2027 AHIP Final Exam – Medicare Certification – Actual Questions & Answers (AHIP) Guarantee Pass (Updated Pdf)

2027 AHIP Final Exam – Medicare Certification – Actual Questions & Answers (AHIP) Guarantee Pass (Updated Pdf) Larry Miller is an Original Medicare beneficiary with Parts A and B coverage. Larry is admitted to Good Care Hospital in January with pneumonia and stays for three days before being discharged. Six months later in July, Larry takes a bad fall and is admitted to Good Care Hospital with a broken leg. After emergency surgery to repair his broken leg, Larry is hospitalized for a week before being discharged home. In December, Larry is admitted to Mount Wellness Hospital once again with a serious case of the flu. For how many Part A deductibles will Larry be responsible for? Larry will be responsible for three Part A deductibles. Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has been receiving rehabilitation services in a skilled nursing facility. He calls you to say that he has just received a notice that Medicare will no longer cover his stay and he still cannot walk properly. He thinks they are ending his services too soon. What do you tell him? He should follow the directions on the notice to file a fast appeal. Mr. Birch should file it by noon of the calendar day following receipt of the provider's notice of termination of services. Mr. Ray would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? Mr. Ray can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. Mrs. Sanders 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? Most 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. Andrews is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met. What could you tell her? Original Medicare covers ambulance services. What impact, if any, have recent regulatory changes had on Medigap plans? The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020. Joan and Loretta are both enrolled in Medicare. Joan pays a premium for Part A coverage. Loretta does not. Which of the following statements best explains this difference? Joan worked only a short time and did not accumulate sufficient work credits. Loretta worked for well over 10 years accumulating credit for more than 40 quarters of contributions to the Medicare program. Mrs. Carpenter 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? Mrs. Carpenter should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. Mr. Hoffman 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 Medicare Part D prescription drug plan. What should you tell him? He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing. Mrs. Larson 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? Mrs. Larson cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. Mary Alice is covered by Original Medicare Parts A and B