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Medicare Exam Questions and Answers: A Comprehensive Guide for 2025/2026, Exams of Nursing

A comprehensive set of questions and answers related to medicare, covering various aspects of the program, including eligibility, enrollment, coverage, and benefits. It is a valuable resource for individuals seeking to understand medicare and its intricacies.

Typology: Exams

2024/2025

Available from 02/26/2025

Nursebrahim01
Nursebrahim01 🇺🇸

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AHIP Exam Latest (2025/2026) Complete
Questions and Correct Answers Complete
GRADED A+
1. Mrs.gBurtongisgagretireegwithgsubstantialgincome.gShegisgenrolledgingangMA-PD
plangandgwasgdisappointedgwithgthegservicegshegreceivedgfromghergprimarygcareg
physiciangbecausegshegwasgtoldgshegwouldghavegtogwaitgfivegweeksgtoggetgangappo
intmentgwhengshegwasgfeelinggill.gShegcalledgyougtogaskgwhatgshegcouldgdogsogshegw
ouldgnotghavegtogputgupgwithgsuchgpoorgaccessgtogcare.gWhatgcouldgyougtellgher?:gS
hegcouldgfilegaggrievancegwithghergplangtogcomplaingaboutgtheglackgofgtimelinessginggettingg
angappointment.
2. EdwardgIPgsufferedgfromgseriousgkidneygdisease.gAsgagresult.gEdwardgbe-
gcamegeligiblegforgMedicaregcoveragegduegtogend-
stagegrenalgdiseaseg(ESRD).gAgclosegrelativegdonatedgtheirgkidneygandgEdwardgs
uccessfullygunderwentgtransplantgsurgeryg12gmonthsgago.gEdwardgisgnowgageg5
0gandgasksgyougifghisgMedicaregcoveragegwillgcontinue,gwhatgshouldgyougsay?:gIn
dividualsgeligiblegforgMedicaregbasedgongESRDggenerallyglosegeligibilityg36gmonthsgafte
rgthegmonthgingwhichgthegindividualgreceivesgagkidneygtransplantgunlessgtheygaregeligiblegforg
Medicaregonganothergbasisgsuchgasgagegorgdisability.gEdwardgmay,ghowever,gremaingenr
olledgingPartgBgbutgsolelygforgcoveragegofgimmunosuppressivegdrugsgifgheghasgnogotherghe
althgcaregcoveragegthatgwouldgcovergthegdrugs.
3. MildredgSavagegenrolledgingAllcaregMedicaregAdvantagegplangseveralgyearsgag
o.gMildredgrecentlyglearnedgthatgshegisgsufferinggfromginoperablegcancergandghasgj
ustgagfewgmonthsgtoglive.gShegwouldglikegtogspendgthesegfinalgmonthsginghospicegc
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AHIP Exam Latest (2025/2026) Complete

Questions and Correct Answers Complete

GRADED A+

  1. Mrs.gBurtongisgagretireegwithgsubstantialgincome.gShegisgenrolledgingangMA-PD plangandgwasgdisappointedgwithgthegservicegshegreceivedgfromghergprimaryg careg physiciangbecausegshegwasgtoldgshegwouldghavegtogwaitgfivegweeksgtoggetg angappo intmentgwhengshegwasgfeelinggill.gShegcalledgyougtogaskgwhatgshegcouldg dogsogshegw ouldgnotghavegtogputgupgwithgsuchgpoorgaccessgtogcare.gWhatgcouldg yougtellgher?:gS hegcouldgfilegaggrievancegwithghergplangtogcomplaingaboutgtheglackgofg timelinessginggettingg angappointment.
  2. EdwardgIPgsufferedgfromgseriousgkidneygdisease.gAsgagresult.gEdwardgbe- g camegeligiblegforgMedicaregcoveragegduegtogend- stagegrenalgdiseaseg(ESRD).g AgclosegrelativegdonatedgtheirgkidneygandgEdwardgs uccessfullygunderwentg transplantgsurgeryg 12 gmonthsgago.gEdwardgisgnowgageg 5 0 gandgasksgyougifghisg Medicaregcoveragegwillgcontinue,gwhatgshouldgyougsay?:gIn dividualsgeligiblegforg MedicaregbasedgongESRDggenerallyglosegeligibilityg 36 gmonthsgafte rgthegmonthging whichgthegindividualgreceivesgagkidneygtransplantgunlessgtheygaregeligiblegforg Medicareg onganothergbasisgsuchgasgagegorgdisability.gEdwardgmay,ghowever,gremaingenr olledgingPartgBgbutgsolelygforgcoveragegofgimmunosuppressivegdrugsgifgheghasgnogotherghe althg caregcoveragegthatgwouldgcovergthegdrugs.
  3. MildredgSavagegenrolledgingAllcaregMedicaregAdvantagegplangseveralgyearsg ag o.gMildredgrecentlyglearnedgthatgshegisgsufferinggfromginoperablegcancergandg hasgj ustgagfewgmonthsgtoglive.gShegwouldglikegtogspendgthesegfinalgmonthsging hospicegc

