1. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Medicare beneficiaries? fe
a.Beneficiaries under Original Medicare have no cost-sharing for most preventive services which
fe fe fe fe fe fe fe fe fe fe fe fe
include immunizations such as annual flu hots.
f e f e f e f e f e fe
a. Medicare Part A generally covers medically necessary physician and other health care professional
fe fe fe fe fe fe fe fe fe fe fe fe
fe services.
b. Benefits covered by Medicare Parts A and B include routine dental care, hearing aids, and routine eye care.
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
c. MedicarePart B generally provides prescription drug coverage. fe fe fe fe fe fe fe
2. Mr. Buck has several family members who died from different cancers. He wants to know if
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Medicare covers cancer screening. What should you tell him? fe fe fe fe fe fe fe fe
a. MedicarecoversallscreeningteststhathavebeenapprovedbytheFDAonafrequencydetermined by
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe the treating physician.
fe fe
b. Medicare covers treatments for existing disease, injury, and malformed limbs or body parts. As
fe fe fe fe fe fe fe fe fe fe fe fe fe
fe such,it doesnotcoverany screening testsandthese mustbe paidfor bythebeneficiary out-of-
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe pocket.
c. Medicare covers some screening tests that must be performed within the first year after
fe fe fe fe fe fe fe fe fe fe fe fe fe
fe enrollment. Beyond that point expensesfor screening tests are the responsibility ofthe
fe fe fe fe fe fe fe fe fe fe fe fe
, beneficiary.
d. f e f e f e
q f e u f e q f e u
Source: Module 1, f e f e f e f e f e Slide f e f e - f e f e Medicare f e f e Part f e f e B f e f e Benefits f e f e - f e f e Preventive f e f e Services
and Screenings
f e f e fe
3. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe for- Service (FFS) Medicare? What could you tell him?
fe fe fe fe fe fe fe fe
a. Part C, whichalwayscovers dentalandvision services, iscoveredunderOriginal Medicare.
qu qu fe fe fe qu qu
b. fe
which covers professional services such as those provided by a doctor are
q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u
covered
q f e u f e
q f Medic
e . u f e q
fe
,q f are e u f e
c. Part A, whichcoverslong-term custodialcareservices, is coveredunderOriginal Medicare.
qu qu qu qu qu
d. Part D,whichcoversprescriptiondrug services, iscoveredunderOriginalMedicare.
qu fe fe qu qu fe
Source: Module 1, Slide - Overview of Medicare Benefits and Coverage -
f e f e f e f e f e f e f e f e f e f e f e
Parts A, B, C, and Slide - Overview of Different Ways to Get Medicare
f e f e f e fe f e f e f e fe fe fe fe fe fe fe
4. Juan Perez, who is turning age 65 next month, intends to work for several more years at
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
fe fe fe fe fe fe fe fe fe fe
fe employer-sponsored healthcare coverage. Juan is a naturalized citizen and has fe fe fe fe fe fe fe fe fe
fe contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe to Medicare and if he enrolls how that will impact his employer- sponsored healthcare
fe fe fe fe fe fe fe fe fe fe fe fe fe
fe coverage. How would you respond? fe fe fe fe
a. Juan is likely to be ineligible for Medicare since he was born outside the United States and
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe has only contributed to the Medicare system for 20 years.
fe fe fe fe fe fe fe fe fe
, b. fe
the q f e u f e fe q f e u f e primary payor fe q f e u f e q
fe f e u f e of fe q f e u f e his fe q f e u f e healthcare fe q f e u f e claims fe q
q
f but
Smallcap
ef ue uf ef e fe q f e u f e must fe q f e u f e continue q
fe f e u f e to offer q
fe f e u f e q
fe f e u f e
sponsored payor.
c. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe sponsored coverage would continue to be the primary payor while Medicare would be fe fe fe fe fe fe fe fe fe fe fe fe
fe considered a secondary payor of his healthcare claims. fe fe fe fe fe fe fe
Incorrect: Medicare is the primary payor for individuals who have group health coverage fe fe fe fe fe fe fe fe fe fe fe fe
fe due to their continued employment with a small employer. A small group health plan is
fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe one offered by a company with fewer than 20 employees.
