2022 AHIPQuestionsand Answers

Mr. Davisis52 yearsoldandhasrecently beendiagnosedwithend-stagerenal disease(ESRD) andwill soonbegin dialysis. Heiswonderingif hecanobtaincoverageunder Medicare. What shouldyoutell him? CORRECT ANSWERHe may sign-upfor Medicareat any timehowever coverageusually beginsonthefourthmonthafter dialysis treatmentsstart. JuanPerez, whoisturningage65next month, intendstoworkfor several moreyearsat Smallcap, Incorporated. Smallcaphasa workforceof15employeesandoffersemployer-sponsoredhealthcarecoverage. Juanisa naturalized citizenandhascontributedtotheMedicaresystemfor over 20 years. Juanasksyouif hewill beentitledtoMedicare andif heenrollshowthat will impact hisemployer-sponsoredhealthcarecoverage. Howwouldyourespond? CORRECT ANSWERJuanislikely tobeeligiblefor Medicareonceheturnsage65 andif heenrollsMedicarewould becometheprimary payor of hishealthcareclaimsandSmallcapdoesnot havetocontinuetooffer himcoverage comparabletothoseunder age65underitsemployer-sponsoredgrouphealthplan. Mr. Moy'swifehasa MedicareAdvantageplan, but hewantstounderstandwhat coverageMedicareSupplemental CORRECT ANSWERMedicareSupplemental Insurancewouldhelpcover hisPart AandPart Bdeductiblesor coinsuranceinOriginal Fee-for-Service(FFS) Medicareaswell aspossibly someservicesthat Medicaredoesnot cover. Mrs. Peňais66 yearsold, hascoverageunder anemployer plan, andwill retirenext year. Sheheardshemust enroll inPart Bat thebeginningof theyeartoensurenogapincoverage. What canyoutell her? CORRECT ANSWERShe may enroll at any timewhilesheiscoveredunder her employer plan, but shewill havea special eight-month enrollment periodafterthelast monthonher employer planthat differsfromthestandard general enrollment period, duringwhichshemay enroll inMedicarePart B. Mrs. Chenwill be65 soon, hasbeena citizenfortwelveyears, hasbeenemployedfull time, andpaidtaxesduring that entireperiod. Sheisconcernedthat shewill not qualifyfor coverageunder part Abecauseshewasnot bornin theUnitedStates. What shouldyoutell her? CORRECT ANSWERMost individualswhoarecitizensandage65or over arecoveredunder Part Aby virtueof havingpaidMedicaretaxeswhileworking, thoughsomemay becoveredasa result of payingmonthly premiums. Mrs. GonzalezisenrolledinOriginal Medicareandhasa Medigappolicy aswell, but it providesnodrugcoverage. Shewouldliketokeepthecoverageshehasbut replaceher existingMedigap planwithonethat providesdrug coverage. What shouldyoutell her? CORRECT ANSWERMrs. Gonzalezcannot purchasea Medigapplanthat covers drugs, but shecouldkeepher Medigappolicy andenroll ina Part Dprescriptiondrug plan. Mrs. West wearsglassesanddenturesandhasenjoyedconsiderablepainrelief fromarthritisthroughmassage therapy. Sheisconcernedabout whether or not Medicarewill covertheseitemsandservices. What shouldyoutell her? CORRECT ANSWERMedicaredoesnot cover massagetherapy, or, ingeneral, glassesor dentures