AHIP 2025 Final Exam 50 questions and answers latest.

AHIP 2025 Final Exam 50 questions and answers latest.

Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to
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know which of the following services Original Medicare will cover if the appropriate criteria are
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met. What could you tell her? - Answer Original Medicare covers ambulance services.
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Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
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Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims
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for services. What advice would you give her? - Answer Mrs. Duarte should file an appeal of this
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initial determination within 120 days of the date she received the MSN in the mail.
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Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
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enrollment period because the features of Part D might have changed. Mrs. Geisler can't
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remember what Part D is so she called you to ask what her neighbor was talking about. What could
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you tell her? - Answer Part D covers prescription drugs and she should look at her premiums,
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formulary, and cost-sharing among other factors to see if they have changed.
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Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
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might be of assistance? - Answer She should contact her state Medicaid agency to see if she
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qualifies for one of several programs that can help with Medicare costs for which she is responsible.
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Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving
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Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had
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been automatically enrolled in Medicare Part B. She wants to understand what this means. What
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should you tell Mrs. Quinn? - Answer Part B primarily covers physician services. She will be paying a
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monthly premium and, except for many preventive and screening tests, generally will have 20% co-
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payments for these services, in addition to an annual deductible. tl tl tl tl tl tl tl tl tl




Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A and
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Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older
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neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides
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foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to
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, tl you for advice. What should you tell her? - Answer You are sorry to disappoint Anita, but a Medigap
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tl F plan is no longer available to those who turn age 65 after January 1, 2020. Anita might instead
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tl consider other Medigap plans that offer foreign travel benefits but do not cover the Part B
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tl deductible.



Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
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What should you tell him? - Answer Mr. Singh can enroll in a stand-alone prescription drug plan and
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continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
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paid taxes during that entire period. She is concerned that she will not qualify for coverage under
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part A because she was not born in the United States. What should you tell her? - Answer Most
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individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid
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Medicare taxes while working, though some may be covered as a result of paying monthly
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premiums.
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Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
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Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
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Medicare beneficiaries? - Answer Beneficiaries under Original Medicare have no cost-sharing for
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most preventive services.
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Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he
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would have certain services and items covered by the plan with minimal out-of-pocket costs
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because his MA-PD coverage has been very good. However, when he received the bill, he was
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surprised to see large charges in excess of his maximum out-of-pocket limit that included some
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services and items he thought would be fully covered. He called you to ask what he could do? What
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could you tell him? - Answer You can offer to review the plans appeal process to help him ask the
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plan to review the coverage decision.
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Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of
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three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not
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include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not
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include drug coverage and intends to obtain his drug coverage through a stand-alone Medicare
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