PY2027 AHIP MODULE 1-5 REVIEW &
FINAL QUESTIONS AND CORRECT
ANSWERS
Jasonuxisuxexperiencinguxparanoiduxdelusionsuxanduxhisuxphysicianuxfeelsuxthatuxheuxsho
ulduxbeuxhospitalized.uxWhatuxshoulduxyouuxtelluxJasonux(oruxhisuxrepresentative)uxaboutu
xtheuxlengthuxofuxanuxinpatientuxpsychiatricuxhospitaluxstayuxthatuxMedicareuxwilluxcover?
ux-uxANSWERS-
Medicareuxwilluxcoveruxauxtotaluxofux190uxdaysuxofuxinpatientuxpsychiatricuxcareuxduringuxJ
ason'suxentireuxlifetime.
Mr.uxHarveyuxwoulduxlikeuxtouxpurchaseuxauxMedicareuxAdvantageux(MA)uxplanuxanduxaux
Medigapuxplanuxtouxpickuxupuxcostsuxnotuxcovereduxbyuxthatuxplan.uxWhatuxshoulduxyouuxt
elluxhim?ux-uxANSWERS-
ItuxisuxillegaluxforuxyouuxtouxselluxMr.uxHarveyuxauxMedigapuxplanuxifuxheuxisuxenrolleduxinuxa
nuxMAuxplan,uxanduxbesides,uxMedigapuxonlyuxworksuxwithuxOriginaluxMedicare.
KevinuxBirchuxenrolleduxinuxOriginaluxMedicareux(PartsuxAuxanduxB).uxMr.uxBirchuxhasuxbe
enuxreceivinguxrehabilitationuxservicesuxinuxauxskilleduxnursinguxfacility.uxHeuxcallsuxyouuxt
ouxsayuxthatuxheuxhasuxjustuxreceiveduxauxnoticeuxthatuxMedicareuxwilluxnouxlongeruxcoveru
xhisuxstayuxanduxheuxstilluxcannotuxwalkuxproperly.uxHeuxthinksuxtheyuxareuxendinguxhisuxs
ervicesuxtoouxsoon.uxWhatuxdouxyouuxtelluxhim?ux-uxANSWERS-
Heuxshoulduxfollowuxtheuxdirectionsuxonuxtheuxnoticeuxtouxfileuxauxfastuxappeal.uxMr.uxBirch
uxshoulduxfileuxituxbyuxnoonuxofuxtheuxcalendaruxdayuxfollowinguxreceiptuxofuxtheuxprovider'
suxnoticeuxofuxterminationuxofuxservices.
Mr.uxRayuxwoulduxlikeuxdruguxcoverageuxbutuxdoesuxnotuxwantuxtouxbeuxenrolleduxinuxauxM
edicareuxAdvantageuxplan.uxWhatuxshoulduxyouuxtelluxhim?ux-uxANSWERS-
Mr.uxRayuxcanuxenrolluxinuxauxstand-
aloneuxprescriptionuxdruguxplanuxanduxcontinueuxtouxbeuxcovereduxforuxPartuxAuxanduxPart
uxBuxservicesuxthroughuxOriginaluxFee-for-ServiceuxMedicare.
Mrs.uxSandersuxwilluxbeux65uxsoon,uxhasuxbeenuxauxcitizenuxforuxtwelveuxyears,uxhasuxbee
nuxemployeduxfull-
time,uxanduxpaiduxtaxesuxduringuxthatuxentireuxperiod.uxSheuxisuxconcerneduxthatuxsheuxwi
lluxnotuxqualifyuxforuxcoverageuxunderuxPartuxAuxbecauseuxsheuxwasuxnotuxbornuxinuxtheux
UniteduxStates.uxWhatuxshoulduxyouuxtelluxher?ux-uxANSWERS-
Mostuxindividualsuxwhouxareuxcitizensuxanduxageux65uxoruxoveruxareuxcovereduxunderuxPa
rtuxAuxbyuxvirtueuxofuxhavinguxpaiduxMedicareuxtaxesuxwhileuxworking,uxthoughuxsomeuxm
ayuxbeuxcovereduxasuxauxresultuxofuxpayinguxmonthlyuxpremiums.
