AHIP 2025 FINAL
Mrs. Paterson is concerned about the
Medigap plans help beneficiaries cover
deductibles and co-payments associat-
Original Medicare benefits, but they co-
ed with Original Medicare. What can you
ordinate with Original Medicare cover-
tell her about Medigap as an option to
age.
address this concern?
Anita Magri will turn age 65 in August
2023. Anita intends to enroll in Origi-
nal Medicare Part A and Part B. She
You are sorry to disappoint Anita, but a
would also like to enroll in a Medicare
Medigap F plan is no longer available to
Supplement (Medigap) plan. Anita's old-
those who turn age 65 after January 1,
er neighbor Mel has told her about the
2020. Anita might instead consider other
Medigap Plan F in which he is en-
Medigap plans that offer foreign travel
rolled. It not only provides foreign travel
benefits but do not cover the Part B de-
emergency benefits but also covers his
ductible.
Medicare Part B deductible. Anita comes
to you for advice. What should you tell
her?
b.
What impact, if any, have recent regula- The Part B deductible is no longer cov-
tory changes had on Medigap plans? ered 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 Medicare will cover a total of 190 days
you tell Mr. Rainey (or his representative) of inpatient psychiatric care during Mr.
about the length of an inpatient psychi- Rainey's entire lifetime.
atric hospital stay that Medicare will cov-
er?
Mrs. Shields is covered by Original
Medicare. She sustained a hip fracture
and is being successfully treated for that
condition. However, she and her physi-
cians feel that after her lengthy hos-
pital stay, she will need a month or
two of nursing and rehabilitative care.
What should you tell them about Original
1/7
, AHIP 2025 FINAL
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. Medicare does not cover massage ther-
She is concerned about whether or not apy, or, in general, glasses or dentures.
Medicare will cover these items and ser-
vices. What should you tell her?
Ms. Gibson recently lost her employer
group health and drug coverage and now
She can enroll in the PPO, but she will
she wants to enroll in a PPO that does
not be able to purchase a stand-alone
not include drug coverage. What should
Medicare Part D prescription drug plan.
you tell her about obtaining drug cover-
age?
Mrs. Radford asks whether there are
Mrs. Radford must be entitled to Part
any special eligibility requirements for
A and enrolled in Part B to enroll in
Medicare Advantage. What should you
Medicare Advantage.
tell her?
Mr. Barker enjoys a comfortable retire-
ment income. He recently had surgery
and expected that he would have cer-
tain services and items covered by the
plan with minimal out-of-pocket costs be-
cause his MA-PD coverage has been You can offer to review the plans appeal
very good. However, when he received process to help him ask the plan to re-
the bill, he was surprised to see large view the coverage decision.
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 you tell him?
Mr. Sanchez has just turned 65 and is
entitled to Part A but has not enrolled in
Part B because he has coverage through
He will have to enroll in Part B.
an employer plan. If he wants to enroll in
a Medicare Advantage plan, what will he
have to do?
2/7
Mrs. Paterson is concerned about the
Medigap plans help beneficiaries cover
deductibles and co-payments associat-
Original Medicare benefits, but they co-
ed with Original Medicare. What can you
ordinate with Original Medicare cover-
tell her about Medigap as an option to
age.
address this concern?
Anita Magri will turn age 65 in August
2023. Anita intends to enroll in Origi-
nal Medicare Part A and Part B. She
You are sorry to disappoint Anita, but a
would also like to enroll in a Medicare
Medigap F plan is no longer available to
Supplement (Medigap) plan. Anita's old-
those who turn age 65 after January 1,
er neighbor Mel has told her about the
2020. Anita might instead consider other
Medigap Plan F in which he is en-
Medigap plans that offer foreign travel
rolled. It not only provides foreign travel
benefits but do not cover the Part B de-
emergency benefits but also covers his
ductible.
Medicare Part B deductible. Anita comes
to you for advice. What should you tell
her?
b.
What impact, if any, have recent regula- The Part B deductible is no longer cov-
tory changes had on Medigap plans? ered 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 Medicare will cover a total of 190 days
you tell Mr. Rainey (or his representative) of inpatient psychiatric care during Mr.
about the length of an inpatient psychi- Rainey's entire lifetime.
atric hospital stay that Medicare will cov-
er?
Mrs. Shields is covered by Original
Medicare. She sustained a hip fracture
and is being successfully treated for that
condition. However, she and her physi-
cians feel that after her lengthy hos-
pital stay, she will need a month or
two of nursing and rehabilitative care.
What should you tell them about Original
1/7
, AHIP 2025 FINAL
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. Medicare does not cover massage ther-
She is concerned about whether or not apy, or, in general, glasses or dentures.
Medicare will cover these items and ser-
vices. What should you tell her?
Ms. Gibson recently lost her employer
group health and drug coverage and now
She can enroll in the PPO, but she will
she wants to enroll in a PPO that does
not be able to purchase a stand-alone
not include drug coverage. What should
Medicare Part D prescription drug plan.
you tell her about obtaining drug cover-
age?
Mrs. Radford asks whether there are
Mrs. Radford must be entitled to Part
any special eligibility requirements for
A and enrolled in Part B to enroll in
Medicare Advantage. What should you
Medicare Advantage.
tell her?
Mr. Barker enjoys a comfortable retire-
ment income. He recently had surgery
and expected that he would have cer-
tain services and items covered by the
plan with minimal out-of-pocket costs be-
cause his MA-PD coverage has been You can offer to review the plans appeal
very good. However, when he received process to help him ask the plan to re-
the bill, he was surprised to see large view the coverage decision.
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 you tell him?
Mr. Sanchez has just turned 65 and is
entitled to Part A but has not enrolled in
Part B because he has coverage through
He will have to enroll in Part B.
an employer plan. If he wants to enroll in
a Medicare Advantage plan, what will he
have to do?
2/7