are.gMildred'sgfamilygasksgyougwhetherghospicegbenefitsgwillgbegpaidg forgundergth egAllcaregMedicaregAdvantagegplan.gWhatgshouldgyougsay?:gMildredg maygremaingen rolledgingAllcaregandgmakegaghospicegelection.gHospicegbenefitsgwillg begpaidgforgbygOrigi nalgMedicaregundergPartgAgandgAllcaregwillgcontinuegtogpaygforg anygnon- hospicegservices.

  1. Mr.gDiazgcontinuedgworkinggwithghisgcompanygandgwasginsuredgunderghisg emp loyer'sggroupgplanguntilghegreachedgageg68.gHeghasgheardgthatgtheregisgag premiumg penaltygforgthosegwhogdidgnotgsigngupgforgPartgBgwhengfirstgeligiblegandg wantsgtogkno wghowgmuchghegwillghavegtogpay.gWhatgshouldgyougtellghim?:gMr.g Diazgwillgnotgpaygan ygpenaltygbecausegheghadgcontinuousgcoveragegunderghisg employer'sgplan.
  2. Mr.gMoy'sgwifeghasgagMedicaregAdvantagegplan,gbutghegwantsgtogunder- g standgwhatgcoveragegMedicaregSupplementalgInsurancegprovidesgsinceghisg he althgcaregneedsgaregdifferentgfromghisgwife'sgneeds.gWhatgcouldgyougtellgMr.g Moy? :gMedicaregSupplementalgInsurancegwouldghelpgcoverghisgPartgAgandgPartgBg deductible sgorgcoinsurancegingOriginalgFee-for- Serviceg(FFS)gMedicaregasgwellgasg possiblygsomegservicesgthatgMedicaregdoesgnotgco ver.
  3. Mrs.gChengwillgbeg 65 gsoon,ghasgbeengagcitizengforgtwelvegyears,ghasgbeeng emplo yedgfullgtime,gandgpaidgtaxesgduringgthatgentiregperiod.gShegisgconcerned

dialysisgtreatmentsgstart.

  1. MadelinegMartinezgwasgwidowedgseveralgyearsgago.gHerghusbandgworkedg for gmanygyearsgandgcontributedgintogthegMedicaregsystem.gHegalsogleftgag substantia lgestategwhichgprovidesgMadelinegwithgangannualgincomegofgapprox- g imatelyg$130,000.gMadeline,gwhoghasgonlygworkedgpart- timegforgtheglastgthreeg years,gwillgsoongturngageg 65 gandghopesgtogenrollgingOriginalg Medicare.gSheg comesgtogyougforgadvice.gWhatgshouldgyougtellgher?:gYougshouldgtell gMadelinegthatgshegwillgbegablegtogenrollgingMedicaregPartgAgwithoutgpayinggmonthlygpre miumsg duegtogherghusband'sglonggworkgrecordgandgparticipationgingthegMedicaregsyste m.g YougshouldgalsogtellgMadelinegthatgshegwillgpaygPartgBgpremiumsgatgmoregthangthegsta ndardglowestgrategbutglessgthangtheghighestgrategdueghergsubstantialgincome.
  2. Ms.gHendersongbelievesgthatgshegwillgqualifygforgMedicaregCoveragegwheng s hegturnsg65,gwithoutgpayingganygpremiums,gbecausegsheghasgbeengworking

forg 40 gyearsgandgpayinggMedicaregtaxes.gWhatgshouldgyougtellgher?:gTogobtain PartgBgcoverage,gshegmustgpaygagstandardgmonthlygpremium,gthoughgitgisghighergforg indi vidualsgwithghighergincomes.

