AHIP FWA UPDATED ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS
Question 1.
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.
Question 2.
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.
Question 3.
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.
Question 4.
Madeline Martinez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also left a substantial estate which provides Madeline
with an annual income of approximately $130,000. Madeline, the last three years, will soon turn
age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you
tell her?
ANSWER
You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record and participation in the Medicare system. You
should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but
less than the highest rate due her substantial income.
1
,Question 5.
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?
ANSWER
Medicare does not cover massage therapy, or, in general, glasses or dentures.
Question 6.
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has
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, with the
exception of many preventive and screening tests, generally will have 20% coinsurance for these
services, in addition to an annual deductible.
Question 7.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't
remember what Part D is so she called you to ask what her neighbor tell her?
ANSWER
Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing
among other factors to see if they have changed.
Question 8.
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?
ANSWER
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received
the MSN in the mail.
Question 9.
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?
ANSWER
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
2
,Question 10.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance?
ANSWER
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.
Question 11.
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 emer- 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 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.
Question 12.
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?
ANSWER
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
Question 13.
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.
3
, Question 14.
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?
ANSWER
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.
Question 15.
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 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.
Question 16.
What impact, if any, have recent regulatory changes had upon Medigap plans?
ANSWER
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January
1, 2020.
Question 17.
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 help beneficiaries cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Question 18.
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?
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.
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CORRECT ANSWERS
Question 1.
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.
Question 2.
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.
Question 3.
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.
Question 4.
Madeline Martinez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also left a substantial estate which provides Madeline
with an annual income of approximately $130,000. Madeline, the last three years, will soon turn
age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you
tell her?
ANSWER
You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record and participation in the Medicare system. You
should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but
less than the highest rate due her substantial income.
1
,Question 5.
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?
ANSWER
Medicare does not cover massage therapy, or, in general, glasses or dentures.
Question 6.
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has
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, with the
exception of many preventive and screening tests, generally will have 20% coinsurance for these
services, in addition to an annual deductible.
Question 7.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't
remember what Part D is so she called you to ask what her neighbor tell her?
ANSWER
Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing
among other factors to see if they have changed.
Question 8.
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?
ANSWER
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received
the MSN in the mail.
Question 9.
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?
ANSWER
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
2
,Question 10.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance?
ANSWER
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.
Question 11.
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 emer- 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 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.
Question 12.
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?
ANSWER
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
Question 13.
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.
3
, Question 14.
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?
ANSWER
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.
Question 15.
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 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.
Question 16.
What impact, if any, have recent regulatory changes had upon Medigap plans?
ANSWER
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January
1, 2020.
Question 17.
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 help beneficiaries cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Question 18.
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?
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.
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