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QUESTIONS & VERIFIED ANSWERS
rs. Quinn recently turned 66 and decided after many years of work to begin receiving
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Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her
that she has been automatically enrolled in Medicare Part B. She wants to understand
what this means. What should you tell Mrs. Quinn?
Part B primarily covers physician services. She will be paying a monthly premium and,
with the exception of many preventive and screening tests, generally will have 20%
coinsurance for these services, in addition to an annual deductible.
rs. Turner is comparing her employer's retiree insurance to Original Medicare and
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would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met? What could you tell her?
Original Medicare covers ambulance services.
r. Diaz continued working with his company and was insured under his employer's
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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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
nita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare
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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 Part F plan 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 Part 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.
r. Moy's wife has a Medicare Advantage plan, but he wants to understand what
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coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr. Moy?
, edicare Supplemental Insurance would help cover his Part A and Part B cost sharing
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in Original Fee-for-Service (FFS) Medicare as well as possibly some services that
Medicare does not cover.
r. Bauer is 49 years old, but eighteen months ago, he was declared disabled by the
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Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him?
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?
Part A, which covers hospital, skilled 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.
s. Moore plans to retire when she turns 65 in a few months. She is in excellent health
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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.
rs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
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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?
Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the facility
for 100 days.
r. Xi will soon turn 65 and has come to you for advice as to what services are provided
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under Original Medicare. What should you tell Mr. Xi that best describes the health
coverage provided to Medicare beneficiaries?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots.
rs. Geisler's neighbor told her she should look at her Part D options during the annual
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Medicare enrollment period because features of Part D might have changed. Mrs.
, eisler can't remember what Part D is so she called you to ask what her neighbor was
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talking about. What could you tell her?
Part D covers prescription drugs, and she should look at her premiums, formulary, and
cost-sharing, among other factors,s to see if they have changed.
hat impact, if any, will recent regulatory changes have upon Medigap plans?
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The Part B deductible will no longer be covered for individuals newly eligible for
Medicare starting January 1, 2020.
r. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for
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the Part D low-income subsidy. Where might he turn for help with his prescription drug
costs?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program.
adeline Martinez was widowed several years ago. Her husband worked for many
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years and contributed to 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 65 and hopes to enroll
in Original Medicare. She comes to you for advice. What should you tell her?
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 participation 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 to her substantial
income.
gent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
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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?
Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
rs. Paterson is concerned about the deductibles and co-payments associated with
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Original Medicare. What can you tell her about Medigap as an option to address this
concern?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles
for medically necessary services