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ANSWERSHEETModule 1 - Overview of Medicare Program Basics: Choices,
Eligibility, and Benefits
Question 1
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.
Question 2
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?
d.
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which
include immunizations such as annual flu shots.
Question 3
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This coverage
has recently been terminated due to the end of the PHE. While Shirley was enrolled in Medicaid, she
missed an opportunity to enroll in Medicare and now wants Part B. Which of the following statements
best describes Shirley’s ability to now enroll in Medicare Part B?
b.
,Shirley is eligible for a Special Enrollment Period (SEP) for up to six months after the termination of
her Medicaid coverage. Under this SEP, Shirley can choose retroactive coverage back to the date of
termination from Medicaid or coverage beginning the month after the month of enrollment.
Question 4
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?
b.
He may sign-up for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
Question 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?
b.
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.
Question 6
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?
d.
,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.
Question 7
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?
d.
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.
Question 8
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?
a.
After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
Question 9
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently
learned that she is suffering from inoperable cancer and has just a few months to live. She would
like to spend these final months in hospice care. Mildred’s family asks you whether hospice benefits
will be paid for under the Allcare Medicare Advantage plan. What should you say?
a.
, Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid
for by Original Medicare under Part A and Allcare will continue to pay for any non-hospice services.
Question 10
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?
d.
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.
Question 11
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward
successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say?
a.
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month
in which the individual receives a kidney transplant unless they are eligible for Medicare on another
basis such as age or disability. Edward may, however, remain enrolled in Part B but solely for
coverage of immunosuppressive drugs if he has no other health care coverage that would cover the
drugs.
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