AHIP 2024 Final E xam Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that mig ht be of assistance? - ANSWER>>>She should contact her state Medicaid agency to see if she qualifies forprograms that can help with Medicare costs for which she is responsible. Madeline Martinez was widowed several years ago. Her husband worked for many y ears and contributed into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Madeline, who has only worked part -time for the last three years, will soon turn age 65 and hopes to e nroll in Original Medicare. She comes to you for advice. What should you tell her? - ANSWER>>>You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participatio n in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him - ANSWER>>>After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee -for-Service (FFS) Medicare? What could you tell him? - ANSWER>>>Part A, which covers hospital, skille d nursing facility, hospice and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire nex t 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? - ANSWER>>>She may enroll at any time while she is covered under her employer plan, but she will have a special eight month enroll ment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? - ANSWER>>>Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should you tell him? - ANSW ER>>>The penalty will be a permanent 10% increase in his Part B premium for every 12 -month period that passed during which he could have enrolled and did not. 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? - ANSWER>>>Medicare is a program for people age 65 or older and those unde r age 65 with certain disabilities, end -stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare. Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently learned that she is suffering from i noperable cancer and has just a few months to live. She would like to spend these final months in hospice care. Mildred's family asks you whether hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you say? - ANSWER>>>M ildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid for by Original Medicare under Part A and Allcare will continue to pay for any non -hospice services. Mr. Gomez notes that a Private Fee -for-Service (PFFS) pla n available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him? - ANSWER>>>He may receive health care services from any doctor allowed to bill Med icare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing. Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-
for-service (PFFS) plan. What questions would you need to ask to determine his eligibility? - ANSWER>>>You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's service area. Mrs. Wang wants to know gen erally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her? - ANSWER>>>Medicare Advantage Plans may offer extra benefits that Origi nal Medicare does not offer such as vision, hearing, and dental services. It must include a maximum out -of-pocket limit on Part A and Part B services. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped pay ing his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? - ANSWER>>>He is not eligible to enroll in a Medicare Advantage plan until he re -enrolls in Medicare Part B. Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out -of-pocket costs because his MA -PD coverage has bee n very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out -of-pocket limit that included some services and items he thought would be fully covered. He called you to ask what he could do? What could y ou tell him? - ANSWER>>>You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mrs. Chi is age 75 and enjoys a comfortable but not extremely high -income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is
for-service (PFFS) plan. What questions would you need to ask to determine his eligibility? - ANSWER>>>You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's service area. Mrs. Wang wants to know gen erally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her? - ANSWER>>>Medicare Advantage Plans may offer extra benefits that Origi nal Medicare does not offer such as vision, hearing, and dental services. It must include a maximum out -of-pocket limit on Part A and Part B services. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped pay ing his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? - ANSWER>>>He is not eligible to enroll in a Medicare Advantage plan until he re -enrolls in Medicare Part B. Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out -of-pocket costs because his MA -PD coverage has bee n very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out -of-pocket limit that included some services and items he thought would be fully covered. He called you to ask what he could do? What could y ou tell him? - ANSWER>>>You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mrs. Chi is age 75 and enjoys a comfortable but not extremely high -income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is
