AHIP - 2027 with correct questions and
answers.
,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? - correct ans:Original Medicare covers ambulance services.
What impact, if any, have recent regulatory changes had on Medigap plans? -
correct ans: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? - correct ans: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.
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? - correct ans: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? - correct ans: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? - correct ans: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? - correct
ans: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. 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? - correct ans: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? - correct ans: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? - correct ans: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. During her initial
enrollment period she purchased a standard Medigap Plan A policy from you
because of its relatively low cost. After speaking to her friend Stan, she asks
whether any of the following are "core benefits" covered in her plan? -
correct ans:I. Coverage for Part A hospital coinsurance amount
II. Coverage for 365 additional days during an insured's lifetime after
Medicare benefits end
III. Coverage for 3 pints of blood
Mr. Ellis continued working with his company and was insured under his
employer's group plan until he reached age 68 when he retired. Five months
later Mr. Ellis enrolled in Part B. 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? - correct ans:Mr.
Ellis will not pay any penalty because he had continuous coverage under his
employer's plan and he enrolled in Part B within the 8-month period
immediately following the last month he had group coverage.
Mrs. Georgia 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? - correct ans:Medigap plans do not cover Original
Medicare benefits, but they coordinate with Original Medicare coverage.
Mr. Turner 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.
Turner that best describes the health coverage provided to Medicare
beneficiaries? - correct ans:Beneficiaries under Original Medicare have no
cost-sharing for most preventive services.
Mr. Harvey 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 ans:It is illegal for you to sell Mr. Harvey a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original
Medicare.
answers.
,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? - correct ans:Original Medicare covers ambulance services.
What impact, if any, have recent regulatory changes had on Medigap plans? -
correct ans: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? - correct ans: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.
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? - correct ans: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? - correct ans: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? - correct ans: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? - correct
ans: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. 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? - correct ans: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? - correct ans: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? - correct ans: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. During her initial
enrollment period she purchased a standard Medigap Plan A policy from you
because of its relatively low cost. After speaking to her friend Stan, she asks
whether any of the following are "core benefits" covered in her plan? -
correct ans:I. Coverage for Part A hospital coinsurance amount
II. Coverage for 365 additional days during an insured's lifetime after
Medicare benefits end
III. Coverage for 3 pints of blood
Mr. Ellis continued working with his company and was insured under his
employer's group plan until he reached age 68 when he retired. Five months
later Mr. Ellis enrolled in Part B. 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? - correct ans:Mr.
Ellis will not pay any penalty because he had continuous coverage under his
employer's plan and he enrolled in Part B within the 8-month period
immediately following the last month he had group coverage.
Mrs. Georgia 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? - correct ans:Medigap plans do not cover Original
Medicare benefits, but they coordinate with Original Medicare coverage.
Mr. Turner 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.
Turner that best describes the health coverage provided to Medicare
beneficiaries? - correct ans:Beneficiaries under Original Medicare have no
cost-sharing for most preventive services.
Mr. Harvey 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 ans:It is illegal for you to sell Mr. Harvey a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original
Medicare.
