Ahip 2025 final
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? - ANS 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 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? -
ANS 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? - ANS 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? - ANS Medicare will
cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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? - ANS
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? - ANS 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? - ANS 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? - ANS Mrs. Radford must be entitled to Part A
and enrolled in Part B to enroll in Medicare Advantage.
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? - ANS 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? - ANS He will have to enroll in Part B.
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? - ANS
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? - ANS She could enroll in a PFFS
plan and a stand-alone Medicare prescription drug plan.
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? - ANS
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.
Mrs. Lyons is in good health, uses a single prescription, and lives independently 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? - ANS All MSAs cover Part A and Part B
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? - ANS 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 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? -
ANS 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? - ANS 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? - ANS Medicare will
cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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? - ANS
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? - ANS 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? - ANS 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? - ANS Mrs. Radford must be entitled to Part A
and enrolled in Part B to enroll in Medicare Advantage.
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? - ANS 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? - ANS He will have to enroll in Part B.
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? - ANS
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? - ANS She could enroll in a PFFS
plan and a stand-alone Medicare prescription drug plan.
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? - ANS
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.
Mrs. Lyons is in good health, uses a single prescription, and lives independently 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? - ANS All MSAs cover Part A and Part B
