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- Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay, she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility Ans>> Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days.
- Mrs.West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through massage therapy. She is concerned about whether or not Medicare will cover these
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items and services. What should you tell her
drug plan.
- Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare.What should you tell him Ans>> He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start.
- Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary Notice (MSN) and disagrees with a determi- nation that partially denied one of her claims for services. What advice would you give her Ans>> Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail.
- Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because the 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 Ans>> Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they have changed.
cover Ans>> Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
- Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare.What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries?- : Beneficiaries under Original Medicare have no cost-sharing for most preventive services.
- Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.What should you tell him Ans>> Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
- 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 Ans>> Most individuals who are citizens and age 65 or over 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.
- Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn Ans>> Part B primarily covers physician services. She will be paying a monthly premium and, except for many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible.
- Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization because of an illness. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare Ans>> Under Original
10 / 17 for Part B when first eligible and wants to know how much he will have to pay.What should you tell him
11 / 17 Ans>> Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
- Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her Ans>> You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible.
- Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the store owner, has provided excellent health benefits to the store's workforce.William, one of the store's long-time employees, will soon be reaching age 65 and eligible for Medicare.William is in good health. He intends to remain an active full-time employee, working several years after becoming eligible for Medicare.What type(s) of retiree health benefit will
13 / 17 prescription drug benefits. III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed for inflation.
14 / 17 IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full.: I, II, and IV only
- Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi Ans>> Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.
- Mrs. Lyons is in good health, uses a single prescription, and lives indepen- dently 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 Ans>> All MSAs cover Part A and Part B benefits, but not Part D prescription
should you tell him numerousprescription drugs, he is considering signing up for it. What
Ans>> He should compare the benefits in his em- ployer-sponsored retiree group health plan with the benefits in his neighbor's MA-PD plan to determine which one will provide sufficient coverage for his prescription needs.
- Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage.What should you tell her about obtaining drug coverage Ans>> She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan.
- Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge Ans>> Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15%of the Medicare rate.
- Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she can enroll in a Medicare Advantage plan Ans>> To join a Medicare Advantage plan, she also must enroll in Part B.
available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her
Ans>> She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
- 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 Ans>> There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
- Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him Ans>> You can offer to review the plans appeal process to help him ask the plan to review the coverage decision.
- Mrs.Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a
