Ahip 2025 final
Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with Original
Medicare coverage. - Answer✔✔ 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?
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. - Answer✔✔ 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?
b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1,
2020. - Answer✔✔ What impact, if any, have recent regulatory changes had on Medigap plans?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. -
Answer✔✔ 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✔✔ 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?
Medicare does not cover massage therapy, or, in general, glasses or dentures. - Answer✔✔ 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?
, She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D
prescription drug plan. - Answer✔✔ 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?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. -
Answer✔✔ Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
You can offer to review the plans appeal process to help him ask the plan to review the coverage
decision. - Answer✔✔ 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?
He will have to enroll in Part B. - Answer✔✔ 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?
- Answer✔✔ 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?
She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. - Answer✔✔ 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?
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. - Answer✔✔ 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 determine his eligibility?
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. - Answer✔✔ Mrs. Lyons is in good
health, uses a single prescription, and lives independently in her own home. She is attracted by the idea
Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with Original
Medicare coverage. - Answer✔✔ 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?
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. - Answer✔✔ 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?
b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1,
2020. - Answer✔✔ What impact, if any, have recent regulatory changes had on Medigap plans?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. -
Answer✔✔ 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✔✔ 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?
Medicare does not cover massage therapy, or, in general, glasses or dentures. - Answer✔✔ 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?
, She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D
prescription drug plan. - Answer✔✔ 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?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. -
Answer✔✔ Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
You can offer to review the plans appeal process to help him ask the plan to review the coverage
decision. - Answer✔✔ 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?
He will have to enroll in Part B. - Answer✔✔ 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?
- Answer✔✔ 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?
She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. - Answer✔✔ 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?
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. - Answer✔✔ 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 determine his eligibility?
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. - Answer✔✔ Mrs. Lyons is in good
health, uses a single prescription, and lives independently in her own home. She is attracted by the idea
