AHIP Final Exam Questions with
Correct Answers || ALREADY
GRADED A+
Which of the following requires intent to obtain payment and the knowledge that
the actions are wrong? -ANSWER Fraud
Which of the following is NOT potentially a penalty for violation of a law or
regulation prohibiting Fraud, Waste, and Abuse (FWA)? -ANSWER Deportation
A person comes to your pharmacy to drop off a prescription for a beneficiary who
is a "regular" customer. The prescription is for a controlled substance with a
quantity of 160. This beneficiary normally receives a quantity of 60, not 160. You
review the prescription and have concerns about possible forgery. What is your
next step? -ANSWER Call the prescriber to verify the quantity
Part B primarily covers physician services. She will be paying a monthly premium
and, with the exception of many preventive and screening tests, generally will have
20% coinsurance for these services, in addition to an annual deductible. -
ANSWER Mrs. Quinn recently turned 66 and decided after many years of work to
begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a
letter informing her that she has been automatically enrolled in Medicare Part B.
She wants to understand what this means. What should you tell Mrs. Quinn?
Original Medicare covers ambulance services. - ANSWER Mrs. Turner is
comparing her employer's retiree insurance to Original Medicare and would like to
know which of the following services Original Medicare will cover if the
appropriate criteria are met? What could you tell her?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan. - ANSWER Mr. Diaz continued working with his company and
was insured under his employer's group plan until he reached age 68. He has heard
,that there is a premium penalty for those who did not sign up for Part B when first
eligible and wants to know how much he will have to pay. What should you tell
him?
You are sorry to disappoint Anita but a Medigap Part 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. - ANSWER Anita Magri will turn age 65 in August 2020. 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 Part F plan 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?
Medicare Supplemental Insurance would help cover his Part A and Part B cost
sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover. - ANSWER Mr. Moy's wife has a Medicare
Advantage plan, but he wants to understand what coverage Medicare Supplemental
Insurance provides since his health care needs are different from his wife's needs.
What could you tell Mr. Moy?
After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age. - ANSWER 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?
Part A, which covers hospital, skilled nursing facility, hospice, and home health
services and Part B, which covers professional services such as those provided by a
doctor are covered under Original Medicare. - ANSWER Mr. Schmidt would like
to plan for retirement and has asked you what is covered under Original Fee-for-
Service (FFS) Medicare? What could you tell him?
Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be
eligible for Medicare. - ANSWER Ms. Moore plans to retire when she turns 65 in a
few months. She is in excellent health and will have considerable income when she
retires. She is concerned that her income will make it impossible for her to qualify
for Medicare. What could you tell her to address her concern?
, Medicare will cover Mrs. Shield's skilled nursing services provided during the first
20 days of her stay, after which she would have a copay until she has been in the
facility for 100 days. - ANSWER 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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots. - ANSWER 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?
Part D covers prescription drugs and she should look at her premiums, formulary,
and cost-sharing among other factors to see if they have changed. - ANSWER Mrs.
Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs.
Geisler can't remember what Part D is so she called you to ask what her neighbor
was talking about. What could you tell her?
The Part B deductible will no longer be covered for individuals newly eligible for
Medicare starting January 1, 2020. - ANSWER What impact, if any, will recent
regulatory changes have upon Medigap plans?
Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program. - ANSWER Mr. Wu is eligible for Medicare.
He has limited financial resources but failed to qualify for the Part D low-income
subsidy. Where might he turn for help with his prescription drug costs?
You should tell Madeline that she will be able to enroll in Medicare Part A
without paying monthly premiums due to her husband's long work record and
participation in the Medicare system. You should also tell Madeline that she will
pay Part B premiums at more than the standard lowest rate but less than the highest
rate due her substantial income. - ANSWER Madeline Martinez was widowed
several years ago. Her husband worked for many years and contributed into the
Medicare system. He also left a substantial estate which provides Madeline with an
annual income of approximately $130,000. Madeline, who has only worked part-
time for the last three years, will soon turn age 65 and hopes to enroll in Original
Medicare. She comes to you for advice. What should you tell her?
, Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage. - ANSWER Agent John
Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not
provide drug benefits. How would you advise Agent John Miller to proceed?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or
deductibles for medically necessary services - ANSWER 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?
He may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start. - ANSWER 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?
Most individuals who are citizens and age 65 or over are covered under Part A by
virtue of having paid Medicare taxes while working, though some may be covered
as a result of paying monthly premiums. - ANSWER Mrs. Chen will be 65 soon,
has been a citizen for twelve years, has been employed full time, and paid taxes
during that entire period. She is concerned that she will not qualify for coverage
under part A because she was not born in the United States. What should you tell
her?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
covered for Part A and Part B services through Original Fee-for-Service Medicare.
- ANSWER Mr. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him?
Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls
Medicare would become the primary payor of his healthcare claims and Smallcap
does not have to continue to offer him coverage comparable to those under age 65
under its employer-sponsored group health plan. - ANSWER Juan Perez, who is
turning age 65 next month, intends to work for several more years at Smallcap,
Incorporated. Smallcap has a workforce of 15 employees and offers employer-
Correct Answers || ALREADY
GRADED A+
Which of the following requires intent to obtain payment and the knowledge that
the actions are wrong? -ANSWER Fraud
Which of the following is NOT potentially a penalty for violation of a law or
regulation prohibiting Fraud, Waste, and Abuse (FWA)? -ANSWER Deportation
A person comes to your pharmacy to drop off a prescription for a beneficiary who
is a "regular" customer. The prescription is for a controlled substance with a
quantity of 160. This beneficiary normally receives a quantity of 60, not 160. You
review the prescription and have concerns about possible forgery. What is your
next step? -ANSWER Call the prescriber to verify the quantity
Part B primarily covers physician services. She will be paying a monthly premium
and, with the exception of many preventive and screening tests, generally will have
20% coinsurance for these services, in addition to an annual deductible. -
ANSWER Mrs. Quinn recently turned 66 and decided after many years of work to
begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a
letter informing her that she has been automatically enrolled in Medicare Part B.
She wants to understand what this means. What should you tell Mrs. Quinn?
Original Medicare covers ambulance services. - ANSWER Mrs. Turner is
comparing her employer's retiree insurance to Original Medicare and would like to
know which of the following services Original Medicare will cover if the
appropriate criteria are met? What could you tell her?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan. - ANSWER Mr. Diaz continued working with his company and
was insured under his employer's group plan until he reached age 68. He has heard
,that there is a premium penalty for those who did not sign up for Part B when first
eligible and wants to know how much he will have to pay. What should you tell
him?
You are sorry to disappoint Anita but a Medigap Part 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. - ANSWER Anita Magri will turn age 65 in August 2020. 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 Part F plan 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?
Medicare Supplemental Insurance would help cover his Part A and Part B cost
sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover. - ANSWER Mr. Moy's wife has a Medicare
Advantage plan, but he wants to understand what coverage Medicare Supplemental
Insurance provides since his health care needs are different from his wife's needs.
What could you tell Mr. Moy?
After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age. - ANSWER 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?
Part A, which covers hospital, skilled nursing facility, hospice, and home health
services and Part B, which covers professional services such as those provided by a
doctor are covered under Original Medicare. - ANSWER Mr. Schmidt would like
to plan for retirement and has asked you what is covered under Original Fee-for-
Service (FFS) Medicare? What could you tell him?
Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be
eligible for Medicare. - ANSWER Ms. Moore plans to retire when she turns 65 in a
few months. She is in excellent health and will have considerable income when she
retires. She is concerned that her income will make it impossible for her to qualify
for Medicare. What could you tell her to address her concern?
, Medicare will cover Mrs. Shield's skilled nursing services provided during the first
20 days of her stay, after which she would have a copay until she has been in the
facility for 100 days. - ANSWER 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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots. - ANSWER 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?
Part D covers prescription drugs and she should look at her premiums, formulary,
and cost-sharing among other factors to see if they have changed. - ANSWER Mrs.
Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs.
Geisler can't remember what Part D is so she called you to ask what her neighbor
was talking about. What could you tell her?
The Part B deductible will no longer be covered for individuals newly eligible for
Medicare starting January 1, 2020. - ANSWER What impact, if any, will recent
regulatory changes have upon Medigap plans?
Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program. - ANSWER Mr. Wu is eligible for Medicare.
He has limited financial resources but failed to qualify for the Part D low-income
subsidy. Where might he turn for help with his prescription drug costs?
You should tell Madeline that she will be able to enroll in Medicare Part A
without paying monthly premiums due to her husband's long work record and
participation in the Medicare system. You should also tell Madeline that she will
pay Part B premiums at more than the standard lowest rate but less than the highest
rate due her substantial income. - ANSWER Madeline Martinez was widowed
several years ago. Her husband worked for many years and contributed into the
Medicare system. He also left a substantial estate which provides Madeline with an
annual income of approximately $130,000. Madeline, who has only worked part-
time for the last three years, will soon turn age 65 and hopes to enroll in Original
Medicare. She comes to you for advice. What should you tell her?
, Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage. - ANSWER Agent John
Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not
provide drug benefits. How would you advise Agent John Miller to proceed?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or
deductibles for medically necessary services - ANSWER 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?
He may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start. - ANSWER 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?
Most individuals who are citizens and age 65 or over are covered under Part A by
virtue of having paid Medicare taxes while working, though some may be covered
as a result of paying monthly premiums. - ANSWER Mrs. Chen will be 65 soon,
has been a citizen for twelve years, has been employed full time, and paid taxes
during that entire period. She is concerned that she will not qualify for coverage
under part A because she was not born in the United States. What should you tell
her?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
covered for Part A and Part B services through Original Fee-for-Service Medicare.
- ANSWER Mr. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him?
Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls
Medicare would become the primary payor of his healthcare claims and Smallcap
does not have to continue to offer him coverage comparable to those under age 65
under its employer-sponsored group health plan. - ANSWER Juan Perez, who is
turning age 65 next month, intends to work for several more years at Smallcap,
Incorporated. Smallcap has a workforce of 15 employees and offers employer-
