1. Edward IP suffered from serious kidney disease. As a result. Edward be- came
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant surgery
12 months ago. Edward is now age 50 and asks you if hisMedicare coverage will
continue, what should you say?
Answer: Individuals eligible forMedicare based on ESRD generally lose eligibility
36 months after the month in which the individual receives a kidney transplant unless
they are eligible for Medicareon another basis such as age or disability.Edward may,
however, remain enrolled inPart B butsolely for coverage of immunosuppressive
drugsif he has no other healthcare coverage that would cover the drugs.
2. Mildred Savage enrolled in Allcare Medicare Advantage plan several years
ago.Mildred recently learned thatshe is suffering from inoperable cancer andhas just
a few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paidfor under the Allcare
Medicare Advantage plan.Whatshould you say?
Answer: Mildredmay remain enrolled in Allcare and make a hospice election.
Hospice benefits will be paid for by Original Medicare under Part A and Allcare
will continue to pay for any non-hospice services.
3. 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 forthose who did notsign up for PartB when first eligible andwants to know
how much he will have to pay. What should you tell him?
Answer: Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
4. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under- stand
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.
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