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.
Mr. Roberts is enrolled in an MA plan. He
recently suffered complications following
hip replacement surgery. As
a result, he has spent the last three months
in Resthaven, a skilled nursing facility. Mr.
Roberts is about to be
discharged. What advice would you give
him regarding his health coverage options?
His open enrollment period as an
institutionalized individual will continue
for two
months after the month he moves out of the
facility.
What impact, if any, will the Medicare
Access and CHIP Reauthorization Act of
2015 (MACRA) have upon
Medigap plans?
The Part B deductible will no longer be
covered for individuals newly eligible for
Medicare starting January 1, 2020.
Mrs. Radford asks whether there are any
special eligibility requirements for
Medicare Advantage. What should
you tell her?
. Mrs. Radford must be entitled to Part A
and enrolled in Part B to enroll in Medicare
Advantage
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. Shields' skilled
nursing services provided during the first
20
days of her stay, after which she would
have a coinsurance until she has been in
the
facility for 100 days.
Mr. Polanski likes the cost of an HMO plan
available in his area, but would like to be
able to visit one or two
doctors who aren't participating providers.
He wants to know if the Point of Service
(POS) option available with
some HMOs will be of any help in this
situation. What should you tell him?
The POS option might be a good solution
for him as it will allow him to visit out-
ofnetwork providers, generally without
prior approval. However, he should be
aware that
it is likely he will have to pay higher cost-
sharing for services from out-of-network
providers.
Mr. Lopez takes several high cost
prescription drugs. He would like to enroll
in a standalone Part D prescription
drug plan that is available in his area. In
what type of Medicare Health Plan can he
enroll?
Private Fee-for-Service (PFFS) plan that
does not include drug coverage.
Monica is an agent focused on serving
seniors eligible for Medicare. As she
reviews her records, she is trying to
determine which of the following items are
considered compensation. What do you tell
her?
I. Commissions
II. Bonuses
III. Mileage reimbursement
IV. Referral fees
I, II, and IV only