,9.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
10.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
11.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
12.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
13.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.
14.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
15.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
Part B.
16.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
17.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)
, 18.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.
19.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.
20.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
21.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
22.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
treat her on a visit-by-visit basis
23.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
24.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.
25.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?
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
10.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
11.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
12.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
13.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.
14.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
15.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
Part B.
16.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
17.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)
, 18.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.
19.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.
20.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
21.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
22.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
treat her on a visit-by-visit basis
23.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
24.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.
25.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?
