Module 1 Final Review Flashcards
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.
Correct: Individuals who meet these criteria may be eligible to participate in Medicare. It is not based on income.
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 for one of several programs that can help with Medicare costs for which she is responsible.
Correct: Mrs. Park can apply for programs through her State Medicaid office that could assist with her Medicare costs, such as Medicare Savings Programs, Part D low-income subsidies, and Medicaid.
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?
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.
Correct: 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. If she chooses retroactive coverage Shirley must pay premiums for the retroactive covered time period.
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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots.
Correct: Beneficiaries enrolled in both Original Medicare (Parts A and B) have no cost-sharing for most preventive services. These services include immunizations such as annual flu shots.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and severe wind damage. The Federal government declared this to be a natural disaster which has recently ended. During this period Anthony’s initial enrollment period expired. Anthony asks you how he can now obtain Medicare coverage. What should you say?
Anthony is eligible for a special enrollment period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration. Anthony may enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months.
Correct: Anthony is eligible for a special enrollment period (SEP) to enroll in Part B because he missed an enrollment period due to the impact of the Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration. Anthony may enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months.
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.
Correct: Even though Mildred is enrolled in a Medicare Advantage plan, hospice benefits will be paid for by Original Medicare under Part A.
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.
Correct: Agent John Miller can help prospect Jerry select a standalone Part D prescription drug plan that complements his current Original Medicare and Medigap coverage. Alternatively, Agent Miller can suggest that Jerry drop his Medigap coverage and enroll in a MA-PD plan.
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?
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.
Correct: Individuals who are enrolled in Medigap plans may only obtain Medicare drug coverage (Part D) through a stand-alone prescription drug plan.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
Correct: A State Pharmaceutical Assistance Program may be able to provide assistance with prescription drug costs for those who are of limited means but do not qualify for the Part D low-income subsidy.
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.
Correct: As long as Mrs. Peňa is covered under her employer’s plan, she can enroll in Part B at any time. If she retires, she will be able to enroll in Part B during a special enrollment period that lasts 8 months following the last month of her employer 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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer’s plan.
Correct: Individuals with coverage based on their own current employment are not subject to the late enrollment penalty.
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.
Correct: Madeline will be able to enroll in premium-free Part A due to her husband’s work record. She will pay a premium for Part B coverage based on her income level (her income-related monthly adjustment amount [IRMMA]). An income level of $130,000 would mean Mrs. Martinez would pay a premium more than the standard (lowest) amount but not at the highest level which looks at incomes above $500,000 for those filing individual income tax returns.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him?
It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
Correct: The purpose of Medigap plans is to supplement Original Medicare benefits. Medigap plans do not work with Medicare Advantage plans. It is illegal to sell a Medigap plan to someone already in a Medicare Advantage health plan.
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.
Correct: Original Medicare consists of Part A and Part B.
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.
Correct: Typically, people eligible for Medicare pay the standard monthly premium rate for Part B. However, this amount may vary based on an individual’s income.
