2022 AHIP
1. Mr. Davis is 52 years old and has recently been diagnosed with end-
stage renal disease (ESRD) and will soon begin dialysis. He is wondering if
he can obtain coverage under Medicare. What should you tell him?: He
may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start.
2. Juan Perez, who is turning age 65 next month, intends to work for sev-
eral more years at Smallcap, Incorporated. Smallcap has a workforce of15
employees and offers employer-sponsored healthcare coverage. Juan is a
naturalized citizen and has contributed to the Medicare system for over 20
years. Juan asks you if he will be entitled to Medicare and if he enrolls how
that will impact his employer-sponsored healthcare coverage. How would
you respond?: Juan is likely to be eligible for Medicare once he turns
age 65 and if he enrolls Medicare would become the primary payor of
his healthcare claims and Smallcap does not have to continue to offer
him coverage comparable to those under age 65 under its employer-
sponsored group health plan.
3. Mr. Moy's wife has a Medicare Advantage plan, but he wants to
understand what coverage Medicare Supplemental Insurance provides
since his health care needs are different from his wife's needs. What could
you tell Mr. Moy?: Medicare Supplemental Insurance would help cover
his Part A and Part
B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare
as well as possibly some services that Medicare does not cover.
4. Mrs. PeHa is 66 years old, has coverage under an employer plan, and
will retire next year. She heard she must enroll in Part B at the beginning
of the year to ensure no gap in coverage. What can you tell her?: She
may enroll at any time while she is covered under her employer plan,
but she will have a special eight-month enrollment period after the
last month on her employer plan that differs from the standard
general enrollment period, during which she may enroll in Medicare
Part B.
5. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
,employed full time, and paid taxes during that entire period. She is
concerned that she will not qualify for coverage under part A because she
was not born in the United States. What should you tell her?: Most
individuals who are citizens and age 65 or over are covered under Part
A by virtue of having paid Medicare taxes while working, though some
may be covered as a result of paying monthly premiums.
6. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap
policy as well, but it provides no drug coverage. She would like to keep the
coverage
,she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her?: Mrs. Gonzalez cannot purchase a
Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan.
7. Mrs. West wears glasses and dentures and has enjoyed considerable
pain relief from arthritis through massage therapy. She is concerned
about whether or not Medicare will cover these items and services. What
should you tell her?: Medicare does not cover massage therapy, or, in
general, glasses or dentures.
8. Mr. Patel is in good health and is preparing a budget in anticipation of
his retirement when he turns 66. He wants to understand the health care
costs he might be exposed to under Medicare if he were to require
hospitalization as a result of an illness. In general terms, what could you
tell him about his costs for inpatient hospital services
under Original Medicare?: Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient hospital
stay, after which it converts into a per-day coinsurance amount
through day 90. After day 90, he would pay a daily amount up to 60
days over his lifetime, after which he would be responsible for all
costs.
9. Ms. Henderson believes that she will qualify for Medicare Coverage
when she turns 65, without paying any premiums, because she has been
working for 40 years and paying Medicare taxes. What should you tell her?:
To obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
10. Mr. Alonso receives some help paying for his two generic
prescription drugs from his employer's retiree coverage, but he wants to
compare it to
a Part D prescription drug plan. He asks you what costs he would
generally expect to encounter when enrolling into a standard MedicarePart
D prescrip- tion drug plan. What should you tell him?: He generally would
pay a monthly premium, annual deductible, and per-prescription cost-
sharing.
11.Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires. She
is concerned that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern?: Medicare is a
program for people age 65 or older and those under age 65 with
, certain disabilities, end-stage renal disease, and Lou Gehrig's disease
so she will be eligible for Medicare.
1. Mr. Davis is 52 years old and has recently been diagnosed with end-
stage renal disease (ESRD) and will soon begin dialysis. He is wondering if
he can obtain coverage under Medicare. What should you tell him?: He
may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start.
2. Juan Perez, who is turning age 65 next month, intends to work for sev-
eral more years at Smallcap, Incorporated. Smallcap has a workforce of15
employees and offers employer-sponsored healthcare coverage. Juan is a
naturalized citizen and has contributed to the Medicare system for over 20
years. Juan asks you if he will be entitled to Medicare and if he enrolls how
that will impact his employer-sponsored healthcare coverage. How would
you respond?: Juan is likely to be eligible for Medicare once he turns
age 65 and if he enrolls Medicare would become the primary payor of
his healthcare claims and Smallcap does not have to continue to offer
him coverage comparable to those under age 65 under its employer-
sponsored group health plan.
3. Mr. Moy's wife has a Medicare Advantage plan, but he wants to
understand what coverage Medicare Supplemental Insurance provides
since his health care needs are different from his wife's needs. What could
you tell Mr. Moy?: Medicare Supplemental Insurance would help cover
his Part A and Part
B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare
as well as possibly some services that Medicare does not cover.
4. Mrs. PeHa is 66 years old, has coverage under an employer plan, and
will retire next year. She heard she must enroll in Part B at the beginning
of the year to ensure no gap in coverage. What can you tell her?: She
may enroll at any time while she is covered under her employer plan,
but she will have a special eight-month enrollment period after the
last month on her employer plan that differs from the standard
general enrollment period, during which she may enroll in Medicare
Part B.
5. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
,employed full time, and paid taxes during that entire period. She is
concerned that she will not qualify for coverage under part A because she
was not born in the United States. What should you tell her?: Most
individuals who are citizens and age 65 or over are covered under Part
A by virtue of having paid Medicare taxes while working, though some
may be covered as a result of paying monthly premiums.
6. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap
policy as well, but it provides no drug coverage. She would like to keep the
coverage
,she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her?: Mrs. Gonzalez cannot purchase a
Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan.
7. Mrs. West wears glasses and dentures and has enjoyed considerable
pain relief from arthritis through massage therapy. She is concerned
about whether or not Medicare will cover these items and services. What
should you tell her?: Medicare does not cover massage therapy, or, in
general, glasses or dentures.
8. Mr. Patel is in good health and is preparing a budget in anticipation of
his retirement when he turns 66. He wants to understand the health care
costs he might be exposed to under Medicare if he were to require
hospitalization as a result of an illness. In general terms, what could you
tell him about his costs for inpatient hospital services
under Original Medicare?: Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient hospital
stay, after which it converts into a per-day coinsurance amount
through day 90. After day 90, he would pay a daily amount up to 60
days over his lifetime, after which he would be responsible for all
costs.
9. Ms. Henderson believes that she will qualify for Medicare Coverage
when she turns 65, without paying any premiums, because she has been
working for 40 years and paying Medicare taxes. What should you tell her?:
To obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
10. Mr. Alonso receives some help paying for his two generic
prescription drugs from his employer's retiree coverage, but he wants to
compare it to
a Part D prescription drug plan. He asks you what costs he would
generally expect to encounter when enrolling into a standard MedicarePart
D prescrip- tion drug plan. What should you tell him?: He generally would
pay a monthly premium, annual deductible, and per-prescription cost-
sharing.
11.Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires. She
is concerned that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern?: Medicare is a
program for people age 65 or older and those under age 65 with
, certain disabilities, end-stage renal disease, and Lou Gehrig's disease
so she will be eligible for Medicare.