Mr.uxBelluxisux52uxyearsuxolduxanduxhasuxrecentlyuxbeenuxdiagnoseduxwithuxend-
stageuxrenaluxdiseaseux(ESRD)uxanduxwilluxsoonuxbeginuxdialysis.uxHeuxisuxwonderinguxifu
xheuxcanuxobtainuxcoverageuxunderuxMedicare.uxWhatuxshoulduxyouuxtelluxhim?ux-
uxANSWERS-
,HeuxmayuxsignuxupuxforuxMedicareuxatuxanyuxtime;uxhowever,uxcoverageuxusuallyuxbegins
uxonuxtheuxfourthuxmonthuxafteruxdialysisuxtreatmentsuxstart.
Mrs.uxLarsonuxisuxenrolleduxinuxOriginaluxMedicareuxanduxhasuxauxMedigapuxpolicyuxasuxw
ell,uxbutuxituxprovidesuxnouxdruguxcoverage.uxSheuxwoulduxlikeuxtouxkeepuxtheuxcoverageux
sheuxhasuxbutuxreplaceuxheruxexistinguxMedigapuxplanuxwithuxoneuxthatuxprovidesuxdrugux
coverage.uxWhatuxshoulduxyouuxtelluxher?ux-uxANSWERS-
Mrs.uxLarsonuxcannotuxpurchaseuxauxMedigapuxplanuxthatuxcoversuxdrugs,uxbutuxsheuxco
ulduxkeepuxheruxMedigapuxpolicyuxanduxenrolluxinuxauxPartuxDuxprescriptionuxdruguxplan.
Whatuximpact,uxifuxany,uxhaveuxrecentuxregulatoryuxchangesuxhaduxonuxMedigapuxplans?
ux-uxANSWERS-
TheuxPartuxBuxdeductibleuxisuxnouxlongeruxcovereduxforuxindividualsuxnewlyuxeligibleuxforux
MedicareuxstartinguxJanuaryux1,ux2020.
Jane'suxneighboruxtolduxheruxsheuxshoulduxlookuxatuxheruxPartuxDuxoptionsuxduringuxtheuxa
nnualuxMedicareuxenrollmentuxperioduxbecauseuxtheuxfeaturesuxofuxPartuxDuxmightuxhave
uxchanged.uxJaneuxcan'tuxrememberuxwhatuxPartuxDuxisuxsouxsheuxcalleduxyouuxtouxaskuxw
hatuxheruxneighboruxwasuxtalkinguxabout.uxWhatuxcoulduxyouuxtelluxher?ux-uxANSWERS-
PartuxDuxcoversuxprescriptionuxdrugsuxanduxsheuxshoulduxlookuxatuxheruxpremiums,uxform
ulary,uxanduxcost-sharinguxamonguxotheruxfactorsuxtouxseeuxifuxtheyuxhaveuxchanged.
JoanuxanduxLorettauxareuxbothuxenrolleduxinuxMedicare.uxJoanuxpaysuxauxpremiumuxforuxP
artuxAuxcoverage.uxLorettauxdoesuxnot.uxWhichuxofuxtheuxfollowinguxstatementsuxbestuxex
plainsuxthisuxdifference?ux-uxANSWERS-
Joanuxworkeduxonlyuxauxshortuxtimeuxanduxdiduxnotuxaccumulateuxsufficientuxworkuxcredit
s.uxLorettauxworkeduxforuxwelluxoverux10uxyearsuxaccumulatinguxcredituxforuxmoreuxthanux
40uxquartersuxofuxcontributionsuxtouxtheuxMedicareuxprogram.
