1.Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure aboutwhat 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? - ANS They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs 2.(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be a correct description? - ANS Medicare Advantage is a way of covering all of the Original Medicare benefits through private health insurance companies. 3.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? - ANS 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. 4.(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? - ANS Mrs. Radford must be entitled to Part A and enrolled in Part B to enrollin Medicare Advantage 5Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped payinghis Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? - ANS He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B 6(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings have in regard to her MA plan during the next open enrollment season? - ANS She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area 7Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? - ANS 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). 8Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she cango to for her health care. What should you tell her? - ANS Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will be charged a lower co-payment if she goes to one of the plan's preferred providers. 9Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received underOriginal Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him? - ANS SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well 10(W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him? - ANS SNPs limit enrollment to certain sub-populations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. 11(W) 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? - ANS Most individuals who are citizens and over age 65 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. 12(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social SecurityAdministration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him? - ANS After receiving such disability payments for24 months, he will be automatically enrolled in Medicare, regardless of age. 13(W) 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? - ANS 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. 14(W) Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, withoutpaying any premiums, because she has been working for 40 years and paying Medicare taxes. Whatshould you tell her? - ANS In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes 15(W) 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? - ANS Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. (W) 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? - ANS She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B