Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she...
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan
and was disappointed with the service she received from her primary care
physician because she was told she would have to wait five weeks to get an
appointment when she was feeling ill. She called you to ask what she could do so
she would not have to put up with such poor access to care. What could you tell
her?
She could file a grievance with her plan to complain about the lack of timeliness in
getting an appointment.
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?
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.
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?
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.
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
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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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
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.
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.
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.
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?
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Beneficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
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?
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.
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.
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?
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.
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?
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