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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?
After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age
Mr. Davis is 49 years old and has been receiving disability benefits from the Social
Security Administration for 12 months. Can you sell him a Medicare Advantage or
Part D Prescription Drug policy?
No, he cannot purchase a Medicare Advantage or Part D policy because he has
not received Social Security or Railroad Retirement disability benefits for 24
months.
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?
In order to obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
weeks. She concerned about having prescription drug coverage. Which of the
following statements provides the best advice?
Prescription drug coverage can be obtained by enrolling in a Medicare
Advantage plan that includes Part D coverage
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan,
the health plan may, at some time in the future, reduce his benefits below what is
available in Original Medicare. What should you tell him about his concern?
Medicare health plans must cover all benefits available under Medicare Part A and
Part B. Many also cover Part D prescription drugs
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 or Lou Gehrig’s disease, so she will be
eligible for Medicare
Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefit package of a Medicare Health Plan before she starts
looking at specific plans.
What could you tell her?
Medicare Health Plans may offer extra benefits that Original Medicare does not
offer such as vision, hearing, and dental services and must include a maximum
out-of-pocket limit on Part A and Part B services
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Mr. Meoni’s wife has a Medicare Advantage plan, but he wants to understand
what coverage Medicare Supplemental Insurance provides since his health care
needs are different from his wife’s needs. What could you tell Mr.Meoni?
Medicare Supplemental Insurance would help cover his Part A and Part B cost
sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover
Mrs. Chen 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 over age 65 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
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
Mr. Lopez has heard that he can sign up for a product called “Medicare
Advantage” but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health plans
that are available through the Medicare Advantage program?
They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description?
Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies
During a sales presentation in Ms. Sullivan’s home, she tells you that she has
heard about a type of Medicare health plan known as Private Fee-for-Service
(PFFS). She wants to know if this would be available to her. What should you tell
her about PFFS plans?
A PFFS plan is one of various types of Medicare Advantage plans offered by private
entities and she may enroll in one if it is available in her area.
Mrs. Radford asks whether there are any special eligibility requirements
for Medicare Advantage. What should you tell her?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A. What should you tell him?
He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare
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Part B.
Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago.
Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What
options does Mrs.
Billings have in regard to her MA plan during the next open enrollment season?
She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for
individuals suffering from ESRD if one is available in her area
Mr. Kumar is considering a Medicare Advantage HMO and has questions
about his ability to access providers. What should you tell him?
In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only
from providers who have a contractual relationship with the plan (except in an
emergency)
Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should
you tell her?
Mrs. Ramos can obtain care from any provider who participates in Original
Medicare, but generally will be charged a lower co-payment if she goes to
one of the plan’s preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care
he has received under Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What could you tell him?
SNPs have special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be very helpful
as well.
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special
Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-
sharing amounts and Mr. Greco would like to join that plan. What should you tell
him?
SNPs limit enrollment to certain sub-populations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has
an attractive premium. He wants to know if he must use doctors in a network like
his current HMO plan requires him to do. What should you tell him?
He may receive health care services from any doctor allowed to bill Medicare, as
long as he shows the doctor the plan’s identification card and the doctor agrees to
accept the PFFS plan’s payment terms and conditions, which could include balance
billing
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-
Service (PFFS) plan. As part of that discussion, what should you be sure to tell
her?
If she uses non-network providers, her doctors and hospital could decide whether to
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treat her on a visit-by-visit basis
Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his
area has an attractive premium. He wants to know what makes them different
from an HMO or a PPO. What should you tell him?
Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts
Original Medicare, as long as the provider has a reasonable opportunity to access
the plan’s terms and conditions and agrees to accept them
If Dr. Elizabeth Brennan does not contract with the PFFS plan, but accepts the
plan’s terms and conditions for payment, how will she be paid?
Generally, the PFFS plan will pay Dr. Brennan directly the same amount
Original Medicare would pay her.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in
her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA), but is not sure if the plan associated with the account will
fit her needs. What specific piece of information about a Medicare MSA plan would
it be important for her to know, prior to enrolling in such a plan?
All MSAs cover Part A and Part B benefits, but not Part D prescription drug
benefits, which could be obtained by also enrolling in a separate prescription
drug plan
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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?
