AHIP FINAL EXAM

Mr., Moy’s, wife ,has ,a ,Medicare ,Advantage ,plan, ,but ,he ,wants ,to ,understand ,what coverage ,Medicare ,Supplemental ,Insurance ,provides ,since ,his ,health ,care ,needs ,are,different ,from ,his ,wife's ,needs. ,What ,could ,you ,tell ,Mr. ,Moy?correct ,answersMedicare,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. 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?correct ,answersShe ,may ,enroll ,at ,any ,time ,while ,she ,is ,covered ,under ,her ,employer ,plan, ,but ,she ,will ,have ,a ,special ,eight-month enrollment ,period ,after ,the ,last ,month ,on ,her ,employer ,plan ,that ,differs ,from ,the ,standard ,general ,enrollment ,period, ,during ,which ,she ,may ,enroll ,in ,Medicare ,Part ,B. 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?correct ,answersMost ,individuals ,who ,are ,citizens ,and ,age ,65 ,or ,over ,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. Mrs. ,Gonzalez ,is ,enrolled ,in ,Original ,Medicare ,and ,has ,a ,Medigap ,policy ,as ,well, ,but ,it provides ,no ,drug ,coverage. ,She ,would ,like ,to ,keep ,the ,coverage ,she ,has ,but ,replace her ,existing ,Medigap ,plan ,with ,one ,that ,provides ,drug ,coverage. ,What ,should ,you ,tell ,her?correct ,answersMrs. ,Gonzalez ,cannot ,purchase ,a ,Medigap ,plan ,that ,covers ,drugs,,but ,she ,could ,keep ,her ,Medigap ,policy ,and ,enroll ,in ,a ,Part ,D ,prescription ,drug ,plan. Mrs. ,West ,wears ,glasses ,and ,dentures ,and ,has ,enjoyed ,considerable ,pain ,relief ,from arthritis ,through ,massage ,therapy. ,She ,is ,concerned ,about ,whether ,or ,not ,Medicare ,will,cover ,these ,items ,and ,services. ,What ,should ,you ,tell ,her?correct ,answersMedicare does ,not ,cover ,massage ,therapy, ,or, ,in ,general, ,glasses ,or ,dentures. Mr., Patel ,is ,in ,good ,health ,and ,is ,preparing ,a ,budget ,in ,anticipation ,of ,his ,retirement when ,he ,turns ,66. ,He ,wants ,to ,understand ,the ,health ,care ,costs ,he ,might ,be ,exposed ,to,under ,Medicare ,if ,he ,were ,to ,require ,hospitalization ,as ,a ,result ,of ,an ,illness. ,In ,general terms, ,what ,could ,you ,tell ,him ,about ,his ,costs ,for ,inpatient ,hospital ,services under ,Original ,Medicare?correct ,answersUnder ,Original ,Medicare, ,there ,is ,a ,single deductible ,amount ,due ,for ,the ,first ,60 ,days ,of ,any ,inpatient ,hospital ,stay, ,after ,which ,it converts ,into ,a ,per-day ,coinsurance ,amount ,through ,day ,90. ,After ,day ,90, ,he ,would ,pay,a ,daily ,amount ,up ,to ,60 ,days ,over ,his ,lifetime, ,after ,which ,he ,would ,be ,responsible ,for all ,costs. Ms. ,Henderson ,believes ,that ,she ,will ,qualify ,for ,Medicare ,Coverage ,when ,she ,turns ,65, ,without ,paying ,any ,premiums, ,because ,she ,has ,been ,working ,for ,40 ,years ,and ,paying ,Medicare ,taxes. ,What ,should ,you ,tell ,her?correct ,answersTo ,obtain ,Part ,B ,coverage, she ,must ,pay ,a ,standard ,monthly ,premium, ,though ,it ,is ,higher ,for ,individuals ,with ,higher,incomes. Mr. ,Alonso ,receives ,some ,help ,paying ,for ,his ,two ,generic ,prescription ,drugs ,from ,his employer's ,retiree ,coverage, ,but ,he ,wants ,to ,compare ,it ,to ,a ,Part ,D ,prescription ,drug plan. ,He ,asks ,you ,what ,costs ,he ,would ,generally ,expect ,to ,encounter ,when ,enrolling into ,a ,standard ,MedicarePart ,D ,prescription ,drug ,plan. ,What ,should ,you ,tell ,him?correct,answers ,He ,generally ,would ,pay ,a ,monthly ,premium, ,annual ,deductible, ,and ,per- prescription ,cost-sharing. Mr. ,Davis ,is ,52 ,years ,old ,and ,has ,recently ,been ,diagnosed ,with ,end-stage ,renal ,disease,(ESRD) ,and ,will ,soon ,begin ,dialysis. ,He ,is ,wondering ,if ,he ,can ,obtain ,coverage ,under Medicare. ,What ,should ,you ,tell ,him?correct ,answersHe ,may ,sign-up ,for ,Medicare ,at any ,time ,however ,coverage ,usually ,begins ,on ,the ,fourth ,month ,after ,dialysis ,treatments start. Juan ,Perez, ,who ,is ,turning ,age ,65 ,next ,month, ,intends ,to ,work ,for ,several ,more ,years ,at,Smallcap, ,Incorporated. ,Smallcap ,has ,a ,workforce ,of15 ,employees ,and ,offers employer-sponsored ,healthcare ,coverage. ,Juan ,is ,a ,naturalized ,citizen ,and ,has contributed ,to ,the ,Medicare ,system ,for ,over ,20 ,years. ,Juan ,asks ,you ,if ,he ,will ,be entitled ,to ,Medicare ,and ,if ,he ,enrolls ,how ,that ,will ,impact ,his ,employer-sponsored healthcare ,coverage. ,How ,would ,you ,respond?correct ,answersJuan ,is ,likely ,to ,be eligible ,for ,Medicare ,once ,he ,turns ,age ,65 ,and ,if ,he ,enrolls ,Medicare ,would ,become ,the,primary ,payor ,of ,his ,healthcare ,claims ,and ,Smallcap ,does ,not ,have ,to ,continue ,to ,offer him ,coverage ,comparable ,to ,those ,under ,age ,65 ,under ,its ,employer- sponsored ,group ,health ,plan. Ms. ,Moore ,plans ,to ,retire ,when ,she ,turns ,65 ,in ,a ,few ,months. ,She ,is ,in ,excellent ,health and ,will ,have ,considerable ,income ,when ,she ,retires. ,She ,is ,concerned ,that ,her ,income will ,make ,it ,impossible ,for ,her ,to ,qualify ,for ,Medicare. ,What ,could ,you ,tell ,her ,to ,address,her ,concern?correct ,answersMedicare ,is ,a ,program ,for ,people ,age ,65 ,or ,older ,and those ,under ,age ,65 ,with ,certain ,disabilities, ,end-stage ,renal ,disease, ,and ,Lou ,Gehrig's disease ,so ,she ,will ,be ,eligible ,for ,Medicare. Mr. ,Xi ,will ,soon ,turn ,age ,65 ,and ,has ,come ,to ,you ,for ,advice ,as ,to ,what ,services ,are provided ,under ,Original ,Medicare. ,What ,should ,you ,tell ,Mr. ,Xi ,that ,best ,describes ,the health ,coverage ,provided ,to ,Medicare ,beneficiaries?correct ,answersBeneficiaries ,under,Original ,Medicare ,have ,no ,cost-sharing ,for ,most ,preventive ,services ,which ,include immunizations ,such ,as ,annual ,flu ,shots. Mrs. ,Duarte ,is ,enrolled ,in ,Original ,Medicare ,Parts ,A ,and ,B. ,She ,has ,recently ,reviewed her ,Medicare ,Summary ,Notice ,(MSN) ,and ,disagrees ,with ,a ,determination ,that ,partially denied ,one ,of ,her ,claims ,for ,services. ,What ,advice ,would ,you ,give ,her?correct answersMrs. ,Duarte ,should ,file ,an ,appeal ,of ,this ,initial ,determination ,within ,120 ,days ,of,the ,date ,she ,received ,the ,MSN ,in ,the ,mail. Mr. ,Capadona ,would ,like ,to ,purchase ,a ,Medicare ,Advantage ,(MA) ,plan ,and ,a ,Medigap,plan ,to ,pick ,up ,costs ,not ,covered ,by ,that ,plan. What ,should ,you ,tell ,him?correct ,answersIt ,is ,illegal ,for ,you ,to ,sell ,Mr. ,Capadona ,a ,Medigap ,plan ,if ,he ,is ,enrolled ,in ,an ,MA ,plan, ,and ,besides, ,Medigap ,only ,works ,with,Original ,Medicare. Mrs. ,Park ,is ,an ,elderly ,retiree. ,Mrs. ,Park ,has ,a ,low ,fixed ,income. ,What ,could ,you ,tell ,Mrs. ,Park ,that ,might ,be ,of ,assistance?correct ,answersShe ,should ,contact ,her ,state Medicaid ,agency ,to ,see ,if ,she ,qualifies ,for ,one ,of ,several ,programs ,that ,can ,help ,with,Medicare ,costs ,for ,which ,she ,is ,responsible. Mr. ,Rainey ,is ,experiencing ,paranoid ,delusions ,and ,his ,physician ,feels ,that ,he ,should ,be,hospitalized. ,What ,should ,you ,tell ,Mr. ,Rainey ,(or ,his ,representative) ,about ,the ,length ,of an ,inpatient ,psychiatric ,hospital ,stay ,that ,Medicare ,will ,cover?correct ,answersMedicare will ,cover ,a ,total ,of ,190 ,days ,of ,inpatient ,psychiatric ,care ,during ,Mr. ,Rainey's ,entire lifetime.