2023 AHIP Module 1 Final Review | questions and answers | accurately answered 100% correct

AHIP Module 1 Final Review 1. Mrs. Durante 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. Durante should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. 2. 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 facility for 100 days. 3. 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. 4. 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 was talking about. What could you 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. 5. 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 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? Answer: Mr. Diaz will not pay any penalty because he had continuous coverage under his employer’s plan.