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You would like to market an MA plan at a
neighborhood pharmacy. What should you keep
in mind to comply with the marketing
requirements for MA plans?
You must set up your table, make marketing
presentations, and accept enrollment
applications only in common areas outside of
where the patient waits for services from the
pharmacist.
Mr. Shultz was still working when he first
qualified for Medicare. At that time, he had
employer group coverage that was creditable.
During his initial Part D eligibility period, he
decided not to enroll because he was satisfied
with his drug coverage. It is now a year later
and Mr.
Shultz has lost his employer group coverage.
How would you advise him?
Mr. Schultz should enroll in a Part D plan
before he has a 63-day break in coverage in
order to avoid a premium penalty.
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Mrs. Raskin is a widow who will attain aged 65
and enroll in Medicare in just a few weeks. She
concerned about having prescription drug
coverage. Which of the following statements
provides the best advice?
Prescription drug coverage can be obtained
by enrolling in a Medicare Advantage plan
that includes Part D coverage
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 health plans must cover all benefits
available under Medicare Part A and Part B.
Many also cover Part D prescription drugs
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
AHIP test NUR COMMUNITY Exam
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concern?
Medicare is a program 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
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. 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?
Medicare Supplemental Insurance would help
cover his Part A and Part B cost sharing in
Original Fee-for-Service
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available through this program.
AHIP test NUR COMMUNITY Exam
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What should you tell him about the types of
health plans that are available through the
Medicare Advantage program?
They are Medicare health plans such as HMOs,
PPOs, PFFS, SNPs, and MSAs
Mr. Wells is trying to understand the
difference between Original Medicare and
Medicare Advantage. What would be a
correct description?
Medicare Advantage is a way of covering all
of the Original Medicare benefits through
private health insurance companies
During a sales presentation in Ms. Sullivan’s
home, she tells you that she has heard about a
type of Medicare health plan known as Private
Fee-for-Service (PFFS). She wants to know if
this would be available to her. What should you
tell her about PFFS plans?
A PFFS plan is one of various types of Medicare
Advantage plans offered by private entities and
she may enroll in one if it is available in her
area.
Mr. Bauer is 49 years old, but eighteen
months ago he was declared disabled by the
Social Security
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Administration 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. 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? 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 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
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ESRD if one is available in her area
Mr. Kumar is considering a Medicare
Advantage HMO and has questions about his
ability to access providers. What should you
tell him?
In most Medicare Advantage HMOs, Mr. Kumar
must obtain his services only from providers
who have a contractual relationship with the
plan (except in an emergency)
AHIP test NUR COMMUNITY Exam
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Mr. Romero is 64, retiring soon, and
considering enrollment in his employer-
sponsored retiree group health plan that
includes drug coverage with nominal copays.
He heard about a neighbor’s MA-PD plan that
you represent and because he takes numerous
prescription drugs, he is considering signing up
for it. What should you tell him?
Beneficiaries should check with their employer
or union group benefits administrator before
changing plans to avoid losing coverage they
want to keep
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 Medicare Health Plan? Medicaid will
coordinate benefits only with Medicaid
participating providers.
Mrs. Andrews asked how a Private Fee-for-
Service (PFFS) plan might affect her access to
services since she receives some assistance for
her health care costs from the State. What
should you tell her?
Medicaid may provide additional benefits, but
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obtain his drug coverage through a stand-
alone Medicare prescription drug plan. What
should you tell him about this situation? He
could enroll in one of the MA plans that
include prescription drug coverage or a
Medigap plan and a stand-alone prescription
drug plan, but he cannot enroll in the MA-only
PPO plan and a stand-alone prescription drug
plan
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