  1. TogobtaingPartgBgcoverage,gshegmustgpaygagstandardgmonthlygpremium,g thou ghgitgisghighergforgindividualsgwithghighergincomes.:gMrs.gGonzalezgcannotg purchas egagMedigapgplangthatgcoversgdrugs,gbutgshegcouldgkeepghergMedigapgpolicyg andgenrollgin gagPartgDgprescriptiongdruggplan.
  2. AgentgJohngMillergisgmeetinggwithgJerrygSmith,gagnewgprospect.gJerrygisgcur- g rentlygenrolledgingMedicaregPartsgAgandgB.gJerryghasgalsogpurchasedgagMedicareg S upplementg(Medigap)gplangwhichgheghasghadgforgseveralgyears.gHowever,gtheg pla ngdoesgnotgprovidegdruggbenefits.gHowgwouldgyougadvisegAgentgJohngMillerg togpro ceed?:gTellgprospectgJerrygSmithgthatghegshouldgconsidergaddinggagstandalonegPartgDgpre scriptiongdruggcoveragegpolicygtoghisgpresentgcoverage.
  3. Ms.gMooregplansgtogretiregwhengshegturnsg 65 gingagfewgmonths.gShegisging exc ellentghealthgandgwillghavegconsiderablegincomegwhengshegretires.gSheg isgcon cernedgthatghergincomegwillgmakegitgimpossiblegforghergtogqualifygforg Medicar e.gWhatgcouldgyougtellghergtogaddressghergconcern?:gMedicaregisga programgforgpeoplegageg 65 gorgoldergandgthosegundergageg 65 gwithgcertaingdisabilities,g end
  • stagegrenalgdisease,gandgLougGehrig'sgdiseasegsogshegwillgbegeligiblegforg Medicare.
  1. Mr.gCapadonagwouldglikegtogpurchasegagMedicaregAdvantageg(MA)gplangandg ag Medigapgplangtogpickgupgcostsgnotgcoveredgbygthatgplan.gWhatgshouldgyougtellg him ?:gItgisgillegalgforgyougtogsellgMr.gCapadonagagMedigapgplangifghegisgenrolledgingang MAgplan,g andgbesides,gMedigapgonlygworksgwithgOriginalgMedicare.
  2. Mrs.gParkgisgangelderlygretiree.gMrs.gParkghasgaglowgfixedgincome.gWhatgcouldg yo ugtellgMrs.gParkgthatgmightgbegofgassistance?:gShegshouldgcontactghergstateg Medicai

thegPHE.gWhilegShirleygwasgenrolledgingMedicaid,gshegmissedgangopportunity togenrollgingMedicaregandgnowgwantsgPartgB.gWhichgofgthegfollowinggstatementsg be stgdescribesgShirley'sgabilitygtognowgenrollgingMedicaregPartgB?:gShirleygisgeli- g giblegforgagSpecialgEnrollmentgPeriodg(SEP)gforgupgtogsixgmonthsgaftergthegterminationg ofgh ergMedicaidgcoverage.gUndergthisgSEP,gShirleygcangchoosegretroactivegcoveragegbackgt ogthegdategofgterminationgfromgMedicaidgorgcoveragegbeginninggthegmonthgafterg thegmont hgofgenrollment.

  1. AnthonygBonifacegturnedg 65 ging2023.gHegwasgnotgreceivinggSocialgSecurityg org RailroadgRetirementgBenefitsgonghisg65thgbirthday.gHegwasginterestedgingobtainin ggMedicaregcoveragegandgisgeligiblegforgpremium- freegPartgA.gBeforegheg couldgenrollgingMedicare,ghisgentiregareagwasgimpactedgbygag hurricanegcausingg massivegfloodinggandgseveregwindgdamage.gThegFederalggove rnmentgdeclaredg thisgtogbegagnaturalgdisastergwhichghasgrecentlygended.gDuringgt hisgperiodg Anthony'sginitialgenrollmentgperiodgexpired.gAnthonygasksgyoughowgh egcang nowgobtaingMedicaregcoverage.gWhatgshouldgyougsay?:gAnthonygisgeligiblegfo r agspecialgenrollmentgperiodg(SEP)gbecauseghegmissedgangenrollmentgperiodgduegtog theg impactgofgthegFederallygdeclaredgdisaster.gThisgSEPgwillgallowgAnthonygtogenrollg ingPartg Bgupgtogsixgmonthsgaftergthegendgofgthegemergencygdeclaration.gAnthonygmayg enrollgingpr emium- freegPartgAgatganygtimegandghisgPartgAgcoveragegwillgbegretroactiveg forgupgtog 6 gmonths.
  2. Mrs.gLyonsgisginggoodghealth,gusesgagsinglegprescription,gandglivesgindepen- g dentlyginghergownghome.gShegisgattractedgbygthegideagofgmaintaininggcontrolg overg agMedicalgSavingsgAccountg(MSA)gbutgisgnotgsuregifgthegplangassociatedg withgtheg accountgwillgfitghergneeds.gWhatgspecificgpiecegofginformationgaboutgag Medicareg