MaryuxAliceuxisuxcovereduxbyuxOriginaluxMedicareuxPartsuxAuxanduxB.uxDuringuxheruxinitial
uxenrollmentuxperioduxsheuxpurchaseduxauxstandarduxMedigapuxPlanuxAuxpolicyuxfromuxy
ouuxbecauseuxofuxitsuxrelativelyuxlowuxcost.uxAfteruxspeakinguxtouxheruxfrienduxStan,uxsheu
xasksuxwhetheruxanyuxofuxtheuxfollowinguxareux"coreuxbenefits"uxcovereduxinuxheruxplan?
I.uxCoverageuxforuxPartuxAuxhospitaluxcoinsuranceuxamount
II.uxCoverageuxforux365uxadditionaluxdaysuxduringuxanuxinsured'suxlifetimeuxafteruxMedica
reuxbenefitsuxendux
III.uxCoverageuxforux3uxpintsuxofuxblood
IV.uxCoverageuxforuxtheuxPartuxBuxdeductibleux-uxANSWERS-I,uxII,uxanduxIIIuxonly
LarryuxMilleruxisuxanuxOriginaluxMedicareuxbeneficiaryuxwithuxPartsuxAuxanduxBuxcoverage
.uxLarryuxisuxadmitteduxtouxGooduxCareuxHospitaluxinuxJanuaryuxwithuxpneumoniauxanduxs
taysuxforuxthreeuxdaysuxbeforeuxbeinguxdischarged.uxSixuxmonthsuxlateruxinuxJuly,uxLarryux
takesuxauxbaduxfalluxanduxisuxadmitteduxtouxGooduxCareuxHospitaluxwithuxauxbrokenuxleg.ux
Afteruxemergencyuxsurgeryuxtouxrepairuxhisuxbrokenuxleg,uxLarryuxisuxhospitalizeduxforuxau
xweekuxbeforeuxbeinguxdischargeduxhome.uxInuxDecember,uxLarryuxisuxadmitteduxtouxMo
untuxWellnessuxHospitaluxonceuxagainuxwithuxauxseriousuxcaseuxofuxtheuxflu.uxForuxhowux
manyuxPartuxAuxdeductiblesuxwilluxLarryuxbeuxresponsibleuxfor?ux-uxANSWERS-
LarryuxwilluxbeuxresponsibleuxforuxthreeuxPartuxAuxdeductibles.
, Mrs.uxCarpenteruxisuxenrolleduxinuxOriginaluxMedicareuxPartsuxAuxanduxB.uxSheuxhasuxrec
entlyuxrevieweduxheruxMedicareuxSummaryuxNoticeux(MSN)uxanduxdisagreesuxwithuxauxd
eterminationuxthatuxpartiallyuxdenieduxoneuxofuxheruxclaimsuxforuxservices.uxWhatuxadvice
uxwoulduxyouuxgiveuxher?ux-uxANSWERS-
Mrs.uxCarpenteruxshoulduxfileuxanuxappealuxofuxthisuxinitialuxdeterminationuxwithinux120uxd
aysuxofuxtheuxdateuxsheuxreceiveduxtheuxMSNuxinuxtheuxmail.
Mr.uxHoffmanuxreceivesuxsomeuxhelpuxpayinguxforuxhisuxtwouxgenericuxprescriptionuxdrug
suxfromuxhisuxemployer'suxretireeuxcoverage,uxbutuxheuxwantsuxtouxcompareuxituxtouxauxPa
rtuxDuxprescriptionuxdruguxplan.uxHeuxasksuxyouuxwhatuxcostsuxheuxwoulduxgenerallyuxexp
ectuxtouxencounteruxwhenuxenrollinguxintouxauxstandarduxMedicareuxPartuxDuxprescription
uxdruguxplan.uxWhatuxshoulduxyouuxtelluxhim?ux-uxANSWERS-
Heuxgenerallyuxwoulduxpayuxauxmonthlyuxpremium,uxannualuxdeductible,uxanduxper-
prescriptionuxcost-sharing.
