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AHIP - 3 Module 3 - Medicare Part D: Prescri... PSI- Personal Lines I
Teacher 32 terms 20 terms 34 terms
BettyJ_Trainer Preview richc20 Preview prof-main33
-Cover all Part A and Part B benefits;
-Provide plan cost-sharing actuarially equivalent to cost sharing
under Medicare Parts A and B, but may be different for specific
services; and
-Include an annual maximum out-of-pocket (MOOP) limit on
total enrollee cost sharing (deductibles, coinsurance, and
Medicare Advantage
copayments) for Part A and Part B services.
-Cover the following services even when provided by non-
network providers:
emergency services:
out-of-area urgently needed services; and
out-of-area renal dialysis
Ms. Moore plans to retire when Medicare is a program for people age 65 or older and those
she turns 65 in a few months. under age 65 with certain disabilities, end stage renal disease or
She is in excellent health and Lou Gehrig's disease, so she will be eligible for Medicare.
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?
Mr. Styles would like to plan for Part A, which covers hospital, skilled nursing facility, hospice and
retirement and has asked you home health services and Part B, which covers professional
what is covered under Original services such as those provided by a doctor are covered under
Fee-for-Service (FFS) Medicare? Original Medicare.
What could you tell him?
See an expert-written answer
,Mr. Hudson is concerned that if Medicare health plans must cover all benefits available under
he signs up for a Medicare Medicare Part A and Part B. Many also cover Part D prescription
health plan, the health plan may, drugs.
at some time in the future,
reduce his benefits below what
is available in Original Medicare.
What should you tell him about
his concern?
Mrs. Geisler's neighbor told her Part D covers prescription drugs and she should look at her
she should look at her Part D premiums, formulary, and cost sharing to see if they have
options during the annual changed.
Medicare enrollment period
because features of Part D might
have changed. Mrs. Geisler can't
remember what Part D is so she
called you to ask what her
neighbor was talking about.
What could you tell her?
Mrs. Weems wants to know Medicare Health Plans may offer extra benefits that Original
generally how the benefits Medicare does not offer such as vision, hearing, and dental
under Original Medicare might services and must include a maximum out-of-pocket limit on Part
compare to the benefit package A and Part B services.
of a Medicare Health Plan
before she starts looking at
specific plans. What could you
tell her?
See an expert-written answer
Mr. Meoni's wife has a Medicare Medicare Supplemental Insurance would help cover his Part A
Advantage plan, but he wants to and Part B cost sharing in Original Fee-for-Service (FFS)
understand what coverage Medicare as well as possibly some services that Medicare does
Medicare Supplemental not cover.
Insurance provides since his
health care needs are different
from his wife's needs. What
could you tell Mr.Meoni?
Mr. Meoni's wife has a Medicare Most individuals who are citizens and over age 65 are covered
Advantage plan, but he wants to under Part A by virtue of having paid Medicare taxes while
understand what coverage working, though some may be covered as a result of paying
Medicare Supplemental monthly premiums.
Insurance provides since his
health care needs are different
from his wife's needs. What
could you tell Mr.Meoni?
Mr. Bauer is 49 years old, but After receiving such disability payments for 24 months, he will be
eighteen months ago he was automatically enrolled in Medicare, regardless of age.
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?
, Mr. Davis is 49 years old and has No, he cannot purchase a Medicare Advantage or Part D policy
been receiving disability because he has not received Social Security or Railroad
benefits from the Social Security Retirement disability benefits for 24 months.
Administration for 12 months.
Can you sell him a Medicare
Advantage or Part D
Prescription Drug policy?
Ms. Henderson believes that she In order to obtain Part B coverage, she must pay a standard
will qualify for Medicare monthly premium, though it is higher for individuals with higher
coverage when she turns 65, incomes.
without paying any premiums,
because she has been working
for 40 years and paying
Medicare taxes. What should
you tell her?
See an expert-written answer
Mr. Diaz continued working with Mr. Diaz will not pay any penalty because he had continuous
his company and was insured coverage under his employer's plan.
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?
Mrs. Peňa is 66 years old, has She may enroll at any time while she is covered under her
coverage under an employer employer plan, but she will have a special eight-month
plan and will retire next year. enrollment period that differs from the standard general
She heard she must enroll in enrollment period, during which she may enroll in Medicare Part
Part B at the beginning of the B.
year to ensure no gap in
coverage. What can you tell
her?
Mrs. Kelly is entitled to Part A, In order to join a Medicare health plan, she must be enrolled in
but is not yet enrolled in Part B. Parts A, B and D
She is considering enrollment in
a Medicare health plan. What
should you advise her to do
before she will be able to enroll
into a Medicare health plan?
Mrs. Toma has a low, fixed She should contact her state Medicaid agency to see if she
income. What could you tell her qualifies for one of several programs that can help with Medicare
that might be of assistance? costs for which she is responsible.