MSAgplangwouldgitgbegimportantgforghergtogknow,gpriorgtogenrollingging suchgagplan?: gAllgMSAsgcovergPartgAgandgPartgBgbenefits,gbutgnotgPartgDgprescriptiong druggbenefits,gwhic hgcouldgbegobtainedgbygalsogenrollinggingagseparategprescriptiong druggplan.

  1. Mrs.gRamosgisgconsideringgagMedicaregAdvantagegPPOgandghasgquestionsg a boutgwhichgprovidersgshegcanggogtogforgherghealthgcare.gWhatgshouldgyougtellg her ?:gMrs.gRamosgcangobtaingcaregfromganygprovidergwhogparticipatesgingOriginalg Medicar e,gbutggenerallygwillghavegaghighergcost- sharinggamountgifgshegseesgagproviderg who/thatgisgnotgagpartgofgthegPPOgnetwork.
  2. Mr.gRomerogisg64,gretiringgsoon,gandgconsideringgenrollmentginghisgem- g ployer- sponsoredgretireeggroupghealthgplangthatgincludesgdruggcoveragegwithg nominalg copays.gHegheardgaboutgagneighbor'sgMA- PDgplangthatgyougrepresentg andgbecauseghegtakesgnumerousgprescriptiongdrugs,g hegisgconsideringgsigningg upgforgit.gWhatgshouldgyougtellghim?:gHegshouldgcompareg thegbenefitsginghisgem-g ployer- sponsoredgretireeggroupghealthgplangwithgthegbenefitsginghisgneighbor'sgMA-PD

10 isgentitledgtogPartgAgandgenrolledgingPartgB.gJuangshouldggogtogthegSocialgSecurityg websit egtogenrollgingMedicaregPartgAgandgBgifgheghasgnotgdonegsogalready.gOnceghegisgenrolled,gh egcangchoosegagMedicaregAdvantagegplan.

  1. Mrs.gRadfordgasksgwhethergtheregareganygspecialgeligibilitygrequirementsgforg M edicaregAdvantage.gWhatgshouldgyougtellgher?:gMrs.gRadfordgmustgbegentitledg togPar tgAgandgenrolledgingPartgBgtogenrollgingMedicaregAdvantage.
  2. Mr.gBarkergenjoysgagcomfortablegretirementgincome.gHegrecentlyghadg surgery gandgexpectedgthatghegwouldghavegcertaingservicesgandgitemsgcoveredg bygthegpla ngwithgminimalgout-of-pocketgcostsgbecauseghisgMA- PDgcoverageg hasgbeengveryggood.gHowever,gwhenghegreceivedgthegbill,ghegwasgsu rprisedgtog seeglargegchargesgingexcessgofghisgmaximumgout-of- pocketglimitgthatgincludedg somegservicesgandgitemsghegthoughtgwouldgbegfullygco vered.gHegcalledgyou

11 togaskgwhatghegcouldgdo?gWhatgcouldgyougtellghim?:gYougcangoffergtogreviewgthe plansgappealgprocessgtoghelpghimgaskgthegplangtogreviewgthegcoveragegdecision.