fe fe fe fe fe fe fe fe fe
d. Juan is likely to be eligible for Medicare once he turns age 65 and if he f e f e f e f e f e f e f e f e f e f e f e f e f e f e f e
enrolls Medicare would become the primary payor of his healthcare claims and Smallcap
f e fe fe fe fe fe fe fe fe fe fe fe fe
does not have to continue to offer him coverage comparable to those under age 65 under its
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
employer-sponsored group health plan.
fe fe fe fe
Source:Module 1,Slide -Eligibility forPartA andPartBBenefitsandSlide -Medicare forfe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
Individuals Who Are Still Working - Small GHPs and Slide - Medicare
fe fe f e f e f e f e f e f e f e f e f e f e
Coordination with Employer Group Health
f e fe f e f e f e
PlansQuestion4 fe
5. Mr. Baueris 49yearsold,buteighteenmonthsagohe was declareddisabledbythe Social
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Security Administration and has been receiving disability payments. He is wondering fe fe fe fe fe fe fe fe fe fe
fe whether he can obtain coverage under Medicare. What should you tell him? fe fe fe fe fe fe fe fe fe fe fe
a. After receiving such disability payments for 24 months, he will be q
fe f e u f e fe q f e u f e fe q f e u f e q
fe f e u f e fe q f e u f e fe q f e u f e fe q f e u f e q
fe f e u f e q
fe f e u f e fe q f e u f e
q automatically enrolled in Medicare,
f e u f e fe q f e u f e fe q f e u f e qu
regardless
o
fage.
b. Individuals who become eligible for such disability payments only have to f e f e f e f e f e f e f e f e f e f e
wait 12 months before f e f e fe f e
they can applyforcoverageunderMedicare. qu fe fe fe
c. Individuals receiving such disability payments from the Social Security f e f e f e f e f e f e f e f e
fe Administration continue to receive those payments but only become eligible for f e f e fe fe fe fe fe fe fe fe
fe Medicare upon reaching age 65. fe fe fe fe
d. He becameeligible forMedicarewhenhisdisabilityeligibilitydeterminationwas
qu fe
fe first made. Source: Module 1, Slide - Medicare Enrollment Part A & B
qu fe fe fe fe fe fe fe fe fe fe fe
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Medicare beneficiaries? fe
a.Beneficiaries under Original Medicare have no cost-sharing for most preventive services which
fe fe fe fe fe fe fe fe fe fe fe fe
include immunizations such as annual flu hots.
f e f e f e f e f e fe
a. Medicare Part A generally covers medically necessary physician and other health care professional
fe fe fe fe fe fe fe fe fe fe fe fe
fe services.
b. Benefits covered by Medicare Parts A and B include routine dental care, hearing aids, and routine eye care.
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
c. MedicarePart B generally provides prescription drug coverage. fe fe fe fe fe fe fe
2. Mr. Buck has several family members who died from different cancers. He wants to know if
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Medicare covers cancer screening. What should you tell him? fe fe fe fe fe fe fe fe
a. MedicarecoversallscreeningteststhathavebeenapprovedbytheFDAonafrequencydetermined by
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe the treating physician.
fe fe
b. Medicare covers treatments for existing disease, injury, and malformed limbs or body parts. As
fe fe fe fe fe fe fe fe fe fe fe fe fe
fe such,it doesnotcoverany screening testsandthese mustbe paidfor bythebeneficiary out-of-
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe pocket.
c. Medicare covers some screening tests that must be performed within the first year after
fe fe fe fe fe fe fe fe fe fe fe fe fe
fe enrollment. Beyond that point expensesfor screening tests are the responsibility ofthe
fe fe fe fe fe fe fe fe fe fe fe fe
, beneficiary.
d. f e f e f e
q f e u f e q f e u
Source: Module 1, f e f e f e f e f e Slide f e f e - f e f e Medicare f e f e Part f e f e B f e f e Benefits f e f e - f e f e Preventive f e f e Services
and Screenings
f e f e fe
3. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe for- Service (FFS) Medicare? What could you tell him?
fe fe fe fe fe fe fe fe
a. Part C, whichalwayscovers dentalandvision services, iscoveredunderOriginal Medicare.
qu qu fe fe fe qu qu
b. fe
which covers professional services such as those provided by a doctor are
q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u f e q
fe f e u
covered
q f e u f e
q f Medic
e . u f e q
fe
,q f are e u f e
c. Part A, whichcoverslong-term custodialcareservices, is coveredunderOriginal Medicare.
