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. 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? -
ANSWER Mr. Wu may still qualify for help in paying Part D costs through his State Phar-
maceutical Assistance Program.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred re-
cently 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? - ANSWER 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.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Origi-
nal Fee-for-Service (FFS) Medicare. What could you tell him? - ANSWER Part A, which co-
vers hospital, skilled nursing facility, hospice, and home health services and Part B, which co-
vers professional services such as those provided by a doctor are covered under Original
Medicare.
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? - ANSWER Tell prospect Jerry Smith that
1
,he should consider adding a standalone Part D prescription drug coverage policy to his pre-
sent coverage.
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 Medi-
care. What should you tell him? - ANSWER He may sign-up for Medicare at any time how-
ever coverage usually begins on the fourth month after dialysis treatments start.
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.
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 Made-
line 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 Medi-
care. She comes to you for advice. What should you tell her? - ANSWER You should tell
Madeline that she will be able to enroll in Medicare Part A without paying monthly premi-
ums 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 low-
est rate but less than the highest rate due her substantial income.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kid-
ney and Edward successfully underwent transplant surgery 12 months ago. Edward is now
age 50 and asks you if his Medicare coverage will continue, what should you say? - AN-
SWER Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months
after the month in which the individual receives a kidney transplant unless they are eligible
for Medicare on another basis such as age or disability. Edward may, however, remain en-
rolled in Part B but solely for coverage of immunosuppressive drugs if he has no other health
care coverage that would cover the drugs.
2
, 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 cover-
age. 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 after
the last month on her employer plan that differs from the standard general enrollment pe-
riod, during which she may enroll in Medicare Part B.
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? - ANSWER 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.
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, with-
out paying any premiums, because she has been working for 40 years and paying Medicare
taxes. What should you tell her? - ANSWER To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park 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.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This cov-
erage 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? -
ANSWER 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.
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
3
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. 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? -
ANSWER Mr. Wu may still qualify for help in paying Part D costs through his State Phar-
maceutical Assistance Program.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred re-
cently 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? - ANSWER 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.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Origi-
nal Fee-for-Service (FFS) Medicare. What could you tell him? - ANSWER Part A, which co-
vers hospital, skilled nursing facility, hospice, and home health services and Part B, which co-
vers professional services such as those provided by a doctor are covered under Original
Medicare.
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? - ANSWER Tell prospect Jerry Smith that
1
,he should consider adding a standalone Part D prescription drug coverage policy to his pre-
sent coverage.
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 Medi-
care. What should you tell him? - ANSWER He may sign-up for Medicare at any time how-
ever coverage usually begins on the fourth month after dialysis treatments start.
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.
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 Made-
line 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 Medi-
care. She comes to you for advice. What should you tell her? - ANSWER You should tell
Madeline that she will be able to enroll in Medicare Part A without paying monthly premi-
ums 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 low-
est rate but less than the highest rate due her substantial income.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kid-
ney and Edward successfully underwent transplant surgery 12 months ago. Edward is now
age 50 and asks you if his Medicare coverage will continue, what should you say? - AN-
SWER Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months
after the month in which the individual receives a kidney transplant unless they are eligible
for Medicare on another basis such as age or disability. Edward may, however, remain en-
rolled in Part B but solely for coverage of immunosuppressive drugs if he has no other health
care coverage that would cover the drugs.
2
, 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 cover-
age. 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 after
the last month on her employer plan that differs from the standard general enrollment pe-
riod, during which she may enroll in Medicare Part B.
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? - ANSWER 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.
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, with-
out paying any premiums, because she has been working for 40 years and paying Medicare
taxes. What should you tell her? - ANSWER To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park 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.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This cov-
erage 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? -
ANSWER 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.
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
3
