Navigating Retirement Healthcare Flashcards

A 65-year-old client is covered by her employer's high-deductible health plan (HDHP) and actively contributes to a Health Savings Account (HSA). She plans to keep working and wants to continue making HSA contributions. What is the MOST accurate advice regarding Medicare enrollment?

Answer: She should delay enrollment in both Medicare Part A and Part B.

To remain eligible to contribute to a Health Savings Account (HSA), an individual cannot be enrolled in any part of Medicare. Since the client is still working and has creditable coverage from her employer, she can delay enrolling in both Medicare Part A and Part B without penalty. Enrolling in either Part A or Part B would make her ineligible for further HSA contributions.

A CRPC® is explaining healthcare funding in retirement to a client. The client believes that Medicare will cover a long-term stay in an assisted living facility if she needs help with activities of daily living like bathing and dressing. Which of the following statements is the MOST accurate clarification?

Answer: Medicare does not cover long-term custodial care; its coverage is limited to short-term, skilled nursing care following a qualifying hospital stay.

A common misconception is that Medicare covers long-term care. Medicare Part A covers a limited amount of skilled nursing facility care (up to 100 days with coinsurance after day 20) following a qualifying inpatient hospital stay. It does not cover custodial care, which involves assistance with activities of daily living and is the most common type of long-term care. Medicaid is the primary payer for long-term custodial care, but it is means-tested and requires individuals to spend down their assets to qualify.

An individual failed to enroll in a Medicare Part D prescription drug plan during their Initial Enrollment Period and did not have other creditable drug coverage for 20 full months. How will the late enrollment penalty be calculated when they eventually sign up?

Answer: A permanent addition to their monthly premium equal to 1% of the national base beneficiary premium for each month of delay.

The Medicare Part D late enrollment penalty is calculated as 1% of the national base beneficiary premium for each full month the individual went without creditable coverage. This amount is rounded to the nearest $0.10 and added to their monthly Part D premium. The penalty is typically permanent, meaning they will pay it for as long as they have Part D coverage.

A client is turning 65 and enrolling in Medicare Part B for the first time. They have several pre-existing health conditions and want to purchase a Medigap (Medicare Supplement) policy. To ensure guaranteed issue rights, when is the best time for them to apply?

Answer: During their one-time, 6-month Medigap Open Enrollment Period, which starts the month they are 65 or older and enrolled in Part B.

The best time to buy a Medigap policy is during the 6-month Medigap Open Enrollment Period. This period begins on the first day of the month in which an individual is both 65 or older and enrolled in Medicare Part B. During this window, insurance companies cannot use medical underwriting to deny coverage or charge a higher premium due to health problems. Outside of this period, guaranteed issue rights are limited to specific situations.

A 62-year-old client is retiring early and losing her employer's health coverage. When comparing continuing her plan through COBRA versus buying a plan on the ACA Marketplace, what is a primary advantage of choosing a Marketplace plan?

Answer: She may be eligible for income-based premium tax credits and subsidies.

A significant advantage of the ACA Marketplace is the availability of income-based premium tax credits and cost-sharing subsidies, which can make coverage much more affordable than COBRA. With COBRA, the individual must pay the full premium plus an administrative fee (up to 102%), with no subsidies available. Both options cover pre-existing conditions, and COBRA generally lasts for 18 months.

When comparing Original Medicare (Parts A & B) with a Medicare Advantage (Part C) plan, which of the following is a key feature UNIQUE to Medicare Advantage plans?

Answer: An annual out-of-pocket maximum for covered medical services.

Medicare Advantage (Part C) plans are required to have an annual limit on out-of-pocket costs for services covered under Parts A and B. Original Medicare does not have an out-of-pocket maximum, which is why many beneficiaries purchase separate Medigap policies. Original Medicare allows beneficiaries to see any provider that accepts Medicare, while Medicare Advantage plans typically have provider networks.