LucasuxFields,uxwhouxisuxturninguxageux65uxnextuxmonth,uxintendsuxtouxworkuxforuxseveral
uxmoreuxyearsuxatuxSmallcap,uxIncorporated.uxSmallcapuxhasuxauxworkforceuxofux15uxem
ployeesuxanduxoffersuxemployer-
sponsoreduxhealthcareuxcoverage.uxLucasuxisuxauxnaturalizeduxcitizenuxanduxhasuxcontri
buteduxtouxtheuxMedicareuxsystemuxforuxoverux20uxyears.uxLucasuxasksuxyouuxifuxheuxwillux
beuxentitleduxtouxMedicareuxanduxifuxheuxenrollsuxhowuxthatuxwilluximpactuxhisuxemployer-
sponsoreduxhealthcareuxcoverage.uxHowuxwoulduxyouuxrespond?ux-uxANSWERS-
LucasuxisuxlikelyuxtouxbeuxeligibleuxforuxMedicareuxonceuxheuxturnsuxageux65uxanduxifuxheux
enrolls,uxMedicareuxwoulduxbecomeuxtheuxprimaryuxpayoruxofuxhisuxhealthcareuxclaimsux
anduxSmallcapuxdoesuxnotuxhaveuxtouxcontinueuxtouxofferuxhimuxcoverageuxcomparableuxt
ouxthoseuxunderuxageux65uxunderuxitsuxemployer-
sponsoreduxgroupuxhealthuxplanuxanduxwoulduxbecomeuxauxsecondaryuxpayor.
Mrs.uxAndrewsuxisuxcomparinguxheruxemployer'suxretireeuxinsuranceuxtouxOriginaluxMedi
careuxanduxwoulduxlikeuxtouxknowuxwhichuxofuxtheuxfollowinguxservicesuxOriginaluxMedicar
euxwilluxcoveruxifuxtheuxappropriateuxcriteriauxareuxmet.uxWhatuxcoulduxyouuxtelluxher?ux-
uxANSWERS-OriginaluxMedicareuxcoversuxambulanceuxservices.
Mr.uxTurneruxwilluxsoonuxturnuxageux65uxanduxhasuxcomeuxtouxyouuxforuxadviceuxasuxtouxw
hatuxservicesuxareuxprovideduxunderuxOriginaluxMedicare.uxWhatuxshoulduxyouuxtelluxMr.u
xTurneruxthatuxbestuxdescribesuxtheuxhealthuxcoverageuxprovideduxtouxMedicareuxbenefic
iaries?ux-uxANSWERS-BeneficiariesuxunderuxOriginaluxMedicareuxhaveuxnouxcost-
sharinguxforuxmostuxpreventiveuxservices.
AnnieuxMillsuxwilluxturnuxageux65uxinuxAugustux2026.uxAnnieuxintendsuxtouxenrolluxinuxOrigi
naluxMedicareuxPartuxAuxanduxPartuxB.uxSheuxwoulduxalsouxlikeuxtouxenrolluxinuxauxMedicar
euxSupplementux(Medigap)uxplan.uxAnnie'suxolderuxneighboruxJohn,uxhasuxtolduxheruxabo
utuxtheuxMedigapuxPlanuxFuxinuxwhichuxheuxisuxenrolled.uxItuxnotuxonlyuxprovidesuxforeignux
traveluxemergencyuxbenefitsuxbutuxalsouxcoversuxhisuxMedicareuxPartuxBuxdeductible.uxA
nnieuxcomesuxtouxyouuxforuxadvice.uxWhatuxshoulduxyouuxtelluxher?ux-uxANSWERS-
YouuxareuxsorryuxtouxdisappointuxAnnie,uxbutuxauxMedigapuxFuxplanuxisuxnouxlongeruxavail
ableuxtouxthoseuxwhouxturnux65uxafteruxJanuaryux1,ux2020.uxAnnieuxmightuxinsteaduxconsi
deruxotheruxMedigapuxplansuxthatuxofferuxforeignuxtraveluxbenefitsuxbutuxdouxnotuxcoveruxt
heuxPartuxBuxdeductible.
