Determining Medicare Coverage

Determining Medicare Coverage

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For this activity, you will be give several scenarios. You will answer the questions posed for each case. Be sure to review all of the information you have learned about the Medicare program.

Case 1: Distinguishing the differences between plans

You are working as a registration specialist for a family practice doctor. Your patient, Lynn Donaldson, calls to ask you some questions about the Medicare program. Lynn, is turning 65 in six months and is trying to plan ahead. She has been told by her friend Gladys, that all she needs is Medicare Part A, but her friend John told her she needs both part A and Part B. Lynn is so confused and has asked you for some advice. What will you tell her?

1. What is the difference between Medicare Part A and B?

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2. Will she need both plans? Why or why not?

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Case 2: Examining Eligibility Requirements

John is 58 years old and has been on disability, collecting Social Security Disability for two years. He has been on Medicaid for the past two years now.

Does John, qualify for Medicare at this time? Why or why not?

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Case 3: Benefits payable

Mason, has several questions about his Medicare coverage. He hears about Medicare Part A, B, C D and just does not quite understand which plans cover what. He scratches his head as he looks over all of the papers and wonders, how he will ever make sense of this program. Can you help Mason?

1. “If I go into the hospital, which Medicare plan will pay for my hospital room and board?”

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2. “If I have to have my knee operated on in the outpatient department, which Medicare plan pays for this?”

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3. “My friend told me that if I need prescriptions, I just use my Medicare Part B plan? I don’t know if this is correct. I thought I read somewhere about another plan.” What plan will cover prescriptions?

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4. “My friend Ellen has an Advantage plan, I wonder what Medicare Plan this is?”

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5. “If I need a wheelchair, what plan will cover this?”

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6. “My wife is 61 years old, can I just add her to my plans, like I did when I was employed at ABC Company Inc.?”

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Case 4: Plans available

Sarah lives in Orlando Florida. She retired there and works at Disney World about 8 hours per week. She has been on Medicare Part B, but is interested in switching to an Advantage Plan. She does not know how to determine what plans are available in her area. She is only taking an aspirin a day, so she is very healthy for her age of 68. Can you help Sarah with finding the plans that are available in her area, as listed on the Medicare.gov website?

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