Study guide 2024 AHIP MODULE (ACTUAL TEST) QUESTIONS AND ANSWERS (SOLVED)

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? a. Medicare covers glasses, but not dentures or massage therapy. b. Medicare does not cover massage therapy, or, in general, glasses or dentures. Correct: Neither Medicare Part A nor Part B covers massage therapy, dentures, or routine eye examinations to prescribe eyeglasses. c. Medicare covers 80% of the cost of these three services. d. Medicare covers 50% of the cost of these three services. Feedback Source: Module 1, Slide - Not Covered by Medicare Part A & B Mr. Capadona 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? a. Medigap plans that cover costs not paid for by an MA plan are available only in Massachusetts, Minnesota, and Wisconsin. b. Medigap policies designed to cover costs not paid for by an MA plan can be purchased, but only if the MA plan’s design is considered to be the “defined standard benefit.” c. Medigap plans are a form of Medicare Advantage, so purchasing both would be redundant coverage. d. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare. Correct: The purpose of Medigap plans is to supplement Original Medicare benefits. Medigap plans do not work with Medicare Advantage plans. It is illegal to sell a Medigap plan to someone already in a Medicare Advantage health plan. Feedback Source: Module 1, Slide - Medigap is NOT Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him? a. He became eligible for Medicare when his disability eligibility determination was first made. b. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Correct: Individuals with disabilities who are under age 65 are automatically enrolled in Medicare Parts A and B the month after they have received Social Security or Railroad Retirement disability benefits for 24 months. c. Individuals receiving such disability payments from the Social Security Administration continue to receive those payments but only become eligible for Medicare upon reaching age 65. d. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. Feedback Source: Module 1, Slide - Medicare Enrollment Part A & B 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? a. She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B. b. 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. Correct: As long as Mrs. Peňa is covered under her employer’s plan, she can enroll in Part B at any time. If she retires, she will be able to enroll in Part B during a special enrollment period that lasts 8 months following the last month of her employer coverage. c. She may not enroll in Part B while covered under an employer group health plan and must wait until the standard general enrollment period after she retires. d. She may only enroll in Part B during the general enrollment period whether she is retired or not Feedback Source: Module 1, Slide - Enrollment in Parts A & B After the Initial Enrollment Period 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? a. Mrs. Gonzalez should purchase a K or L Medigap plan. b. Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it likely won’t offer coverage that is equivalent to that provided under Part D. c. 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. Correct: Individuals who are enrolled in Medigap plans may only obtain Medicare drug coverage (Part D) through a stand-alone prescription drug plan. d. Medigap is a replacement for Original Medicare and she has been paying for double coverage. She should simply drop her Medigap policy. Feedback Source: Module 1, Slide - Beneficiaries with Medigap Plans with Drug Coverage Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance? a. She should not sign up for a Medicare Advantage plan. b. She should only seek help from private organizations to cover her Medicare costs. c. She can apply to the Medicare agency for lower premiums and cost-sharing. d. 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. Correct: Mrs. Park can apply for programs through her State Medicaid office that could assist with her Medicare costs, such as Medicare Savings Programs, Part D low-income subsidies, and Medicaid. Feedback Source: Module 1, Slide - Help for Individuals with Limited Income/Resources 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? a. He generally would pay only a per-prescription co-payment. Medicare covers all other costs. b. He generally would pay only a monthly premium. Medicare covers all other costs. c. He generally would pay only a monthly premium and deductible. Medicare covers all other costs. d. He generally would pay a monthly premium, annual deductible, and per-prescription cost- sharing. Correct: Costs for Part D beneficiaries typically include a monthly premium, annual deductible, and per-prescription cost-sharing. Feedback Source: Module 1, Slide - Original Medicare and Part D Prescription Drug 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? a. 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. Correct: Beneficiaries are responsible for a single deductible amount for each benefit period, followed by a per day coinsurance amount through day 90. For day 91 and beyond, there is a charge for each “lifetime reserve day” up to 60 days over a beneficiary’s lifetime. After this, he would be responsible for all costs. b. Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The percentage increases after 60 days and again after 90 days. c. Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a non-participating provider. d. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases until day 90. After 90 days he would pay the full amount of all costs. Feedback Source: Module 1, Slide - Medicare Part A - Original Medicare Cost-Sharing for Inpatient Hospital Care 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? a. All individuals who are citizens and age 65 or over will be covered under Part A. b. Most individuals who are citizens and age 65 or over and are covered under Part A must pay a monthly premium for that coverage. c. Most individuals who are citizens and age 65 or over and wish to be covered under Part A must enroll in a Medicare Advantage Plan. d. 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. Correct: Most individuals who are cit