  1. Whichgofgthegfollowinggstatement(s)gis/aregcorrectgaboutgagMedicaregSav- g ingsgAccountg(MSA)gPlans? I. MSAsgmayghavegeithergagpartialgnetwork,gfullgnetwork,gorgnognetworkgofg pr oviders. II. MSAgplansgcovergPartgAgandgPartgBgbenefitsgbutgnotgPartgDgprescriptiongdrugg be nefits. III. AngindividualgwhogisgenrolledgingangMSAgplangisgresponsiblegforgagminimalg de ductiblegofg$500gindexedgforginflation. IV. Non- networkgprovidersgmustgacceptgthegsamegamountgthatgOriginalg Medicare gwouldgpaygthemgasgpaymentgingfull.:gI,gII,gandgIVgonly
  2. Mr.gGrecogisgingexcellentghealth,glivesginghisgownghome,gandghasgagsizeableg inc omegfromghisginvestments.gHeghasgagfriendgenrolledgingagMedicaregAdvan- g tagegSpecialgNeedsgPlang(SNP).gHisgfriendghasgmentionedgthatgthegSNPgchargesg ve ryglowgcost- sharinggamountsgandgMr.gGrecogwouldglikegtogjoingthatgplan.g Whatgshouldgyougtell ghim?:gSNPsglimitgenrollmentgtogcertaingsubpopulationsgofg beneficiaries.gGivenghisgcurr entgsituation,ghegisgunlikelygtogqualifygandgwouldgnotgbeg ablegtogenrollgingthegSNP.
  3. Danielgisgagmiddle- incomegMedicaregbeneficiary.gHeghasgchronicgbronchitis,gputtingghimgatgseveregris kgforgpneumonia.gOtherwise,gheghasgnogproblemsgfunc- g tioning.gWhichgtypegofgSNPgisglikelygtogbegmostgappropriategforghim?:gC-SNP

13 notgoffergsuchgasgvision,ghearing,gandgdentalgservices.gItgmustgincludegagmaximum out-of-pocketglimitgongPartgAgandgPartgBgservices.

  1. Mr.gWellsgisgtryinggtogunderstandgthegdifferencegbetweengOriginalgMedicareg a ndgMedicaregAdvantage.gWhatgwouldgbegthegcorrectgdescription?:gMedicareg Adva ntagegisgagwaygofgcoveringgallgthegOriginalgMedicaregbenefitsgthroughgprivateg healthgins urancegcompanies.
  2. Mr.gKellygwantsgtogknowgwhetherghegisgeligiblegtogsigngupgforgagPrivateg fee- for-serviceg(PFFS)gplan.gWhatgquestionsgwouldgyougneedgtogaskgtogdeter- g mineghisgeligibility?:gYougwouldgneedgtogaskgMr.gKellygifghegisgentitledgtogPartgA,genroll edgingPartgB,gandgifgheglivesgingthegPFFSgplan'sgservicegarea.
  3. Ms.gGibsongrecentlyglostghergemployerggroupghealthgandgdruggcoveragegandg no wgshegwantsgtogenrollgingagPPOgthatgdoesgnotgincludegdruggcoverage.gWhatg shoul dgyougtellghergaboutgobtaininggdruggcoverage?:gShegcangenrollgingthegPPO,g butgshegwi llgnotgbegablegtogpurchasegagstand-alonegMedicaregPartgDgprescriptiongdrugg plan.
  4. Mr.gKumargisgconsideringgagMedicaregAdvantagegHMOgandghasgquestionsg ab outghisgabilitygtogaccessgproviders.gWhatgshouldgyougtellghim?:gIngmostg Medicareg AdvantagegHMOs,gMr.gKumargmustggenerallygobtainghisgservicesgonlyg fromgprovidersg withingthegplan'sgnetworkg(exceptgingangemergencygorgwheregcaregisg unavailablegwithing thegnetwork).
  5. Mrs.gQuinnghasgjustgturnedg65,gisgingexcellentghealthgandghasgagrelativelyg highg income.gShegusesgnogmedicationsgandgseesgnogreasongtogspendgmoneyg ongagMe dicaregprescriptiongdruggplangifgshegdoesgnotgneedgthegcoverage.gSheg currentlyg doesgnotghavegcreditablegcoverage.gWhatgcouldgyougtellghergaboutg thegimplicatio nsgofgsuchgagdecision?:gIfgshegdoesgnotgsigngupgforgagMedicareg prescriptiongdruggplang asgsoongasgshegisgeligiblegtogdogso,gandgifgshegdoesgsigngupg atgaglatergdate,ghergpremiumg

14 willgbegpermanentlygincreasedgbyg1%gofgthegnationalg averagegpremiumgforgeverygmonth gthatgshegwasgnotgcovered.

