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 ...
Module 1
1. 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.
2. 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.
3. 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.
4. 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.
5. Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare? What could you tell him?
Part A, which covers hospital, skilled nursing facility, hospice, and home health services and
Part B, which covers professional services such as those provided by a doctor are covered
under Original Medicare.
6. 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.
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, AHIP STUDY GUIDE QUESTIONS
7. 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 expect 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.
8. Mrs. Peña 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.
9. 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.
10. 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.
11. 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.
12. 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 you tell 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.
13. 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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, AHIP STUDY GUIDE QUESTIONS
14. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand 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.
15. 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.
16. 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?
After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
17. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
under Original Medicare. What should you tell Mr. Xi that best describes the health coverage
provided to Medicare beneficiaries?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which
include immunizations such as annual flu shots.
18. 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 employees 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.
19. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently 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.
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