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Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
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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
Ed
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.
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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance?
She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help
with Medicare costs for which she is responsible.
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Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's
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retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs
he would generally expect to encounter when enrolling into a standard Medicare Part D prescription
Ed
drug plan. What should you tell him?
He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.
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.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and
will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you
tell him?
He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis
treatments start.
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Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
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Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for
services. What advice would you give her?
Ed
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the
MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember
what Part D is so she called you to ask what her neighbor was 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 to see if they have changed.
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.
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Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
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Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
Medicare beneficiaries?
Ed
Beneficiaries under Original Medicare have no cost-sharing for most preventive services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B
services through Original Fee-for-Service Medicare.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid
taxes during that entire period. She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell her?
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid
Medicare taxes while working, though some may be covered as a result of paying monthly premiums.
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rd
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving
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Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had
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been automatically enrolled in Medicare Part B. She wants to understand what this means. What
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should you tell Mrs. Quinn?
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Part B primarily covers physician services. She will be paying a monthly premium and, except for many
preventive and screening tests, generally will have 20% co-payments for these services, in addition to an
Ed
annual deductible.
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 because 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.
What impact, if any, have recent regulatory changes had on Medigap plans?
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1,
2020.
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ird
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?
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Medigap plans do not cover Original Medicare benefits, but they coordinate with Original Medicare
Ed
coverage.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and 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.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in
case she needs them. What should you tell her?
Medicare covers hospice services, and they will be available for her.
Mr. Diaz continued working with his company and was insured under his employer's 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?
e
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
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rd
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Ed
ie
ird
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
uB
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
Ed
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.
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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance?
She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help
with Medicare costs for which she is responsible.
ie
ie
ird
ird
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's
uB
uB
retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs
he would generally expect to encounter when enrolling into a standard Medicare Part D prescription
Ed
drug plan. What should you tell him?
He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.
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.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and
will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you
tell him?
He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis
treatments start.
ie
rd
e
i
i
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rd
Bi
Ed
du
, u
Ed
ie
ird
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
uB
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for
services. What advice would you give her?
Ed
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the
MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember
what Part D is so she called you to ask what her neighbor was 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 to see if they have changed.
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.
ie
ie
ird
ird
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
uB
uB
Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
Medicare beneficiaries?
Ed
Beneficiaries under Original Medicare have no cost-sharing for most preventive services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B
services through Original Fee-for-Service Medicare.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid
taxes during that entire period. She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell her?
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid
Medicare taxes while working, though some may be covered as a result of paying monthly premiums.
ie
rd
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving
e
Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had
i
i
uB
rd
Bi
Ed
du
, u
Ed
ie
been automatically enrolled in Medicare Part B. She wants to understand what this means. What
ird
should you tell Mrs. Quinn?
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Part B primarily covers physician services. She will be paying a monthly premium and, except for many
preventive and screening tests, generally will have 20% co-payments for these services, in addition to an
Ed
annual deductible.
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 because 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.
What impact, if any, have recent regulatory changes had on Medigap plans?
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1,
2020.
ie
ie
ird
ird
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?
uB
uB
Medigap plans do not cover Original Medicare benefits, but they coordinate with Original Medicare
Ed
coverage.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and 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.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in
case she needs them. What should you tell her?
Medicare covers hospice services, and they will be available for her.
Mr. Diaz continued working with his company and was insured under his employer's 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?
e
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
i
rd
e
i
i
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rd
Bi
Ed
du