FINAL QUESTIONS AND CORRECT
ANSWERS
Jasonuxisuxexperiencinguxparanoiduxdelusionsuxanduxhisuxphysicianuxfeelsuxthatuxheuxsho
ulduxbeuxhospitalized.uxWhatuxshoulduxyouuxtelluxJasonux(oruxhisuxrepresentative)uxaboutu
xtheuxlengthuxofuxanuxinpatientuxpsychiatricuxhospitaluxstayuxthatuxMedicareuxwilluxcover?
ux-uxANSWERS-
Medicareuxwilluxcoveruxauxtotaluxofux190uxdaysuxofuxinpatientuxpsychiatricuxcareuxduringuxJ
ason'suxentireuxlifetime.
Mr.uxHarveyuxwoulduxlikeuxtouxpurchaseuxauxMedicareuxAdvantageux(MA)uxplanuxanduxaux
Medigapuxplanuxtouxpickuxupuxcostsuxnotuxcovereduxbyuxthatuxplan.uxWhatuxshoulduxyouuxt
elluxhim?ux-uxANSWERS-
ItuxisuxillegaluxforuxyouuxtouxselluxMr.uxHarveyuxauxMedigapuxplanuxifuxheuxisuxenrolleduxinuxa
nuxMAuxplan,uxanduxbesides,uxMedigapuxonlyuxworksuxwithuxOriginaluxMedicare.
KevinuxBirchuxenrolleduxinuxOriginaluxMedicareux(PartsuxAuxanduxB).uxMr.uxBirchuxhasuxbe
enuxreceivinguxrehabilitationuxservicesuxinuxauxskilleduxnursinguxfacility.uxHeuxcallsuxyouuxt
ouxsayuxthatuxheuxhasuxjustuxreceiveduxauxnoticeuxthatuxMedicareuxwilluxnouxlongeruxcoveru
xhisuxstayuxanduxheuxstilluxcannotuxwalkuxproperly.uxHeuxthinksuxtheyuxareuxendinguxhisuxs
ervicesuxtoouxsoon.uxWhatuxdouxyouuxtelluxhim?ux-uxANSWERS-
Heuxshoulduxfollowuxtheuxdirectionsuxonuxtheuxnoticeuxtouxfileuxauxfastuxappeal.uxMr.uxBirch
uxshoulduxfileuxituxbyuxnoonuxofuxtheuxcalendaruxdayuxfollowinguxreceiptuxofuxtheuxprovider'
suxnoticeuxofuxterminationuxofuxservices.
Mr.uxRayuxwoulduxlikeuxdruguxcoverageuxbutuxdoesuxnotuxwantuxtouxbeuxenrolleduxinuxauxM
edicareuxAdvantageuxplan.uxWhatuxshoulduxyouuxtelluxhim?ux-uxANSWERS-
Mr.uxRayuxcanuxenrolluxinuxauxstand-
aloneuxprescriptionuxdruguxplanuxanduxcontinueuxtouxbeuxcovereduxforuxPartuxAuxanduxPart
uxBuxservicesuxthroughuxOriginaluxFee-for-ServiceuxMedicare.
Mrs.uxSandersuxwilluxbeux65uxsoon,uxhasuxbeenuxauxcitizenuxforuxtwelveuxyears,uxhasuxbee
nuxemployeduxfull-
time,uxanduxpaiduxtaxesuxduringuxthatuxentireuxperiod.uxSheuxisuxconcerneduxthatuxsheuxwi
lluxnotuxqualifyuxforuxcoverageuxunderuxPartuxAuxbecauseuxsheuxwasuxnotuxbornuxinuxtheux
UniteduxStates.uxWhatuxshoulduxyouuxtelluxher?ux-uxANSWERS-
Mostuxindividualsuxwhouxareuxcitizensuxanduxageux65uxoruxoveruxareuxcovereduxunderuxPa
rtuxAuxbyuxvirtueuxofuxhavinguxpaiduxMedicareuxtaxesuxwhileuxworking,uxthoughuxsomeuxm
ayuxbeuxcovereduxasuxauxresultuxofuxpayinguxmonthlyuxpremiums.
