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1. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 years and paying Medicare taxes. What should you tell her?: To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher
for individuals with higher incomes.
2. Mr. Patel is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs
he might be exposed to under Medicare if he were to require hospitalization
as a result of an illness. In general terms, what could you tell him about his
costs for inpatient hospital services under Original Medicare?: Under Original
Medicare, there is a single deductible amount due for the first 60 days of any
inpatient hospital stay, after which it converts into a per-day coinsurance amount
through day 90. After day 90, he would pay a daily amount up to 60 days over his
lifetime, after which he would be responsible for all costs.
3. Juan Perez, who is turning age 65 next month, intends to work for several
more years at Smallcap, Incorporated. Smallcap has a workforce of 15
employ- ees and offers employer-sponsored healthcare coverage. Juan is a
naturalized citizen and has contributed to the Medicare system for over 20
years. Juan asks you if he will be entitled to Medicare and if he enrolls how
that will impact his employer-sponsored healthcare coverage. How would
you respond?: Juan is likely to be eligible for Medicare once he turns age 65 and
if he enrolls Medicare would become the primary payor of his healthcare claims
and Smallcap does not have to continue to offer him coverage comparable to
those under age 65 under its employer-sponsored group health plan.
4. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur
rently 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.
5. Mrs. PeaH is 66 years old, has coverage under an employer plan, and will
retire next 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?: She may enroll at
any time while she is covered under her employer plan, but she will have a special
eight-month enrollment period after the last month on her employer plan that
differs from the standard general enrollment period, during which she may enroll
in Medicare Part B.
6. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan
and a Medigap plan to pick up costs not covered by that plan. What should
, AHIP ALL MODULES
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him?: It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in
an MA plan, and besides, Medigap only works with Original Medicare.
7. 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?:
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.
8. Mr. Buck has several family members who died from different cancers. He
wants to know if Medicare covers cancer screening. What should you tell
him?: Medicare covers the periodic performance of a range of screening tests
that are meant to provide early detection of disease. Mr. Buck will need to check
specific tests before obtaining them to see if they will be covered.
9. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with a
determi- nation that partially denied one of her claims for services. What
advice would you give her?: Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
10. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy
as well, but it provides no drug coverage. She would like to keep the
coverage she has but replace her existing Medigap plan with one that
provides drug coverage. What should you tell her?: Mrs. Gonzalez cannot
purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan.
11. Mr. Alonso receives some help paying for his two generic prescription
drugs from his employer's retiree coverage, but he wants to compare it to a
Part D prescription drug plan. He asks you what costs he would generally
ex- pect to encounter when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him?: He generally would pay a
monthly premium, annual deductible, and per-prescription cost-sharing.
12. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell
Mr. Moy?: Medicare Supplemental Insurance would help cover his Part A and
Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as
well as possibly some services that Medicare does not cover.
13. Mr. Rainey is experiencing paranoid delusions and his physician feels
that he should be hospitalized. What should you tell Mr. Rainey (or his
Study online at
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1. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 years and paying Medicare taxes. What should you tell her?: To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher
for individuals with higher incomes.
2. Mr. Patel is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs
he might be exposed to under Medicare if he were to require hospitalization
as a result of an illness. In general terms, what could you tell him about his
costs for inpatient hospital services under Original Medicare?: Under Original
Medicare, there is a single deductible amount due for the first 60 days of any
inpatient hospital stay, after which it converts into a per-day coinsurance amount
through day 90. After day 90, he would pay a daily amount up to 60 days over his
lifetime, after which he would be responsible for all costs.
3. Juan Perez, who is turning age 65 next month, intends to work for several
more years at Smallcap, Incorporated. Smallcap has a workforce of 15
employ- ees and offers employer-sponsored healthcare coverage. Juan is a
naturalized citizen and has contributed to the Medicare system for over 20
years. Juan asks you if he will be entitled to Medicare and if he enrolls how
that will impact his employer-sponsored healthcare coverage. How would
you respond?: Juan is likely to be eligible for Medicare once he turns age 65 and
if he enrolls Medicare would become the primary payor of his healthcare claims
and Smallcap does not have to continue to offer him coverage comparable to
those under age 65 under its employer-sponsored group health plan.
4. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur
rently 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.
5. Mrs. PeaH is 66 years old, has coverage under an employer plan, and will
retire next 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?: She may enroll at
any time while she is covered under her employer plan, but she will have a special
eight-month enrollment period after the last month on her employer plan that
differs from the standard general enrollment period, during which she may enroll
in Medicare Part B.
6. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan
and a Medigap plan to pick up costs not covered by that plan. What should
, AHIP ALL MODULES
Study online at
you tellhttps://quizlet.com/_9zf2dv
, AHIP ALL MODULES
Study online at
https://quizlet.com/_9zf2dv
him?: It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in
an MA plan, and besides, Medigap only works with Original Medicare.
7. 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?:
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.
8. Mr. Buck has several family members who died from different cancers. He
wants to know if Medicare covers cancer screening. What should you tell
him?: Medicare covers the periodic performance of a range of screening tests
that are meant to provide early detection of disease. Mr. Buck will need to check
specific tests before obtaining them to see if they will be covered.
9. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with a
determi- nation that partially denied one of her claims for services. What
advice would you give her?: Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
10. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy
as well, but it provides no drug coverage. She would like to keep the
coverage she has but replace her existing Medigap plan with one that
provides drug coverage. What should you tell her?: Mrs. Gonzalez cannot
purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan.
11. Mr. Alonso receives some help paying for his two generic prescription
drugs from his employer's retiree coverage, but he wants to compare it to a
Part D prescription drug plan. He asks you what costs he would generally
ex- pect to encounter when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him?: He generally would pay a
monthly premium, annual deductible, and per-prescription cost-sharing.
12. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell
Mr. Moy?: Medicare Supplemental Insurance would help cover his Part A and
Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as
well as possibly some services that Medicare does not cover.
13. Mr. Rainey is experiencing paranoid delusions and his physician feels
that he should be hospitalized. What should you tell Mr. Rainey (or his
