AHIP 2024 LATEST UPDATE!!
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 or Lou Gehrig's disease, so she will be
eligible for Medicare.
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.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at
some time in the future, reduce his benefits below what is available in Original Medicare. What should
you tell him about his concern? - ANSWER Medicare health plans must cover all benefits available under
Medicare Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few weeks. She concerned
about having prescription drug coverage. Which of the following statements provides the best advice? -
ANSWER Prescription drug coverage can be obtained by enrolling in a Medicare Advantage plan that
includes Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the
benefit package of a Medicare Health Plan before she starts looking at specific plans. What could you tell
her? - ANSWER Medicare Health Plans may offer extra benefits that Original Medicare does not offer
such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A
and Part B services.
Mr. Meoni'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.Meoni? - 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.
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
Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in a
Medicare health plan. What should you advise her to do before she will be able to enroll into a Medicare
health plan? - ANSWER In order to join a Medicare health plan, she also must enroll in Part B.
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance? - ANSWER 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.
Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for some type
of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to know what the
assistance could do for him if he qualifies. What could you tell him? - ANSWER He might qualify for help
with Part D prescription drug costs and help paying Part A and/or Part B premiums, deductibles, and/or
cost sharing.
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? - ANSWER 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 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
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. Schmidt's
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.
, 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? - ANSWER Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
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.
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.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at
some
time in the future, reduce his benefits below what is available in Original Medicare. What should you tell
him about his concern? - ANSWER Medicare health plans must cover all benefits available under
Medicare Part A and Part B. Many also cover Part D prescription drugs.
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.
, 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.
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. 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.
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.
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.
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? - ANSWER She may enroll at any time
while she is covered under her employer plan, but she will have a special eight month enrollment period
that differs from the standard general enrollment period, during which she may enroll in Medicare Part
B.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
income