Mr.uxBelluxisux52uxyearsuxolduxanduxhasuxrecentlyuxbeenuxdiagnoseduxwithuxend-
stageuxrenaluxdiseaseux(ESRD)uxanduxwilluxsoonuxbeginuxdialysis.uxHeuxisuxwonderinguxifu
xheuxcanuxobtainuxcoverageuxunderuxMedicare.uxWhatuxshoulduxyouuxtelluxhim?ux-
uxANSWERS-
,HeuxmayuxsignuxupuxforuxMedicareuxatuxanyuxtime;uxhowever,uxcoverageuxusuallyuxbegins
uxonuxtheuxfourthuxmonthuxafteruxdialysisuxtreatmentsuxstart.
Mrs.uxLarsonuxisuxenrolleduxinuxOriginaluxMedicareuxanduxhasuxauxMedigapuxpolicyuxasuxw
ell,uxbutuxituxprovidesuxnouxdruguxcoverage.uxSheuxwoulduxlikeuxtouxkeepuxtheuxcoverageux
sheuxhasuxbutuxreplaceuxheruxexistinguxMedigapuxplanuxwithuxoneuxthatuxprovidesuxdrugux
coverage.uxWhatuxshoulduxyouuxtelluxher?ux-uxANSWERS-
Mrs.uxLarsonuxcannotuxpurchaseuxauxMedigapuxplanuxthatuxcoversuxdrugs,uxbutuxsheuxco
ulduxkeepuxheruxMedigapuxpolicyuxanduxenrolluxinuxauxPartuxDuxprescriptionuxdruguxplan.
Whatuximpact,uxifuxany,uxhaveuxrecentuxregulatoryuxchangesuxhaduxonuxMedigapuxplans?
ux-uxANSWERS-
TheuxPartuxBuxdeductibleuxisuxnouxlongeruxcovereduxforuxindividualsuxnewlyuxeligibleuxforux
MedicareuxstartinguxJanuaryux1,ux2020.
Jane'suxneighboruxtolduxheruxsheuxshoulduxlookuxatuxheruxPartuxDuxoptionsuxduringuxtheuxa
nnualuxMedicareuxenrollmentuxperioduxbecauseuxtheuxfeaturesuxofuxPartuxDuxmightuxhave
uxchanged.uxJaneuxcan'tuxrememberuxwhatuxPartuxDuxisuxsouxsheuxcalleduxyouuxtouxaskuxw
hatuxheruxneighboruxwasuxtalkinguxabout.uxWhatuxcoulduxyouuxtelluxher?ux-uxANSWERS-
PartuxDuxcoversuxprescriptionuxdrugsuxanduxsheuxshoulduxlookuxatuxheruxpremiums,uxform
ulary,uxanduxcost-sharinguxamonguxotheruxfactorsuxtouxseeuxifuxtheyuxhaveuxchanged.
JoanuxanduxLorettauxareuxbothuxenrolleduxinuxMedicare.uxJoanuxpaysuxauxpremiumuxforuxP
artuxAuxcoverage.uxLorettauxdoesuxnot.uxWhichuxofuxtheuxfollowinguxstatementsuxbestuxex
plainsuxthisuxdifference?ux-uxANSWERS-
Joanuxworkeduxonlyuxauxshortuxtimeuxanduxdiduxnotuxaccumulateuxsufficientuxworkuxcredit
s.uxLorettauxworkeduxforuxwelluxoverux10uxyearsuxaccumulatinguxcredituxforuxmoreuxthanux
40uxquartersuxofuxcontributionsuxtouxtheuxMedicareuxprogram.
