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 Medic
...
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? Ans- After receiving such
disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of
age.
Mrs. Pena 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? Ans- She may enroll ay 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
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? Ans- Part A, which covers hospital,
skilled nursing facility, hospice, and home health service and Part B, which covers professional
services such as those provided by a doctor are covered under Original Medicare
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? Ans- 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 coinsurance amount through day 90. After day90, he
would pay a daily amount up to 60 days over this lifetime, after which he would be responsible
for all costs
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance? Ans- 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. Gonzales 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? Ans- Mrs. Gonzales cannot
purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in
a Part D prescription drug plan
Mr. Davis 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? Ans- He may sig-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start
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? AnsMedicare 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.
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? Ans- Medicare covers the 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.
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? Ans- Medicare will cover a total of
190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Juan Perez, 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. Juan is a naturalized citizen and has contributed to the Medicare
system for over 20 years. Juan 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? AnsJuan 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.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one
of her claims for services. What advice would you give her? Ans- Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she received the MSN in the mail.
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? Ans- Tell prospect Jerry Smith that he should consider
adding a standalone Part D prescription drug coverage policy to his present coverage.
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? Ans- To obtain Part B coverage, she must pay a stand
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