2022 AHIP Study Guide (including FWA, Discrimination & Compliance)
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal
... [Show More] disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him? –
Answer: : He may sign-up for Medicare at any time however coverage usually begins on
the fourth month after dialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers
employer-sponsored healthcare coverage. Juan is a naturalized citizen and has
contributed to the Medicare system for over 20 years. Juan asks you if he will be
entitled to Medicare and if he enrolls how that will impact his employer-sponsored
healthcare coverage. How would you respond? –
Answer: : Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls
Medicare would become the primary payor of his healthcare claims and Smallcap does
not have to continue to offer him coverage comparable to those under age 65 under its
employer-sponsored group health plan.
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? –
Answer: : Medicare Supplemental Insurance would help cover his Part A and Part B
deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as
possibly some services that Medicare does not cover.
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? –
Answer: : She may enroll at any time while she is covered under her employer plan, but
she will have a special eight-month enrollment period after the last month on her
employer plan that differs from the standard general enrollment period, during which
she may enroll in Medicare Part B.
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? –
Answer: : 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. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it
provides no drug coverage. She would like to keep the coverage she has but replace
her existing Medigap plan with one that provides drug coverage. What should you tell
her? [Show Less]