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
he should consider adding a standalone Part D prescription drug coverage policy to his pre-
sent coverage.
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.
Mr. Vasquez 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 un-
der Medicare if he were to require hospitalization because of an illness. In general terms,
what could you tell him about his costs for inpatient hospital services under Original Medi-
care? - ANSWER 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 coinsur-
ance amount through day 90. After day 90, he would pay a daily amount up to 60 days over
his lifetime, after which he would be responsible for all costs.
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 (SPAP).
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a
Medicare Advantage plan, but he wants to understand what coverage Medicare Supple-
mental Insurance provides since his health care needs are different from his wife's needs.
What could you tell Mr. Moy? - ANSWER Medicare Supplemental Insurance would help
1
,cover his Part A deductible and Part B coinsurance or copayments in Original Fee-for-Service
(FFS) Medicare as well as possibly some services that Medicare does not cover.
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 Med-
icare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he en-
rolls how that will impact his employer- sponsored healthcare coverage. How would you re-
spond? - ANSWER Juan 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. Juan 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 but Smallcap must continue to offer him coverage under its employer-sponsored
group health plan and would become a secondary payor.
Ms. Kumar 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
certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible
for Medicare.
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiv-
ing Social Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her that
she had been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Ellis? - ANSWER Part B primarily covers physician ser-
vices. She will be paying a monthly premium and, except for many preventive and screening
tests, generally will have 20% co-payments for these services, in addition to an annual de-
ductible.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Ad-
vantage plan. What should you tell him? - ANSWER Mr. Singh 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.
2
, Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs.
Cook 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.
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.
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. 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.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice ser-
vices in case she needs them. What should you tell her? - ANSWER Medicare covers hos-
pice services, and they will be available for her.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retire-
ment 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 im-
pacted by a hurricane causing massive flooding and severe wind damage. The Federal gov-
ernment 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 Medi-
care coverage. What should you say? - ANSWER Anthony is eligible for a special enroll-
ment period (SEP) because he missed an enrollment period due to the impact of the Feder-
ally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after
3
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
he should consider adding a standalone Part D prescription drug coverage policy to his pre-
sent coverage.
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.
Mr. Vasquez 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 un-
der Medicare if he were to require hospitalization because of an illness. In general terms,
what could you tell him about his costs for inpatient hospital services under Original Medi-
care? - ANSWER 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 coinsur-
ance amount through day 90. After day 90, he would pay a daily amount up to 60 days over
his lifetime, after which he would be responsible for all costs.
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 (SPAP).
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a
Medicare Advantage plan, but he wants to understand what coverage Medicare Supple-
mental Insurance provides since his health care needs are different from his wife's needs.
What could you tell Mr. Moy? - ANSWER Medicare Supplemental Insurance would help
1
,cover his Part A deductible and Part B coinsurance or copayments in Original Fee-for-Service
(FFS) Medicare as well as possibly some services that Medicare does not cover.
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 Med-
icare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he en-
rolls how that will impact his employer- sponsored healthcare coverage. How would you re-
spond? - ANSWER Juan 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. Juan 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 but Smallcap must continue to offer him coverage under its employer-sponsored
group health plan and would become a secondary payor.
Ms. Kumar 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
certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible
for Medicare.
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiv-
ing Social Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her that
she had been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Ellis? - ANSWER Part B primarily covers physician ser-
vices. She will be paying a monthly premium and, except for many preventive and screening
tests, generally will have 20% co-payments for these services, in addition to an annual de-
ductible.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Ad-
vantage plan. What should you tell him? - ANSWER Mr. Singh 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.
2
, Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs.
Cook 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.
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.
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. 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.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice ser-
vices in case she needs them. What should you tell her? - ANSWER Medicare covers hos-
pice services, and they will be available for her.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retire-
ment 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 im-
pacted by a hurricane causing massive flooding and severe wind damage. The Federal gov-
ernment 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 Medi-
care coverage. What should you say? - ANSWER Anthony is eligible for a special enroll-
ment period (SEP) because he missed an enrollment period due to the impact of the Feder-
ally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after
3