qu qu qu qu qu
d. Part D,whichcoversprescriptiondrug services, iscoveredunderOriginalMedicare.
qu fe fe qu qu fe
Source: Module 1, Slide - Overview of Medicare Benefits and Coverage -
f e f e f e f e f e f e f e f e f e f e f e
Parts A, B, C, and Slide - Overview of Different Ways to Get Medicare
f e f e f e fe f e f e f e fe fe fe fe fe fe fe
4. Juan Perez, who is turning age 65 next month, intends to work for several more years at
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
fe fe fe fe fe fe fe fe fe fe
fe employer-sponsored healthcare coverage. Juan is a naturalized citizen and has fe fe fe fe fe fe fe fe fe
fe contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe to Medicare and if he enrolls how that will impact his employer- sponsored healthcare
fe fe fe fe fe fe fe fe fe fe fe fe fe
fe coverage. How would you respond? fe fe fe fe
a. Juan is likely to be ineligible for Medicare since he was born outside the United States and
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe has only contributed to the Medicare system for 20 years.
fe fe fe fe fe fe fe fe fe
, b. fe
the q f e u f e fe q f e u f e primary payor fe q f e u f e q
fe f e u f e of fe q f e u f e his fe q f e u f e healthcare fe q f e u f e claims fe q
q
f but
Smallcap
ef ue uf ef e fe q f e u f e must fe q f e u f e continue q
fe f e u f e to offer q
fe f e u f e q
fe f e u f e
sponsored payor.
c. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe sponsored coverage would continue to be the primary payor while Medicare would be fe fe fe fe fe fe fe fe fe fe fe fe
fe considered a secondary payor of his healthcare claims. fe fe fe fe fe fe fe
Incorrect: Medicare is the primary payor for individuals who have group health coverage fe fe fe fe fe fe fe fe fe fe fe fe
fe due to their continued employment with a small employer. A small group health plan is
fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe one offered by a company with fewer than 20 employees.
fe fe fe fe fe fe fe fe fe
d. Juan is likely to be eligible for Medicare once he turns age 65 and if he f e f e f e f e f e f e f e f e f e f e f e f e f e f e f e
enrolls Medicare would become the primary payor of his healthcare claims and Smallcap
f e fe fe fe fe fe fe fe fe fe fe fe fe
does not have to continue to offer him coverage comparable to those under age 65 under its
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
employer-sponsored group health plan.
fe fe fe fe
Source:Module 1,Slide -Eligibility forPartA andPartBBenefitsandSlide -Medicare forfe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
Individuals Who Are Still Working - Small GHPs and Slide - Medicare
fe fe f e f e f e f e f e f e f e f e f e f e
Coordination with Employer Group Health
f e fe f e f e f e
PlansQuestion4 fe
5. Mr. Baueris 49yearsold,buteighteenmonthsagohe was declareddisabledbythe Social
fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe fe
fe Security Administration and has been receiving disability payments. He is wondering fe fe fe fe fe fe fe fe fe fe
fe whether he can obtain coverage under Medicare. What should you tell him? fe fe fe fe fe fe fe fe fe fe fe
a. After receiving such disability payments for 24 months, he will be q
fe f e u f e fe q f e u f e fe q f e u f e q
fe f e u f e fe q f e u f e fe q f e u f e fe q f e u f e q
fe f e u f e q
fe f e u f e fe q f e u f e
q automatically enrolled in Medicare,
f e u f e fe q f e u f e fe q f e u f e qu
regardless
o
fage.
b. Individuals who become eligible for such disability payments only have to f e f e f e f e f e f e f e f e f e f e
wait 12 months before f e f e fe f e
they can applyforcoverageunderMedicare. qu fe fe fe
c. Individuals receiving such disability payments from the Social Security f e f e f e f e f e f e f e f e
fe Administration continue to receive those payments but only become eligible for f e f e fe fe fe fe fe fe fe fe
fe Medicare upon reaching age 65. fe fe fe fe
d. He becameeligible forMedicarewhenhisdisabilityeligibilitydeterminationwas
qu fe
fe first made. Source: Module 1, Slide - Medicare Enrollment Part A & B
qu fe fe fe fe fe fe fe fe fe fe fe
