AHIP FWA EXAM UPDATED ACTUAL QUESTIONS AND CORRECT
ANSWERS
✔✔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? - ✔✔Medicare will
cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
✔✔Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance? - ✔✔She 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.
✔✔Anita Magri will turn age 65 in August 2022. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Part F plan
in which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should you
tell her? - ✔✔You are sorry to disappoint Anita but a Medigap Part F plan is no longer
available to those who turn age 65 after January 1,2020. Anita might instead consider
other Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
✔✔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? - ✔✔To 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 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.
✔✔Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - ✔✔Medicare
covers the periodic performance of a range of screening tests that are meant to provide
early detection of disease. Mr. Buck will need to check specific tests before obtaining
them to see if they will be covered.
✔✔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? - ✔✔Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
✔✔What impact, if any, have recent regulatory changes had upon Medigap plans? -
✔✔The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
✔✔Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - ✔✔*** Medigap plans help beneficiaries cover Original Medicare benefits,
but they coordinate with Original Medicare coverage.
✔✔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? - ✔✔Under 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.
✔✔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? - ✔✔She 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.
✔✔Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs? - ✔✔Mr. Wu may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program.
✔✔Mr. Romero is 64, retiring soon, and considering enrollment in his employer-
sponsored retiree group health plan that includes drug coverage with nominal copays.
He heard about a neighbor's MA-PD plan that you represent and because he takes
numerous prescription drugs, he is considering signing up for it. What should you tell
him? - ✔✔He should compare the benefits in his employer-sponsored retiree group
health plan with the benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
, ✔✔Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare.
What should she be aware of when considering enrollment in a Medicare Advantage
(MA) plan? - ✔✔She cannot enroll in an MA Medical Savings Account (MSA) plan.
✔✔Which of the following statement(s) is/are correct about a Medicare Savings Account
(MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible
of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full. - ✔✔I, II, and IV only
✔✔Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level.
She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She
also wants to have prescription drug coverage since her doctor recently prescribed
several expensive medications. Currently, she is enrolled in Original Medicare and a
standalone Part D plan. How would you advise Mrs. Chi? - ✔✔Mrs. Chi may enroll in a
MA MSA plan and remain in her current standalone Part D prescription drug plan.
✔✔Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment.
How much may Dr. Brennan charge? - ✔✔Dr. Brennan can charge Mary Rogers no
more than the cost sharing specified in the PFFS plan's terms and condition of payment
which may include balance billing up to 15%of the Medicare rate.
✔✔Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area
has an attractive premium. He wants to know if he must use doctors in a network as his
current HMO plan requires him to do. What should you tell him? - ✔✔He may receive
health care services from any doctor allowed to bill Medicare, as long as he shows the
doctor the plan's identification card and the doctor agrees to accept the PFFS plan's
payment terms and conditions, which could include balance billing.
✔✔Mrs. Lyons is in good health, uses a single prescription, and lives independently in
her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA) but is not sure if the plan associated with the account will fit her
needs. What specific piece of information about a Medicare MSA plan would it be
important for her to know, prior to enrolling in such a plan? - ✔✔All MSAs cover Part A
and Part B benefits, but not Part D prescription drug benefits, which could be obtained
by also enrolling in a separate prescription drug plan.
ANSWERS
✔✔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? - ✔✔Medicare will
cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
✔✔Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance? - ✔✔She 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.
✔✔Anita Magri will turn age 65 in August 2022. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Part F plan
in which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should you
tell her? - ✔✔You are sorry to disappoint Anita but a Medigap Part F plan is no longer
available to those who turn age 65 after January 1,2020. Anita might instead consider
other Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
✔✔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? - ✔✔To 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 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.
✔✔Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - ✔✔Medicare
covers the periodic performance of a range of screening tests that are meant to provide
early detection of disease. Mr. Buck will need to check specific tests before obtaining
them to see if they will be covered.
✔✔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? - ✔✔Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
✔✔What impact, if any, have recent regulatory changes had upon Medigap plans? -
✔✔The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
✔✔Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - ✔✔*** Medigap plans help beneficiaries cover Original Medicare benefits,
but they coordinate with Original Medicare coverage.
✔✔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? - ✔✔Under 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.
✔✔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? - ✔✔She 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.
✔✔Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs? - ✔✔Mr. Wu may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program.
✔✔Mr. Romero is 64, retiring soon, and considering enrollment in his employer-
sponsored retiree group health plan that includes drug coverage with nominal copays.
He heard about a neighbor's MA-PD plan that you represent and because he takes
numerous prescription drugs, he is considering signing up for it. What should you tell
him? - ✔✔He should compare the benefits in his employer-sponsored retiree group
health plan with the benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
, ✔✔Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare.
What should she be aware of when considering enrollment in a Medicare Advantage
(MA) plan? - ✔✔She cannot enroll in an MA Medical Savings Account (MSA) plan.
✔✔Which of the following statement(s) is/are correct about a Medicare Savings Account
(MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible
of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full. - ✔✔I, II, and IV only
✔✔Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level.
She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She
also wants to have prescription drug coverage since her doctor recently prescribed
several expensive medications. Currently, she is enrolled in Original Medicare and a
standalone Part D plan. How would you advise Mrs. Chi? - ✔✔Mrs. Chi may enroll in a
MA MSA plan and remain in her current standalone Part D prescription drug plan.
✔✔Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment.
How much may Dr. Brennan charge? - ✔✔Dr. Brennan can charge Mary Rogers no
more than the cost sharing specified in the PFFS plan's terms and condition of payment
which may include balance billing up to 15%of the Medicare rate.
✔✔Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area
has an attractive premium. He wants to know if he must use doctors in a network as his
current HMO plan requires him to do. What should you tell him? - ✔✔He may receive
health care services from any doctor allowed to bill Medicare, as long as he shows the
doctor the plan's identification card and the doctor agrees to accept the PFFS plan's
payment terms and conditions, which could include balance billing.
✔✔Mrs. Lyons is in good health, uses a single prescription, and lives independently in
her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA) but is not sure if the plan associated with the account will fit her
needs. What specific piece of information about a Medicare MSA plan would it be
important for her to know, prior to enrolling in such a plan? - ✔✔All MSAs cover Part A
and Part B benefits, but not Part D prescription drug benefits, which could be obtained
by also enrolling in a separate prescription drug plan.
