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?
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.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like 
to know which of the following services Original Medicare will cover if the appropriate criteria 
are met. What could you tell her?
Original Medicare covers ambulance services.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park 
that might be of assistance?
She should contact her state Medicaid agency to see if she qualifies for one of several programs 
that can help with Medicare costs for which she is responsible.
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 items 
and services. What should you tell her?
Medicare does not cover massage therapy, or, in general, glasses or dentures.
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?
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.
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?
He may sign-up for Medicare at any time however coverage usually begins on the fourth month 
after dialysis treatments start.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one 
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does 
not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does 
not include drug coverage and intends to obtain his drug coverage through a stand-alone 
Medicare prescription drug plan. What should you tell him about this situation?
He could enroll either in one of the MA plans that include prescription drug coverage or Original 
Medicare with a Medigap plan and standalone Part D prescription drug coverage, but he cannot 
enroll in the MA-only PPO plan and a stand-alone 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?
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
What impact, if any, have recent regulatory changes had on Medigap plans?
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting 
January 1, 2020.
Mr. Diaz continued working with his company and was insured under his employer's group plan 
until he reached 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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's 
plan.
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?
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.
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?
He should compare the benefits in his employer-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.