Save
Students also studied
Flashcard sets Study guides Practice tests
AHIP - 3 Module 3 - Medicare Part D: Prescri... PSI- Personal Lines I
Teacher 32 terms 20 terms 34 terms
BettyJ_Trainer Preview richc20 Preview prof-main33
-Cover all Part A and Part B benefits;
-Provide plan cost-sharing actuarially equivalent to cost sharing
under Medicare Parts A and B, but may be different for specific
services; and
-Include an annual maximum out-of-pocket (MOOP) limit on
total enrollee cost sharing (deductibles, coinsurance, and
Medicare Advantage
copayments) for Part A and Part B services.
-Cover the following services even when provided by non-
network providers:
emergency services:
out-of-area urgently needed services; and
out-of-area renal dialysis
Ms. Moore plans to retire when Medicare is a program for people age 65 or older and those
she turns 65 in a few months. under age 65 with certain disabilities, end stage renal disease or
She is in excellent health and Lou Gehrig's disease, so she will be eligible for Medicare.
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?
Mr. Styles would like to plan for Part A, which covers hospital, skilled nursing facility, hospice and
retirement and has asked you home health services and Part B, which covers professional
what is covered under Original services such as those provided by a doctor are covered under
Fee-for-Service (FFS) Medicare? Original Medicare.
What could you tell him?
See an expert-written answer
,Mr. Hudson is concerned that if Medicare health plans must cover all benefits available under
he signs up for a Medicare Medicare Part A and Part B. Many also cover Part D prescription
health plan, the health plan may, drugs.
at some time in the future,
reduce his benefits below what
is available in Original Medicare.
What should you tell him about
his concern?
Mrs. Geisler's neighbor told her Part D covers prescription drugs and she should look at her
she should look at her Part D premiums, formulary, and cost sharing to see if they have
options during the annual changed.
Medicare enrollment period
because features of Part D might
have changed. Mrs. Geisler can't
remember what Part D is so she
called you to ask what her
neighbor was talking about.
What could you tell her?
Mrs. Weems wants to know Medicare Health Plans may offer extra benefits that Original
generally how the benefits Medicare does not offer such as vision, hearing, and dental
under Original Medicare might services and must include a maximum out-of-pocket limit on Part
compare to the benefit package A and Part B services.
of a Medicare Health Plan
before she starts looking at
specific plans. What could you
tell her?
See an expert-written answer
Mr. Meoni's wife has a Medicare Medicare Supplemental Insurance would help cover his Part A
Advantage plan, but he wants to and Part B cost sharing in Original Fee-for-Service (FFS)
understand what coverage Medicare as well as possibly some services that Medicare does
Medicare Supplemental not cover.
Insurance provides since his
health care needs are different
from his wife's needs. What
could you tell Mr.Meoni?
Mr. Meoni's wife has a Medicare Most individuals who are citizens and over age 65 are covered
Advantage plan, but he wants to under Part A by virtue of having paid Medicare taxes while
understand what coverage working, though some may be covered as a result of paying
Medicare Supplemental monthly premiums.
Insurance provides since his
health care needs are different
from his wife's needs. What
could you tell Mr.Meoni?
Mr. Bauer is 49 years old, but After receiving such disability payments for 24 months, he will be
eighteen months ago he was automatically enrolled in Medicare, regardless of age.
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?
, Mr. Davis is 49 years old and has No, he cannot purchase a Medicare Advantage or Part D policy
been receiving disability because he has not received Social Security or Railroad
benefits from the Social Security Retirement disability benefits for 24 months.
Administration for 12 months.
Can you sell him a Medicare
Advantage or Part D
Prescription Drug policy?
Ms. Henderson believes that she In order to obtain Part B coverage, she must pay a standard
will qualify for Medicare monthly premium, though it is higher for individuals with higher
coverage when she turns 65, incomes.
without paying any premiums,
because she has been working
for 40 years and paying
Medicare taxes. What should
you tell her?
See an expert-written answer
Mr. Diaz continued working with Mr. Diaz will not pay any penalty because he had continuous
his company and was insured coverage under his employer's plan.
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?
Mrs. Peňa is 66 years old, has She may enroll at any time while she is covered under her
coverage under an employer employer plan, but she will have a special eight-month
plan and will retire next year. enrollment period that differs from the standard general
She heard she must enroll in enrollment period, during which she may enroll in Medicare Part
Part B at the beginning of the B.
year to ensure no gap in
coverage. What can you tell
her?
Mrs. Kelly is entitled to Part A, In order to join a Medicare health plan, she must be enrolled in
but is not yet enrolled in Part B. Parts A, B and D
She is considering enrollment in
a Medicare health plan. What
should you advise her to do
before she will be able to enroll
into a Medicare health plan?
Mrs. Toma has a low, fixed She should contact her state Medicaid agency to see if she
income. What could you tell her qualifies for one of several programs that can help with Medicare
that might be of assistance? costs for which she is responsible.
