AHIP STUDY SET Module 1-5 100% Questions with
CORRECT ANSWERS |
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? - ANSWER 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.
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.
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.
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.
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 MedicarePart D
prescription drug plan. What should you tell him? - ANSWER He generally
would pay a monthly premium, annual deductible, and per-prescription
costsharing.
1. Mr. Xi will soon turn age 65 and has come to you for advice as to
what services are provided under Original Medicare. What should
you tell Mr. Xi that best describes the health coverage provided to
Medicare beneficiaries? - ANSWER Beneficiaries under Original
Medicare have no cost-sharing for most preventive services which
include immunizations such as annual flu shots.
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.
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? - ANSWER 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.
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.
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.
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? - ANSWER After receiving
such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
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.
Which of the following statement is/are correct about a Medicare
Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of
providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription
drug benefits.
, III. An individual who is enrolled in an MSA plan is responsible for a
minimal deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that
Original Medicare would pay them as payment in full. - ANSWER I, II, and
IV only
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
you represent. It is one of three plans operated by the same organization in
Mr. Lombardi's area. The MA PPO plan does not include drug coverage,
but the other two plans do. Mr. Lombardi likes the PPO plan that does not
include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him
about this situation? - ANSWER He could enroll either in one of the MA
plans that include prescription drug coverage or Original Medicare with a
Medigap plan and standalone Part D prescription drug coverage, but he
cannot enroll in the MA-only PPO plan and a stand-alone prescription drug
plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should you
tell her? - ANSWER Mrs. Ramos can obtain care from any provider who
participates in Original Medicare, but
generally will have a higher cost-sharing amount if she sees a
provider who/that is not a part of the PPO network.
Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug coverage
with nominal copays. He heard about a neighbor's MAPD plan that you
represent and because he takes numerous prescription drugs, he is
considering signing up for it. What should you tell him? - ANSWER He
should compare the benefits in his employer-sponsored retiree group
health plan with the benefits in his neighbor's MA-PD plan to determine
which one will provide sufficient coverage for his prescription needs.
CORRECT ANSWERS |
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? - ANSWER 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.
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.
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.
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.
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 MedicarePart D
prescription drug plan. What should you tell him? - ANSWER He generally
would pay a monthly premium, annual deductible, and per-prescription
costsharing.
1. Mr. Xi will soon turn age 65 and has come to you for advice as to
what services are provided under Original Medicare. What should
you tell Mr. Xi that best describes the health coverage provided to
Medicare beneficiaries? - ANSWER Beneficiaries under Original
Medicare have no cost-sharing for most preventive services which
include immunizations such as annual flu shots.
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.
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? - ANSWER 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.
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.
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.
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? - ANSWER After receiving
such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
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.
Which of the following statement is/are correct about a Medicare
Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of
providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription
drug benefits.
, III. An individual who is enrolled in an MSA plan is responsible for a
minimal deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that
Original Medicare would pay them as payment in full. - ANSWER I, II, and
IV only
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
you represent. It is one of three plans operated by the same organization in
Mr. Lombardi's area. The MA PPO plan does not include drug coverage,
but the other two plans do. Mr. Lombardi likes the PPO plan that does not
include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him
about this situation? - ANSWER He could enroll either in one of the MA
plans that include prescription drug coverage or Original Medicare with a
Medigap plan and standalone Part D prescription drug coverage, but he
cannot enroll in the MA-only PPO plan and a stand-alone prescription drug
plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should you
tell her? - ANSWER Mrs. Ramos can obtain care from any provider who
participates in Original Medicare, but
generally will have a higher cost-sharing amount if she sees a
provider who/that is not a part of the PPO network.
Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug coverage
with nominal copays. He heard about a neighbor's MAPD plan that you
represent and because he takes numerous prescription drugs, he is
considering signing up for it. What should you tell him? - ANSWER He
should compare the benefits in his employer-sponsored retiree group
health plan with the benefits in his neighbor's MA-PD plan to determine
which one will provide sufficient coverage for his prescription needs.
