Ahip 2025 final
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1. Mrs. Paterson is concerned about the deductibles and co-payments asso-
ciated 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.
2. 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?: 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.
3. What impact, if any, have recent regulatory changes had on Medigap plans?-
: b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
4. Mr. Rainey is experiencing paranoid delusions and his physician feels that
he should be hospitalized. What should you tell Mr. Rainey (or his representa-
tive) 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.
5. 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?:
6. 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?: Medicare does not cover massage therapy, or, in general, glasses or dentures.
7. Ms. Gibson recently lost her employer group health and drug coverage and
now she wants to enroll in a PPO that does not include drug coverage. What
should you tell her about obtaining drug coverage?: She can enroll in the PPO,
but she will not be able to purchase a stand-alone Medicare Part D prescription drug
plan.
8. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?: Mrs. Radford must be entitled
to Part A and enrolled in Part B to enroll in Medicare Advantage.
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9. Mr. Barker enjoys a comfortable retirement income. He recently had surgery
and expected that he would have certain services and items covered by the
plan with minimal out-of-pocket costs because his MA-PD coverage has been
very good. However, when he received the bill, he was surprised to see large
charges in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called you to ask
what he could do? What could you tell him?: You can offer to review the plans
appeal process to help him ask the plan to review the coverage decision.
10. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled
in Part B because he has coverage through an employer plan. If he wants to
enroll in a Medicare Advantage plan, what will he have to do?: He will have to
enroll in Part B.
11. 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?:
12. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area
that does not include drug coverage. She wants to enroll in the plan and enroll
in a stand-alone prescription drug plan. What should you tell her?: She could
enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
13. Mr. Kelly wants to know whether he is eligible to sign up for a Private
fee-for-service (PFFS) plan. What questions would you need to ask to deter-
mine his eligibility?: You would need to ask Mr. Kelly if he is enrolled in Part A and
Part B and if he lives in the PFFS plan's service area.
14. Mrs. Lyons is in good health, uses a single prescription, and lives indepen-
dently 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.
15. Who is most likely to benefit from the Medicare Prescription Payment
Plan?:
16. Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment
in a Medicare prescription drug plan because, although she is entitled to Part
A, she is not enrolled under Medicare Part B. What should you tell her?: An
individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a
Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
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1. Mrs. Paterson is concerned about the deductibles and co-payments asso-
ciated 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.
2. 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?: 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.
3. What impact, if any, have recent regulatory changes had on Medigap plans?-
: b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
4. Mr. Rainey is experiencing paranoid delusions and his physician feels that
he should be hospitalized. What should you tell Mr. Rainey (or his representa-
tive) 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.
5. 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?:
6. 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?: Medicare does not cover massage therapy, or, in general, glasses or dentures.
7. Ms. Gibson recently lost her employer group health and drug coverage and
now she wants to enroll in a PPO that does not include drug coverage. What
should you tell her about obtaining drug coverage?: She can enroll in the PPO,
but she will not be able to purchase a stand-alone Medicare Part D prescription drug
plan.
8. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?: Mrs. Radford must be entitled
to Part A and enrolled in Part B to enroll in Medicare Advantage.
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9. Mr. Barker enjoys a comfortable retirement income. He recently had surgery
and expected that he would have certain services and items covered by the
plan with minimal out-of-pocket costs because his MA-PD coverage has been
very good. However, when he received the bill, he was surprised to see large
charges in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called you to ask
what he could do? What could you tell him?: You can offer to review the plans
appeal process to help him ask the plan to review the coverage decision.
10. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled
in Part B because he has coverage through an employer plan. If he wants to
enroll in a Medicare Advantage plan, what will he have to do?: He will have to
enroll in Part B.
11. 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?:
12. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area
that does not include drug coverage. She wants to enroll in the plan and enroll
in a stand-alone prescription drug plan. What should you tell her?: She could
enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
13. Mr. Kelly wants to know whether he is eligible to sign up for a Private
fee-for-service (PFFS) plan. What questions would you need to ask to deter-
mine his eligibility?: You would need to ask Mr. Kelly if he is enrolled in Part A and
Part B and if he lives in the PFFS plan's service area.
14. Mrs. Lyons is in good health, uses a single prescription, and lives indepen-
dently 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.
15. Who is most likely to benefit from the Medicare Prescription Payment
Plan?:
16. Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment
in a Medicare prescription drug plan because, although she is entitled to Part
A, she is not enrolled under Medicare Part B. What should you tell her?: An
individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a
Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
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