  1. Mr.gShapiroggetsgbygongagverygsmallgamountgofgfixedgincome.gHeghasgheardg the regmaygbegextraghelpgpayinggforgPartgDgprescriptiongdrugsgforgMedicareg beneficia riesgwithglimitedgincome.gHegwantsgtogknowgwhetherghegmightgqualify.gWhatgshoul dgyougtellghim?:gThegextraghelpgisgavailablegtogbeneficiariesgwhoseg incomegandgassetsg dognotgexceedgannualglimitsgspecifiedgbygtheggovernment.
  2. CharlesgMcCarthygisgagMedicaregbeneficiarygwhogsuffersgfromgdiabetes.gMr.g M cCarthygisgconsideringgenrollmentgingagMA- PDgplangthatgyougrepresent.gHeg asksgyougwhetherghisginsulingcostsgwillgbegcovere d.gWhatgshouldgyougsay?:gMr.g McCarthy'sginsulingcostsgforgagone- monthgsupplygcannotgbegmoregthang$35ginganyg coveragegphasegundergthegprescriptiong druggplangbeginningging2023.

16 Jose,gaggrandfathergwhogwasggrantedgasylumgandghasgworkedgingthegUnitedg Stat esgforgmanygyears. Correct:gJose,ghavinggbeenggrantedgasylum,gisglegallygpresentgingthegUnitedg Stat esgthusgmeetinggonegofgthegcriteriagforgPartgDgeligibility. c.Betsy,gaggrandmothergfromgoverseasgwhoghasgoverstayedghergvisa.gd.Helena,ga ngoverseasgcollegegstudentgwhoghasgoverstayedghergvisa.:gJose,gag grandfathergwh ogwasggrantedgasylumgandghasgworkedgingthegUnitedgStatesgforgmanyg years.

  1. Mr.gCarlinighasgheardgthatgMedicaregprescriptiongdruggplansgaregonlygofferedg th roughgprivategcompaniesgundergagprogramgknowngasgMedicaregAdvantageg (MA), gnotgbygtheggovernment.gHeglikesgOriginalgMedicaregandgdoesgnotgwantg togsigngupg forgangMAgproduct,gbutghegalsogwantsgprescriptiongdruggcoverage.g Whatgshouldg yougtellghim?:gMr.gCarlinigcangstaygwithgOriginalgMedicaregandgalsog enrollgingagMedicare gprescriptiongdruggplangthroughgagprivategcompanygthatghas

17 contractedgwithgtheggovernmentgtogprovidegonlygsuchgdruggcoveragegtogeligible Medicaregbeneficiaries.

  1. Mrs.gWaltersgisgentitledgtogPartgAgandghasgmedicalgcoveragegwithoutgdrugg cov eragegthroughgangemployergretireegplan.gShegisgnotgenrolledgingPartgB.gSinceg thegem ployergplangdoesgnotgcovergprescriptiongdrugs,gshegwantsgtogenrollging agMedicare gprescriptiongdruggplan.gWillgshegbegablegto?:gYes.gMrs.gWaltersgmustgbegentitledgtogP artgAgand/orgenrolledgingPartgBgtogbegeligiblegforgcoveragegundergtheg Medicaregprescripti ongdruggprogram.
  2. Mr.gHutchinsonghasgdruggcoveragegthroughghisgformergemployer'sgretireeg pl an.gHegisgconcernedgaboutgthegPartgDgpremiumgpenaltygifghegdoesgnotgenrollg ingag Medicaregprescriptiongdruggplan,gbutgdoesgnotgwantgtogpurchasegextrag coverageg thatghegwillgnotgneed.gWhatgshouldgyougtellghim?:gIfgthegdruggcoverageg heghasgisgnotge xpectedgtogpay,gongaverage,gatgleastgasgmuchgasgMedicare'sgstandardgPartgDgcoveragege xpectsgtogpay,gthenghegwillgneedgtogenrollgingMedicaregPartgDgduringghisginitialgeligibilitygperi odgtogavoidgtheglategenrollmentgpenalty.
  3. Mr.gJacobgunderstandsgthatgtheregisgagstandardgMedicaregPartgDgprescrip- g tiongdruggbenefit,gbutgwhengheglooksgatginformationgongvariousgplansgavailableg ing hisgarea,ghegseesgagwidegrangegingwhatgtheygchargegforgdeductibles,gpremi- g ums,gandgcostgsharing.gHowgcangyougexplaingthisgtoghim?:gMedicaregPartgDgdrugg pla nsgmayghavegdifferentgbenefitgstructures,gbutgongaverage,gtheygmustgallgbegatgleastg asggoo dgasgthegstandardgmodelgestablishedgbygtheggovernment.
  4. Mrs.gMcIntiregisgenrolledginghergstate'sgMedicaidgplangandghasgjustgbecomeg eli giblegforgMedicaregasgwell.gWhatgcangshegexpectgwillghappengtoghergdrugg coverag e?:gUnlessgshegchoosesgagMedicaregPartgDgprescriptiongdruggplangongherg own,gshegwillg begautomaticallygenrolledgingonegavailableginghergarea.