MaryuxAliceuxisuxcovereduxbyuxOriginaluxMedicareuxPartsuxAuxanduxB.uxDuringuxheruxinitial
uxenrollmentuxperioduxsheuxpurchaseduxauxstandarduxMedigapuxPlanuxAuxpolicyuxfromuxy
ouuxbecauseuxofuxitsuxrelativelyuxlowuxcost.uxAfteruxspeakinguxtouxheruxfrienduxStan,uxsheu
xasksuxwhetheruxanyuxofuxtheuxfollowinguxareux"coreuxbenefits"uxcovereduxinuxheruxplan?
I.uxCoverageuxforuxPartuxAuxhospitaluxcoinsuranceuxamount
II.uxCoverageuxforux365uxadditionaluxdaysuxduringuxanuxinsured'suxlifetimeuxafteruxMedica
reuxbenefitsuxendux
III.uxCoverageuxforux3uxpintsuxofuxblood
IV.uxCoverageuxforuxtheuxPartuxBuxdeductibleux-uxANSWERS-I,uxII,uxanduxIIIuxonly
LarryuxMilleruxisuxanuxOriginaluxMedicareuxbeneficiaryuxwithuxPartsuxAuxanduxBuxcoverage
.uxLarryuxisuxadmitteduxtouxGooduxCareuxHospitaluxinuxJanuaryuxwithuxpneumoniauxanduxs
taysuxforuxthreeuxdaysuxbeforeuxbeinguxdischarged.uxSixuxmonthsuxlateruxinuxJuly,uxLarryux
takesuxauxbaduxfalluxanduxisuxadmitteduxtouxGooduxCareuxHospitaluxwithuxauxbrokenuxleg.ux
Afteruxemergencyuxsurgeryuxtouxrepairuxhisuxbrokenuxleg,uxLarryuxisuxhospitalizeduxforuxau
xweekuxbeforeuxbeinguxdischargeduxhome.uxInuxDecember,uxLarryuxisuxadmitteduxtouxMo
untuxWellnessuxHospitaluxonceuxagainuxwithuxauxseriousuxcaseuxofuxtheuxflu.uxForuxhowux
manyuxPartuxAuxdeductiblesuxwilluxLarryuxbeuxresponsibleuxfor?ux-uxANSWERS-
LarryuxwilluxbeuxresponsibleuxforuxthreeuxPartuxAuxdeductibles.
, Mrs.uxCarpenteruxisuxenrolleduxinuxOriginaluxMedicareuxPartsuxAuxanduxB.uxSheuxhasuxrec
entlyuxrevieweduxheruxMedicareuxSummaryuxNoticeux(MSN)uxanduxdisagreesuxwithuxauxd
eterminationuxthatuxpartiallyuxdenieduxoneuxofuxheruxclaimsuxforuxservices.uxWhatuxadvice
uxwoulduxyouuxgiveuxher?ux-uxANSWERS-
Mrs.uxCarpenteruxshoulduxfileuxanuxappealuxofuxthisuxinitialuxdeterminationuxwithinux120uxd
aysuxofuxtheuxdateuxsheuxreceiveduxtheuxMSNuxinuxtheuxmail.
Mr.uxHoffmanuxreceivesuxsomeuxhelpuxpayinguxforuxhisuxtwouxgenericuxprescriptionuxdrug
suxfromuxhisuxemployer'suxretireeuxcoverage,uxbutuxheuxwantsuxtouxcompareuxituxtouxauxPa
rtuxDuxprescriptionuxdruguxplan.uxHeuxasksuxyouuxwhatuxcostsuxheuxwoulduxgenerallyuxexp
ectuxtouxencounteruxwhenuxenrollinguxintouxauxstandarduxMedicareuxPartuxDuxprescription
uxdruguxplan.uxWhatuxshoulduxyouuxtelluxhim?ux-uxANSWERS-
Heuxgenerallyuxwoulduxpayuxauxmonthlyuxpremium,uxannualuxdeductible,uxanduxper-
prescriptionuxcost-sharing.
