Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program? - ANSWER They are...
AHIP|| 200 questions|| Correct
ANSWERS|| VERIFIED
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about
what type of plan designs are available through this program. What should you tell him about the types
of health plans that are available through the Medicare Advantage program? - ANSWER They are
Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - ANSWER Medicare Advantage is a way of covering all
of the Original Medicare benefits through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans? - ANSWER A PFFS plan is one of various
types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available
in her area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? - ANSWER Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him? - ANSWER He is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings have in
regard to her MA plan during the next open enrollment season? - ANSWER She may remain in her ABC
MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in
her area
, Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - ANSWER In most Medicare Advantage HMOs, Mr. Kumar must
obtain his services only from providers who have a contractual relationship with the plan (except in an
emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
go to for her health care. What should you tell her? - ANSWER Mrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will be charged a lower co-payment if she
goes to one of the plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under
Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans
(SNPs). What could you tell him? - ANSWER SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as
well
(W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his
investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that
plan. What should you tell him? - ANSWER SNPs limit enrollment to certain sub-populations of
beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the
SNP.
(W) 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 over age 65 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.
(W) 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.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug policy?
- ANSWER No, he cannot purchase a Medicare Advantage or Part D policy because he has not received
Social Security or Railroad Retirement disability benefits for 24 months.
, (W) 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? - ANSWER In order to obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes
(
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. Shields'
skilled nursing services provided during the first 20 days of her stay, after which she would have a
coinsurance until she has been in the facility for 100 days.
Mrs. Quinn has just turned 65 and 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% co-payments for
these services, in addition to an annual deductible.
(W) 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? - ANSWER Medicare covers 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.
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
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
acupuncture. She is concerned about whether or not Medicare will cover these items and services. What
should you tell her? - ANSWER Medicare does not cover acupuncture, or, in general, glasses or dentures
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