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Guide Exam Practice Questions With
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Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but
is not sure about what type of plan designs are available through this program. What
should you tell him about the types of health plans that are available through the
Medicare Advantage program? - ANSWER-They are Medicare health plans such as
HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description? - ANSWER-Medicare
Advantage is a way of covering all of the Original Medicare benefits through private
health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard
about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She
wants to know if this would be available to her. What should you tell her about PFFS
plans? - ANSWER-A PFFS plan is one of various types of Medicare Advantage plans
offered by private entities and she may enroll in one if it is available in her area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - ANSWER-Mrs. Radford must be
entitled to Part A and enrolled in Part B to enroll in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A. What should you tell him? -
ANSWER-He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago.
Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What
options does Mrs. Billings have in regard to her MA plan during the next open
enrollment season? - ANSWER-She may remain in her ABC MA plan or enroll in a
Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her
area
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - ANSWER-In most Medicare
,Advantage HMOs, Mr. Kumar must obtain his services only from providers who have a
contractual relationship with the plan (except in an emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - ANSWER-Mrs.
Ramos can obtain care from any provider who participates in Original Medicare, but
generally will be charged a lower co-payment if she goes to one of the plan's preferred
providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - ANSWER-SNPs
have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well
(W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special Needs
Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing
amounts and Mr. Greco would like to join that plan. What should you tell him? -
ANSWER-SNPs limit enrollment to certain sub-populations of beneficiaries. Given his
current situation, he is unlikely to qualify and would not be able to enroll in the SNP.
(W) 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? - ANSWER-Most individuals who are citizens and over age 65 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.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by
the Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him? -
ANSWER-After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social
Security Administration for 12 months. Can you sell him a Medicare Advantage or Part
D Prescription Drug policy? - ANSWER-No, he cannot purchase a Medicare Advantage
or Part D policy because he has not received Social Security or Railroad Retirement
disability benefits for 24 months.
(W) 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? - ANSWER-In order to obtain Part B
coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes
, (W) 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? - ANSWER-Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
(W) Mrs. Peňa 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? - ANSWER-She may enroll at any time while she is
covered under her employer plan, but she will have a special eight-month enrollment
period that differs from the standard general enrollment period, during which she may
enroll in Medicare Part B
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering
enrollment in a Medicare health plan. What should you advise her to do before she will
be able to enroll into a Medicare health plan? - ANSWER-In order to join a Medicare
health plan, she also must enroll in Part B
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance?
- ANSWER-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
(W) Mr. Yu has limited income and resources so you have encouraged him to see if he
qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble
to apply and wants to know what the assistance could do for him if he qualifies. What
could you tell him? - ANSWER-He might qualify for help with Part D prescription drug
costs and help paying Part A and/or Part B premiums, deductibles, and/or cost sharing.
(W) 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? - ANSWER-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 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
(W) 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? - ANSWER-
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after
Guide Exam Practice Questions With
Answers 2026/2027 (100% Guaranteed
Pass)
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but
is not sure about what type of plan designs are available through this program. What
should you tell him about the types of health plans that are available through the
Medicare Advantage program? - ANSWER-They are Medicare health plans such as
HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description? - ANSWER-Medicare
Advantage is a way of covering all of the Original Medicare benefits through private
health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard
about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She
wants to know if this would be available to her. What should you tell her about PFFS
plans? - ANSWER-A PFFS plan is one of various types of Medicare Advantage plans
offered by private entities and she may enroll in one if it is available in her area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - ANSWER-Mrs. Radford must be
entitled to Part A and enrolled in Part B to enroll in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A. What should you tell him? -
ANSWER-He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago.
Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What
options does Mrs. Billings have in regard to her MA plan during the next open
enrollment season? - ANSWER-She may remain in her ABC MA plan or enroll in a
Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her
area
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - ANSWER-In most Medicare
,Advantage HMOs, Mr. Kumar must obtain his services only from providers who have a
contractual relationship with the plan (except in an emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - ANSWER-Mrs.
Ramos can obtain care from any provider who participates in Original Medicare, but
generally will be charged a lower co-payment if she goes to one of the plan's preferred
providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - ANSWER-SNPs
have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well
(W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special Needs
Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing
amounts and Mr. Greco would like to join that plan. What should you tell him? -
ANSWER-SNPs limit enrollment to certain sub-populations of beneficiaries. Given his
current situation, he is unlikely to qualify and would not be able to enroll in the SNP.
(W) 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? - ANSWER-Most individuals who are citizens and over age 65 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.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by
the Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him? -
ANSWER-After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social
Security Administration for 12 months. Can you sell him a Medicare Advantage or Part
D Prescription Drug policy? - ANSWER-No, he cannot purchase a Medicare Advantage
or Part D policy because he has not received Social Security or Railroad Retirement
disability benefits for 24 months.
(W) 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? - ANSWER-In order to obtain Part B
coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes
, (W) 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? - ANSWER-Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
(W) Mrs. Peňa 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? - ANSWER-She may enroll at any time while she is
covered under her employer plan, but she will have a special eight-month enrollment
period that differs from the standard general enrollment period, during which she may
enroll in Medicare Part B
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering
enrollment in a Medicare health plan. What should you advise her to do before she will
be able to enroll into a Medicare health plan? - ANSWER-In order to join a Medicare
health plan, she also must enroll in Part B
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance?
- ANSWER-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
(W) Mr. Yu has limited income and resources so you have encouraged him to see if he
qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble
to apply and wants to know what the assistance could do for him if he qualifies. What
could you tell him? - ANSWER-He might qualify for help with Part D prescription drug
costs and help paying Part A and/or Part B premiums, deductibles, and/or cost sharing.
(W) 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? - ANSWER-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 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
(W) 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? - ANSWER-
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after
