Agent Harriet Walker has recently begun marketing Medicare Advantage and
related products aimed at meeting the needs of senior citizens. Client Mildred
Jones has expressed interest in a Medicare Advantage plan. It is now the
beginning of September. If you were in Agent Walker’s position, what would you
do? Correct Answer: Inquire whether the client qualifies for a special enrollment
period, andif not, solicit an enrollment application once the annual open
enrollment election period begins on October 15th.
Mrs. Fields wants to know whether applying for the Part D low income subsidy
will be worth the time to fill out the paperwork. What could you tell her? Correct
Answer: The Part D low income subsidy could substantially lower her overall
costs. She can apply by contacting her state Medicaid office, or calling theSocial
Security Administration
Mr. Wendt suffers from diabetes which has gotten progressively worse during the
last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part
D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan
during the last annual open enrollment period (AEP) which hasjust closed. Mr.
Wendt has heard certain MA plans might provide him with more specialized
coverage for his diabetes and wants to know if he must wait until the next annual
open enrollment period (AEP) before enrolling in such a plan. What should you
tell him? Correct Answer: If there is a special needs plan (SNP) in Mr. Wendt’s
area that specializes in caring for individuals with diabetes, he may enroll in the
SNP at any time under a special election period (SEP)
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 herto qualify for Medicare. What could you
tell her to address her concern? Correct Answer: Medicare is aprogram 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
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?
Correct Answer: 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?
Correct Answer: Medicare health plans must cover all benefits availableunder
Medicare Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
weeks. She concernedabout having prescription drug coverage. Which of the
following statements provides the best advice?
Correct Answer: Prescription drug coverage can be obtained by enrolling in a
Medicare Advantage planthat includes Part D coverage.
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 tellher? Correct Answer: 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 outof-pocket limit onPart A and Part B services.
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? Correct
Answer: Medicare Supplemental Insurance would help cover his Part Aand 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? Correct Answer: Most individuals who are
citizens and over age 65 are covered under Part A by virtue of having paid
Medicaretaxes while working, though some may be covered as a result of paying
monthly premiums.
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? Correct Answer: After receiving such disabilitypayments 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?Correct Answer: 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 youtell her? Correct Answer: 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 hereached 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? Correct
Answer: Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer’s plan.
Mrs. Peňa 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. What can you tell her? Correct Answer: She may enroll at any time
while she is covered under her employer plan, but she will have a special eightmonth enrollment period that differs from the standard general enrollment period,
during which she may enroll in Medicare Part B.
Mrs. Kelly is entitled 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 Medicarehealth plan? Correct Answer: In order to join a
Medicare health plan, she also must enroll in Part B.
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