WGU C963 Objective Assessment Questions and Answers
(2024 / 2025) | 100% Correct Verified Answers
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance? - -She should contact her state Medicaid agency to
see if she qualifies...
WGU C963 Objective Assessment Questions and Answers
() | 100% Correct Verified Answers
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance? - -She should contact her state Medicaid agency to
see if she qualifies forprograms that can help with Medicare costs for which she is
responsible.
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.
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. 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? - -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.
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
, WGU C963 Objective Assessment Questions and Answers
() | 100% Correct Verified Answers
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.
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? - -Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his
present coverage.
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? - -The penalty will be a permanent 10% increase in his
Part B premium for every 12-month period that passed during which he could have enrolled
and did not.
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? - -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.
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
, WGU C963 Objective Assessment Questions and Answers
() | 100% Correct Verified Answers
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. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his current
HMO plan requires him to do. What should you tell him? - -He may receive health
care services from any doctor allowed to bill Medicare, as long as he shows the doctor the
plan's identification card and the doctor agrees to accept the PFFS plan's payment terms
and conditions, which could include balance billing.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? - -You would
need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's
service area.
Mrs. Wang wants to know generally how the benefits under Original Medicare might
compare to the benefits package of a Medicare Advantage Plan before she starts looking at
specific plans. What could you tell her? - -Medicare Advantage Plans may offer extra
benefits that Original Medicare does not offer such as vision, hearing, and dental services.
It must include a maximum out-of-pocket limit on Part A and Part B services.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to
enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell
him? - -He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
, WGU C963 Objective Assessment Questions and Answers
() | 100% Correct Verified Answers
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected
that he would have certain services and items covered by the plan with minimal out-of-
pocket costs because his MA-PD coverage has been very good. However, when he received
the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit
that included some services and items he thought would be fully covered. He called you to
ask what he could do? What could you tell him? - -You can offer to review the plans
appeal process to help him ask the plan to review the coverage decision.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants
to have prescription drug coverage since her doctor recently prescribed several expensive
medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan.
How would you advise Mrs. Chi? - -Mrs. Chi may enroll in a MA MSA plan and remain
in her current standalone Part D prescription drug plan.
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? - -Mrs. Ramos
can obtain care from any provider who participates in Original Medicare, but generally will
have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO
network.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - -Medicare Advantage is a way of
covering all the Original Medicare benefits through private health insurance companies.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over
twenty years ago but is not a citizen. Since his entry into the country, Juan has worked at
Smallcap Incorporated and contributed to the Medicare system. Juan suffers from
diabetes. He will soon retire and asks you if he can enroll in a Medicare Advantage plan that
you represent. How would you respond? - -Juan is eligible to enroll in a Medicare
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