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AHIP (America’s Health Insurance Plans)
Newest 2025 Final Exam Test Bank
featuring 500 accurate and verified
questions covering Medicare Advantage,
Medicare Part D, fraud, waste, and abuse
(FWA), enrollment procedures,
compliance guidelines
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?
......answer.....Medigap plans help beneficiaries cover Original
Medicare benefits, but they coordinate with Original Medicare
coverage.
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
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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? ......answer.....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.
What impact, if any, have recent regulatory changes had on
Medigap plans? ......answer.....b.
The Part B deductible is no longer covered for individuals newly
eligible for Medicare starting January 1, 2020.
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.
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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.
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? ......answer.....She can enroll in the PPO, but she
will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.
Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her?
......answer.....Mrs. Radford must be entitled to Part A and enrolled
in Part B to enroll in Medicare Advantage.
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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? ......answer.....You can
offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
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.....He will have to enroll in Part B.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in
her area that does not include drug coverage. She wants to enroll
AHIP (America’s Health Insurance Plans)
Newest 2025 Final Exam Test Bank
featuring 500 accurate and verified
questions covering Medicare Advantage,
Medicare Part D, fraud, waste, and abuse
(FWA), enrollment procedures,
compliance guidelines
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?
......answer.....Medigap plans help beneficiaries cover Original
Medicare benefits, but they coordinate with Original Medicare
coverage.
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
,2|Page
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? ......answer.....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.
What impact, if any, have recent regulatory changes had on
Medigap plans? ......answer.....b.
The Part B deductible is no longer covered for individuals newly
eligible for Medicare starting January 1, 2020.
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.
,3|Page
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.
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? ......answer.....She can enroll in the PPO, but she
will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.
Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her?
......answer.....Mrs. Radford must be entitled to Part A and enrolled
in Part B to enroll in Medicare Advantage.
, 4|Page
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? ......answer.....You can
offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
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.....He will have to enroll in Part B.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in
her area that does not include drug coverage. She wants to enroll
