AHIP 2025 FINAL
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
Medicare. What can you tell her about Medigap as an option to address this concern? - -
Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A and
Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older
neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides
foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to
you for advice. What should you tell her? - - You are sorry to disappoint Anita, but a Medigap F
plan is no longer available to those who turn age 65 after January 1, 2020. Anita might instead
consider other Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
What impact, if any, have recent regulatory changes had on Medigap plans? - - b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting
January 1, 2020.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient
psychiatric hospital stay that Medicare will cover? - - Medicare will cover a total of 190 days
of inpatient psychiatric care during Mr. Rainey's entire lifetime.
, Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay,
she will need a month or two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility? - -
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.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll
in a PPO that does not include drug coverage. What should you tell her about obtaining drug
coverage? - - She can enroll in the PPO, but she will not be able to purchase a stand-alone
Medicare Part D prescription drug plan.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? - - Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage.
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 been 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
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
Medicare. What can you tell her about Medigap as an option to address this concern? - -
Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A and
Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older
neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides
foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to
you for advice. What should you tell her? - - You are sorry to disappoint Anita, but a Medigap F
plan is no longer available to those who turn age 65 after January 1, 2020. Anita might instead
consider other Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
What impact, if any, have recent regulatory changes had on Medigap plans? - - b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting
January 1, 2020.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient
psychiatric hospital stay that Medicare will cover? - - Medicare will cover a total of 190 days
of inpatient psychiatric care during Mr. Rainey's entire lifetime.
, Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay,
she will need a month or two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility? - -
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.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll
in a PPO that does not include drug coverage. What should you tell her about obtaining drug
coverage? - - She can enroll in the PPO, but she will not be able to purchase a stand-alone
Medicare Part D prescription drug plan.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? - - Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage.
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 been 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