After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age
Mr. Davis is 49 years old and has been receiving disability benefits from the Social
Security Administration for 12 months. Can you sell him a Medicare Advantage or
Part D Prescription Drug policy?
No, he cannot purchase a Medicare Advantage or Part D policy because he has
not received Social Security or Railroad Retirement disability benefits for 24
months.
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?
In order to obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
weeks. She concerned about having prescription drug coverage. Which of the
following statements provides the best advice?
Prescription drug coverage can be obtained by enrolling in a Medicare
Advantage plan that includes Part D coverage
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan,
the health plan may, at some time in the future, reduce his benefits below what is
available in Original Medicare. What should you tell him about his concern?
Medicare health plans must cover all benefits available under Medicare Part A and
Part B. Many also cover Part D prescription drugs
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 or Lou Gehrig’s disease, so she will be
eligible for Medicare
Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefit package of a Medicare Health Plan before she starts
looking at specific plans.
What could you tell her?
Medicare Health Plans may offer extra benefits that Original Medicare does not
offer such as vision, hearing, and dental services and must include a maximum
out-of-pocket limit on Part A and Part B services
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Mr. Meoni’s wife has a Medicare Advantage plan, but he wants to understand
what coverage Medicare Supplemental Insurance provides since his health care
needs are different from his wife’s needs. What could you tell Mr.Meoni?
Medicare Supplemental Insurance would help cover his Part A and Part B cost
sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover
Mrs. Chen 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 over age 65 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
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
Mr. Lopez has heard that he can sign up for a product called “Medicare
Advantage” but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health plans
that are available through the Medicare Advantage program?
They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description?
Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies
During a sales presentation in Ms. Sullivan’s home, she tells you that she has
heard about a type of Medicare health plan known as Private Fee-for-Service
(PFFS). She wants to know if this would be available to her. What should you tell
her about PFFS plans?
A PFFS plan is one of various types of Medicare Advantage plans offered by private
entities and she may enroll in one if it is available in her area.
Mrs. Radford asks whether there are any special eligibility requirements
for Medicare Advantage. What should you tell her?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A. What should you tell him?
He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare
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Part B.
Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago.
Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What
options does Mrs.
Billings have in regard to her MA plan during the next open enrollment season?
She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for
individuals suffering from ESRD if one is available in her area
Mr. Kumar is considering a Medicare Advantage HMO and has questions
about his ability to access providers. What should you tell him?
In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only
from providers who have a contractual relationship with the plan (except in an
emergency)
Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should
you tell her?
Mrs. Ramos can obtain care from any provider who participates in Original
Medicare, but generally will be charged a lower co-payment if she goes to
one of the plan’s preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care
he has received under Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What could you tell him?
SNPs have special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be very helpful
as well.
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special
Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-
sharing amounts and Mr. Greco would like to join that plan. What should you tell
him?
SNPs limit enrollment to certain sub-populations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has
an attractive premium. He wants to know if he must use doctors in a network like
his current HMO plan requires him to do. What should you tell him?
He may receive health care services from any doctor allowed to bill Medicare, as
long as he shows the doctor the plan’s identification card and the doctor agrees to
accept the PFFS plan’s payment terms and conditions, which could include balance
billing
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-
Service (PFFS) plan. As part of that discussion, what should you be sure to tell
her?
If she uses non-network providers, her doctors and hospital could decide whether to
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treat her on a visit-by-visit basis
Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his
area has an attractive premium. He wants to know what makes them different
from an HMO or a PPO. What should you tell him?
Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts
Original Medicare, as long as the provider has a reasonable opportunity to access
the plan’s terms and conditions and agrees to accept them
If Dr. Elizabeth Brennan does not contract with the PFFS plan, but accepts the
plan’s terms and conditions for payment, how will she be paid?
Generally, the PFFS plan will pay Dr. Brennan directly the same amount
Original Medicare would pay her.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in
her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA), but is not sure if the plan associated with the account will
fit her needs. What specific piece of information about a Medicare MSA plan would
it be important for her to know, prior to enrolling in such a plan?
All MSAs cover Part A and Part B benefits, but not Part D prescription drug
benefits, which could be obtained by also enrolling in a separate prescription
drug plan
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