19 druggplan?:gShegcouldgcomparegthegcoveragegtogseegifgthegMedicaregPartgDgplan offersgbettergbenefitsgandgcoveragegthangthegFEHBgplangforgthegspecificgmedicationsg sh egneedsgandgwhetherganygadditionalgbenefitsgaregworthgthegPartgDgpremiumgcostsg ongtop gofghergFEHBgcontribution.

  1. Mrs.gBerkowitzgwantsgtogenrollgingagMedicaregAdvantagegplangthatgdoesgnotg in cludegdruggcoveragegandgalsogenrollgingagstand- alonegMedicaregprescriptiong druggplan.gUndergwhatgcircumstancesgcangshegdogt his?:gIfgthegMedicaregAdvan-g tagegplangisgagPrivategFee-for- Serviceg(PFFS)gplangthatgdoesgnotgoffergdruggcoverageg orgagMedicalgSavingsgAccountgpl an,gMrs.gBerkowitzgcangdogthis.
  2. Mr.Torresghasgagsmallgsavingsgaccount.gHegwouldglikegtogpaygforghisgmonthlygPar tgDgpremiumsgwithgangautomaticgmonthlygwithdrawalgfromghisgsavingsg accountgu ntilgitgisgexhausted,gandgthenghaveghisgpremiumsgwithheldgfromghisg SocialgSecuri tygcheck.gWhatgshouldgyougtellghim?:gInggeneral,ghegmustgselectgag singlegPartgDgpremi umgpaymentgmechanismgthatgwillgbegusedgthroughoutgthegyear.
  3. Mr.gBickfordgdidgnotgquitegqualifygforgthegextraghelpglow- incomegsubsidyg undergthegMedicaregPartgDgPrescriptiongDruggprogramgandgheg isgwonderingg ifgtheregisganygothergoptiongheghasgforgobtainingghelpgwithghisgcon siderableg druggcosts.gWhatgshouldgyougtellghim?:gHegcouldgcheckgwithgthegmanufa cturersg ofghisgmedicationsgtogseegifgtheygoffergangassistancegprogramgtoghelpgpeoplegwi thg limitedgmeansgtogobtaingthegmedicationsgtheygneed.gAlternatively,ghegcouldgcheckgt ogseegwhetherghisgstateghasgagpharmacygassistancegprogramgtoghelpghimgwithghisg exp enses.
  4. Mrs.gFieldsgwantsgtogknowgwhethergapplyinggforgthegPartgDglow- incomeg subsidygwillgbegworthgthegtimegtogfillgoutgthegpaperwork.gWhatgcouldgyougt

20 ellg her?:gThegPartgDglow- incomegsubsidygcouldgsubstantiallyglowerghergoverallgcosts.g Shegcangapplygbygcontactin gghergstategMedicaidgofficegorgcallinggthegSocialgSecurityg Administration.

  1. WhichgofgthegfollowinggstatementsgaboutgMedicaregPartgDgaregcorrect? I. PartgDgplansgmustgenrollganygeligiblegbeneficiarygwhogappliesgregardlessgofg he althgstatusgexceptginglimitedgcircumstances. II. Privategfee-for- serviceg(PFFS)gplansgaregnotgrequiredgtogusegagpharmacyg networkgbutgmaygch oosegtoghavegone. III. BeneficiariesgenrolledgingagMA- MedicalgSavingsgAccountg(MSA)gplangmayg onlygobtaingPartgDgbenefitsgthroughg agstandalonegPDP. IV. BeneficiariesgenrolledgingagMA- PPOgmaygobtaingPartgDgbenefitsgthroughgag standalonegPDPgorgthroughgtheirgpla n.:gI,gII,gandgIIIgonly
  2. Mrs.gLopezgisgenrolledgingagcostgplangforghergMedicaregbenefits.gSheghasg rece ntlyglostgcreditablegcoveragegpreviouslygavailablegthroughgherghusband'sg emplo yer.gShegisginterestedgingenrollinggingagMedicaregPartgDgprescriptiongdrug