LucasuxFields,uxwhouxisuxturninguxageux65uxnextuxmonth,uxintendsuxtouxworkuxforuxseveral
uxmoreuxyearsuxatuxSmallcap,uxIncorporated.uxSmallcapuxhasuxauxworkforceuxofux15uxem
ployeesuxanduxoffersuxemployer-
sponsoreduxhealthcareuxcoverage.uxLucasuxisuxauxnaturalizeduxcitizenuxanduxhasuxcontri
buteduxtouxtheuxMedicareuxsystemuxforuxoverux20uxyears.uxLucasuxasksuxyouuxifuxheuxwillux
beuxentitleduxtouxMedicareuxanduxifuxheuxenrollsuxhowuxthatuxwilluximpactuxhisuxemployer-
sponsoreduxhealthcareuxcoverage.uxHowuxwoulduxyouuxrespond?ux-uxANSWERS-
LucasuxisuxlikelyuxtouxbeuxeligibleuxforuxMedicareuxonceuxheuxturnsuxageux65uxanduxifuxheux
enrolls,uxMedicareuxwoulduxbecomeuxtheuxprimaryuxpayoruxofuxhisuxhealthcareuxclaimsux
anduxSmallcapuxdoesuxnotuxhaveuxtouxcontinueuxtouxofferuxhimuxcoverageuxcomparableuxt
ouxthoseuxunderuxageux65uxunderuxitsuxemployer-
sponsoreduxgroupuxhealthuxplanuxanduxwoulduxbecomeuxauxsecondaryuxpayor.
Mrs.uxAndrewsuxisuxcomparinguxheruxemployer'suxretireeuxinsuranceuxtouxOriginaluxMedi
careuxanduxwoulduxlikeuxtouxknowuxwhichuxofuxtheuxfollowinguxservicesuxOriginaluxMedicar
euxwilluxcoveruxifuxtheuxappropriateuxcriteriauxareuxmet.uxWhatuxcoulduxyouuxtelluxher?ux-
uxANSWERS-OriginaluxMedicareuxcoversuxambulanceuxservices.
Mr.uxTurneruxwilluxsoonuxturnuxageux65uxanduxhasuxcomeuxtouxyouuxforuxadviceuxasuxtouxw
hatuxservicesuxareuxprovideduxunderuxOriginaluxMedicare.uxWhatuxshoulduxyouuxtelluxMr.u
xTurneruxthatuxbestuxdescribesuxtheuxhealthuxcoverageuxprovideduxtouxMedicareuxbenefic
iaries?ux-uxANSWERS-BeneficiariesuxunderuxOriginaluxMedicareuxhaveuxnouxcost-
sharinguxforuxmostuxpreventiveuxservices.
AnnieuxMillsuxwilluxturnuxageux65uxinuxAugustux2026.uxAnnieuxintendsuxtouxenrolluxinuxOrigi
naluxMedicareuxPartuxAuxanduxPartuxB.uxSheuxwoulduxalsouxlikeuxtouxenrolluxinuxauxMedicar
euxSupplementux(Medigap)uxplan.uxAnnie'suxolderuxneighboruxJohn,uxhasuxtolduxheruxabo
utuxtheuxMedigapuxPlanuxFuxinuxwhichuxheuxisuxenrolled.uxItuxnotuxonlyuxprovidesuxforeignux
traveluxemergencyuxbenefitsuxbutuxalsouxcoversuxhisuxMedicareuxPartuxBuxdeductible.uxA
nnieuxcomesuxtouxyouuxforuxadvice.uxWhatuxshoulduxyouuxtelluxher?ux-uxANSWERS-
YouuxareuxsorryuxtouxdisappointuxAnnie,uxbutuxauxMedigapuxFuxplanuxisuxnouxlongeruxavail
ableuxtouxthoseuxwhouxturnux65uxafteruxJanuaryux1,ux2020.uxAnnieuxmightuxinsteaduxconsi
deruxotheruxMedigapuxplansuxthatuxofferuxforeignuxtraveluxbenefitsuxbutuxdouxnotuxcoveruxt
heuxPartuxBuxdeductible.
