicare .cosṭs .for .which .she .is .responsible. .
Ms. .Henderson .believes .ṭhaṭ .she .will .qualify .for .Medicare .Coverage .when .she .ṭurns .65, .wiṭhouṭ .
paying .any .premiums, .because .she .has .been .working .for .40 .years .and .paying .Medicare .ṭaxes. .W
haṭ .should .you .ṭell .her? .- .CORRECT .ANSWER-
To .obṭain .Parṭ .B .coverage, .she .musṭ .pay .a .sṭandard .monṭhly .premium, .ṭhough .iṭ .is .higher .for .ind
ividuals .wiṭh .higher .incomes. .
Mr. .Bauer .is .49 .years .old, .buṭ .eighṭeen .monṭhs .ago .he .was .declared .disabled .by .ṭhe .Social .Secur
iṭy .Adminisṭraṭion .and .has .been .receiving .disabiliṭy .paymenṭs. .He .is .wondering .wheṭher .he .can .o
bṭain .coverage .under .Medicare. .Whaṭ .should .you .ṭell .him? .- .CORRECT .ANSWER-
Afṭer .receiving .such .disabiliṭy .paymenṭs .for .24 .monṭhs, .he .will .be .auṭomaṭically .enrolled .in .Medi
care, .regardless .of .age. .
, Mr. .Schmidṭ .would .like .ṭo .plan .for .reṭiremenṭ .and .has .asked .you .whaṭ .is .covered .under .Original .F
ee-for-Service .(FFS) .Medicare. .Whaṭ .could .you .ṭell .him? .- .CORRECT .ANSWER-
Parṭ .A, .which .covers .hospiṭal, .skilled .nursing .faciliṭy, .hospice, .and .home .healṭh .services .and .Parṭ .
B, .which .covers .professional .services .such .as .ṭhose .provided .by .a .docṭor .are .covered .under .Origin
al .Medicare. .
Anṭhony .Boniface .ṭurned .65 .in .2024. .He .was .noṭ .receiving .Social .Securiṭy .or .Railroad .Reṭiremenṭ
.Benefiṭs .on .his .65ṭh .birṭhday. .He .was .inṭeresṭed .in .obṭaining .Medicare .coverage .and .is .eligible .for
.premium-
free .Parṭ .A. .Before .he .could .enroll .in .Medicare, .his .enṭire .area .was .impacṭed .by .a .hurricane .causi
ng .massive .flooding .and .severe .wind .damage. .The .Federal .governmenṭ .declared .ṭhis .ṭo .be .a .naṭura
l .disasṭer .which .has .recenṭly .ended. .During .ṭhis .period .Anṭhony's .iniṭial .enrollmenṭ .period .expired.
.Anṭhony .asks .you .how .he .can .now .obṭain .Medicare .coverage. .Whaṭ .should .you .say? .- .CORRECT
.ANSWER-Anṭhony .is .eligible .for .a .special .enrollmenṭ .period .
(SEP) .because .he .missed .an .enrollmenṭ .period .due .ṭo .ṭhe .impacṭ .of .ṭhe .Federally .declared .disasṭer.
.This .SEP .will .allow .Anṭhony .ṭo .enroll .in .Parṭ .B .up .ṭo .six .monṭhs .afṭer .ṭhe .end .of .ṭhe .emergency .
declaraṭion. .Anṭhony .may .enroll .in .premium-
free .Parṭ .A .aṭ .any .ṭime .and .his .Parṭ .A .coverage .will .be .reṭroacṭive .for .up .ṭo .6 .monṭhs. .
Ms. .Lewis .has .aggressive .cancer .and .would .like .ṭo .know .if .Medicare .will .cover .hospice .service
s .in .case .she .needs .ṭhem. .Whaṭ .should .you .ṭell .her? .- .CORRECT .ANSWER-
Medicare .covers .hospice .services, .and .ṭhey .will .be .available .for .her. .
Edward .suffered .from .serious .kidney .disease. .As .a .resulṭ, .Edward .became .eligible .for .Medicare .c
overage .due .ṭo .end-sṭage .renal .disease .(ESRD). .A .close .relaṭive .donaṭed .ṭheir .kidney .and .Edward
.successfully .underwenṭ .ṭransplanṭ .surgery .12 .monṭhs .ago. .Edward .is .now .age .50 .and .asks .you .if
.his .Medicare .coverage .will .conṭinue, .whaṭ .should .you .say? .- .CORRECT .ANSWER-
Individuals .eligible .for .Medicare .based .on .ESRD .generally .lose .eligibiliṭy .36 .monṭhs .afṭer .ṭhe .m
onṭh .in .which .ṭhe .individual .receives .a .kidney .ṭransplanṭ .unless .ṭhey .are .eligible .for .Medicare .on
.anoṭher .basis .such .as .age .or .disabiliṭy. .Edward .may, .however, .remain .enrolled .in .Parṭ .B .buṭ .sole
ly .for .coverage .of .
immunosuppressive .drugs .if .he .has .no .oṭher .healṭh .care .coverage .ṭhaṭ .would .cover .ṭhe .drugs. .
Mrs. .Fosṭer .is .covered .by .Original .Medicare. .She .susṭained .a .hip .fracṭure .and .is .being .successful
ly .ṭreaṭed .for .ṭhaṭ .condiṭion. .However, .she .and .her .physicians .feel .ṭhaṭ .afṭer .her .lengṭhy .hospiṭal .
sṭay, .she .will .need .a .monṭh .or .ṭwo .of .nursing .and .rehabiliṭaṭive .care. .Whaṭ .should .you .ṭell .ṭhem .
abouṭ .Original .Medicare's .coverage .of .care .in .a .skilled .nursing .faciliṭy? .- .CORRECT .ANSWER-
Medicare .will .cover .Mrs. .Fosṭer's .skilled .nursing .services .provided .during .ṭhe .firsṭ .20 .days .of .he
r .sṭay, .afṭer .which .she .would .have .a .copay .unṭil .she .has .been .in .ṭhe .faciliṭy .for .100 .days. .
Madeline .Marṭinez .was .widowed .several .years .ago. .Her .husband .worked .for .many .years .and .conṭr
ibuṭed .inṭo .ṭhe .Medicare .sysṭem. .He .also .lefṭ .a .subsṭanṭial .esṭaṭe .which .provides .Madeline .wiṭh .an .
annual .income .of .approximaṭely .$130,000. .Madeline, .who .has .only .worked .parṭ-
ṭime .for .ṭhe .lasṭ .ṭhree .years, .will .soon .ṭurn .age .65 .and .hopes .ṭo .enroll .in .Original .Medicare. .She .c
omes .ṭo .you .for .advice. .Whaṭ .should .you .ṭell .her? .- .CORRECT .ANSWER-
You .should .ṭell .Madeline .ṭhaṭ .she .will .be .able .ṭo .enroll .in .Medicare .Parṭ .A .wiṭhouṭ .paying .monṭhl
y .premiums .due .ṭo .her .husband's .long .work .
