QUESTIONS UNIT 1 Flashcards
Queen Colleen 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.
B would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him?
B can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-For-Service Medicare
Queen Colleen, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. B is a naturalized citizen and has contribute to the Medicare system for over 20 years. B asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. How would you respond?
Queen Colleen is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan.
B 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.
B recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter B 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 B?
Part B primarily covers physician services. B will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% coinsurance for these services, in addition to an annual deductible.
B is comparing his 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?
Original Medicare covers ambulance services.
B 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 B 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.
B 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?
B may still qualify for help in paying Part D costs through his state Pharmaceutical Assistance Program.
B 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.
B’s neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. B can’t remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her?
Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they changed.
B will turn age 65 in August 2020. B intends to enroll in Original Medicare Part A and Part B. He would also like to enroll in a Medicare Supplement (Medigap) plan. B’s older neighbor Mel has told him about the Medigap Part F plan in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part b deductible. B comes to you for advice. what should you tell him?
B will not pay any penalty because he had continuous coverage under his employer’s plan.
B 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.
Agent Jennifer is meeting with Jasmine, a new prospect. Jasmine is currently enrolled in Medicare Parts A and B.. Jasmine has also purchased Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent Jennifer to proceed?
Tell prospect Jasmine that she should consider adding a standalone Part D prescription drug coverage policy to his present coverage.
Christina Aguilera 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 Christina with an annual income of approximately $130,000. Christina, 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 Christina 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 Christina that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income.
Britney Spears is concerned about the deductibles and co-payments associated with Original Medicare. What can you tell her about Medigap as an option to address this concern?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services.
