AHIP 2021 Questions & Answers
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what th...
mrs quinn recently turned 66 and decided after many years of work to begin receiving social security benefits shortly thereafter mrs quinn received a letter
AHIP 2021 Questions & Answers
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security
benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically
enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs.
Quinn? - ANSWER-Part B primarily covers physician services. She will be paying a monthly premium and,
with the exception of many preventive and screening tests, generally will have 20% coinsurance for these
services, in addition to an annual deductible.
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? - ANSWER-Original Medicare covers ambulance services.
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.
Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare Part A and Part
B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel has
told her about the Medigap Part F plan in which he is enrolled. It not only provides foreign travel
emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What
should you tell her? - ANSWER-You are sorry to disappoint Anita but a Medigap Part F plan is no longer
available to those who turn age 65 after January 1,2020. Anita might instead consider other Medigap
plans that offer foreign travel benefits but do not cover the Part B deductible.
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? - ANSWER-Medicare Supplemental Insurance would help cover his Part A and
Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that
Medicare does not cover.
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.
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? - ANSWER-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.
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? - ANSWER-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.
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 her lengthy hospital stay she
will need a month or two of nursing and rehabilitative care. What should you tell them about Original
Medicare's coverage of care in a skilled nursing facility? - ANSWER-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.
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? - ANSWER-Beneficiaries under Original Medicare have no cost-sharing for most
preventive services which include immunizations such as annual flu shots.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
enrollment period because 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? -
ANSWER-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.
What impact, if any, will recent regulatory changes have upon Medigap plans? - ANSWER-The Part B
deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020.
, Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
income subsidy. Where might he turn for help with his prescription drug costs? - ANSWER-Mr. Wu may
still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed
into the Medicare system. He also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked part-time for the last three years,
will soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should
you tell her? - ANSWER-You should tell Madeline that she will be able to enroll in Medicare Part A
without paying monthly premiums due to her husband's long work record and participation in the
Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due her substantial income.
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? - ANSWER-Tell prospect Jerry Smith that he should consider adding a standalone Part
D prescription drug coverage policy to his present coverage.
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? - ANSWER-Medigap plans
help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services
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? - ANSWER-He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
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 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.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him? - ANSWER-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.
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