AHIP Module 1 – 5
Questions and
Answers
,AHIP Module 1
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 65 or older and those under the
age 65 with certain disabilities, end-stage renal disease, and Lou
Gehrig’s disease so she will be eligible for Medicare.
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. 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 Advantage plans must cover all benefits available under
Medicare Part A and Part B. Many also cover Part D prescription
drugs.
Mrs. Roberts has just received a new Medicare identity card in the
mail. She is concerned that it is a forgery since it does not have her
Social Security number on it. What should you tell her?
The card she received is valid, the change has been made to protect
Medicare beneficiaries from identity theft, and she should now
destroy her old card.
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.
Mr. Moy’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.Moy?
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.
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 US. 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.
Bauer is 49 years old, but eighteen months ago he was declared
disabled by the SSA 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. Denton is 52 years old and has recently been diagnosed with
end-stage renal disease and will soon begin dialysis. He is wondering
if he can obtain coverage under Medicare. What should you tell him?
He may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start.
, Ms. Henderson believes that she will qualify for Medicare coverage
when she turns 65, w/o 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.
Mr. Diaz continued working with his company and was insured
under his employer’s group plan until he reached 68 years old. 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.
Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer’s plan.
Mrs. Pena 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 coverage.
She may not enroll at any time while she is covered under her
employer plan, but she will have a special eight month enrollment
period that differs from the standard general enrollment period,
during which she may enroll in Medicare Part B.
Mrs. Kelly, age 65, is entitles to Part A, but is not yet enrolled in Part B.
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?
In order to join a Medicare plan, she also must enroll in Part B.
Mrs. Park is an elderly retiree. She has a low, fixed income. What
could you tell Mrs. Park that might be of assistance?
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.
Questions and
Answers
,AHIP Module 1
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 65 or older and those under the
age 65 with certain disabilities, end-stage renal disease, and Lou
Gehrig’s disease so she will be eligible for Medicare.
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. 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 Advantage plans must cover all benefits available under
Medicare Part A and Part B. Many also cover Part D prescription
drugs.
Mrs. Roberts has just received a new Medicare identity card in the
mail. She is concerned that it is a forgery since it does not have her
Social Security number on it. What should you tell her?
The card she received is valid, the change has been made to protect
Medicare beneficiaries from identity theft, and she should now
destroy her old card.
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.
Mr. Moy’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.Moy?
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.
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 US. 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.
Bauer is 49 years old, but eighteen months ago he was declared
disabled by the SSA 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. Denton is 52 years old and has recently been diagnosed with
end-stage renal disease and will soon begin dialysis. He is wondering
if he can obtain coverage under Medicare. What should you tell him?
He may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start.
, Ms. Henderson believes that she will qualify for Medicare coverage
when she turns 65, w/o 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.
Mr. Diaz continued working with his company and was insured
under his employer’s group plan until he reached 68 years old. 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.
Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer’s plan.
Mrs. Pena 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 coverage.
She may not enroll at any time while she is covered under her
employer plan, but she will have a special eight month enrollment
period that differs from the standard general enrollment period,
during which she may enroll in Medicare Part B.
Mrs. Kelly, age 65, is entitles to Part A, but is not yet enrolled in Part B.
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?
In order to join a Medicare plan, she also must enroll in Part B.
Mrs. Park is an elderly retiree. She has a low, fixed income. What
could you tell Mrs. Park that might be of assistance?
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.
