AHIP FINAL EXAM TEST FULLY ELABORATED
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD)
and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What
should you tell him? - answers✔✔He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her
that she had been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Quinn? - answers✔✔Part B primarily covers physician
services. She will be paying a monthly premium and, except for many preventive and screening
tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
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? -
answers✔✔Medigap plans help beneficiaries cover coinsurance, co-payments, and/or
deductibles for medically necessary services.
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? - answers✔✔Beneficiaries under Original Medicare have
no cost-sharing for most preventive services which include immunizations such as annual flu
shots.
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? - answers✔✔Medicare will cover a
total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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? - answers✔✔
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the
store owner, has provided excellent health benefits to the store's workforce. William, one of the
store's long-time employees, will soon be reaching age 65 and eligible for Medicare. William is
in good health. He intends to remain an active full-time employee, working several years after
becoming eligible for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be
able to offer William? - answers✔✔Hank's can continue to offer William the same employee
health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare
Advantage plan that is offered to the public.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was
disappointed with the service she received from her primary care physician because she was
told she would have to wait five weeks to get an appointment when she was feeling ill. She
called you to ask what she could do so she would not have to put up with such poor access to
care. What could you tell her? - answers✔✔She could file a grievance with her plan to complain
about the lack of timeliness in getting an appointment.
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? - answers✔✔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.
Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra
help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He
wants to know whether he might qualify. What should you tell him? - answers✔✔The extra
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD)
and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What
should you tell him? - answers✔✔He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her
that she had been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Quinn? - answers✔✔Part B primarily covers physician
services. She will be paying a monthly premium and, except for many preventive and screening
tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
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? -
answers✔✔Medigap plans help beneficiaries cover coinsurance, co-payments, and/or
deductibles for medically necessary services.
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? - answers✔✔Beneficiaries under Original Medicare have
no cost-sharing for most preventive services which include immunizations such as annual flu
shots.
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? - answers✔✔Medicare will cover a
total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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? - answers✔✔
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the
store owner, has provided excellent health benefits to the store's workforce. William, one of the
store's long-time employees, will soon be reaching age 65 and eligible for Medicare. William is
in good health. He intends to remain an active full-time employee, working several years after
becoming eligible for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be
able to offer William? - answers✔✔Hank's can continue to offer William the same employee
health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare
Advantage plan that is offered to the public.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was
disappointed with the service she received from her primary care physician because she was
told she would have to wait five weeks to get an appointment when she was feeling ill. She
called you to ask what she could do so she would not have to put up with such poor access to
care. What could you tell her? - answers✔✔She could file a grievance with her plan to complain
about the lack of timeliness in getting an appointment.
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? - answers✔✔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.
Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra
help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He
wants to know whether he might qualify. What should you tell him? - answers✔✔The extra
