AHIP NONDISCRIMINATION TRAINING EXAM
PAPER UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS
◉ 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? Answer: He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis
treatments start.
◉ Mrs. Turner 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? Answer: Original Medicare covers
ambulance services.
◉ 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 because of an illness.
In general terms, what could you tell him about his costs for
inpatient hospital services under Original Medicare? Answer: 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. Shields is covered by Original Medicare. She sustained a hip
fracture and is being successfully treated for that condition.
However, she and her physicians feel that after her lengthy hospital
stay, she will need a month or two of nursing and rehabilitative care.
What should you tell them about Original Medicare's coverage of
care in a skilled nursing facility? Answer: Medicare will cover Mrs.
Shield's skilled nursing services provided during the first 20 days of
her stay, after which she would have a copay until she has been in
the facility for 100 days.
◉ Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell him?
Answer: Mr. Singh 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. 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? Answer:
Medigap plans do not cover Original Medicare benefits, but they
coordinate with Original Medicare coverage.
◉ 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? Answer: 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.
◉ 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? Answer: He generally would pay a monthly premium,
annual deductible, and per-prescription cost-sharing.
◉ 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?
Answer: Mrs. 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.
◉ Anita Magri will turn age 65 in August 2023. 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 Plan F 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? Answer: You are sorry to
disappoint Anita, but a Medigap 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.
◉ Mrs. Quinn recently turned 66 and decided after many years of
work to retire and begin receiving Social Security benefits. Shortly
thereafter Mrs. Quinn received a letter informing her that she had
been automatically enrolled in Medicare Part B. She wants to
understand what this means. What should you tell Mrs. Quinn?
Answer: Part B primarily covers physician services. She will be
paying a monthly premium and, except for many preventive and
screening tests, generally will have 20% co-payments for these
services, in addition to an annual deductible.
◉ 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? Answer: Mr. Diaz will not pay
any penalty because he had continuous coverage under his
employer's plan.
PAPER UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS
◉ 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? Answer: He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis
treatments start.
◉ Mrs. Turner 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? Answer: Original Medicare covers
ambulance services.
◉ 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 because of an illness.
In general terms, what could you tell him about his costs for
inpatient hospital services under Original Medicare? Answer: 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. Shields is covered by Original Medicare. She sustained a hip
fracture and is being successfully treated for that condition.
However, she and her physicians feel that after her lengthy hospital
stay, she will need a month or two of nursing and rehabilitative care.
What should you tell them about Original Medicare's coverage of
care in a skilled nursing facility? Answer: Medicare will cover Mrs.
Shield's skilled nursing services provided during the first 20 days of
her stay, after which she would have a copay until she has been in
the facility for 100 days.
◉ Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell him?
Answer: Mr. Singh 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. 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? Answer:
Medigap plans do not cover Original Medicare benefits, but they
coordinate with Original Medicare coverage.
◉ 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? Answer: 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.
◉ 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? Answer: He generally would pay a monthly premium,
annual deductible, and per-prescription cost-sharing.
◉ 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?
Answer: Mrs. 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.
◉ Anita Magri will turn age 65 in August 2023. 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 Plan F 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? Answer: You are sorry to
disappoint Anita, but a Medigap 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.
◉ Mrs. Quinn recently turned 66 and decided after many years of
work to retire and begin receiving Social Security benefits. Shortly
thereafter Mrs. Quinn received a letter informing her that she had
been automatically enrolled in Medicare Part B. She wants to
understand what this means. What should you tell Mrs. Quinn?
Answer: Part B primarily covers physician services. She will be
paying a monthly premium and, except for many preventive and
screening tests, generally will have 20% co-payments for these
services, in addition to an annual deductible.
◉ 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? Answer: Mr. Diaz will not pay
any penalty because he had continuous coverage under his
employer's plan.
