AHIP FINAL TEST | QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS | ALREADY GRADED A+ | LATEST
UPDATE
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? - CORRECT ANSWER -
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.
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? -
CORRECT ANSWER - Medicare does not cover massage therapy, or, in
general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance? - CORRECT ANSWER - She
should contact her state Medicaid agency to see if she qualifies for one of
several programs that can help with Medicare costs for which she is responsible.
Mr. Alonso receives some help paying for his two generic prescription drugs
from his employer's retiree coverage, but he wants to compare it to a Part D
prescription drug plan. He asks you what costs he would generally expect to
encounter when enrolling into a standard Medicare Part D prescription drug
plan. What should you tell him? - CORRECT ANSWER - He generally would
pay a monthly premium, annual deductible, and per-prescription cost-sharing.
,Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as
well, but it provides no drug coverage. She would like to keep the coverage she
has but replace her existing Medigap plan with one that provides drug coverage.
What should you tell her? - CORRECT ANSWER - Mrs. Gonzalez cannot
purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan.
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? - CORRECT ANSWER -
He may sign-up for Medicare at any time however coverage usually begins on
the fourth month after dialysis treatments start.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her? - CORRECT ANSWER - Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she received the
MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because the 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? - CORRECT
ANSWER - 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.
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? - CORRECT ANSWER - Medicare will cover a total of 190 days of
inpatient psychiatric care during Mr. Rainey's entire lifetime.
,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? - CORRECT
ANSWER - Beneficiaries under Original Medicare have no cost-sharing for
most preventive services.
Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him? - CORRECT ANSWER
- 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.
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? - CORRECT ANSWER - 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.
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? - CORRECT ANSWER - 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.
Mr. Patel is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he
might be exposed to under Medicare if he were to require hospitalization
because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare? - CORRECT
ANSWER - Under Original Medicare, there is a single deductible amount due
for the first 60 days of any inpatient hospital stay, after which it converts into a
, per-day coinsurance amount through day 90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for
all costs.
What impact, if any, have recent regulatory changes had on Medigap plans? -
CORRECT ANSWER - The Part B deductible is no longer covered for
individuals newly eligible for Medicare starting January 1, 2020.
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? - CORRECT ANSWER - Medigap plans do not cover
Original Medicare benefits, but they coordinate with Original Medicare
coverage.
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? - CORRECT
ANSWER - Original Medicare covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will
cover hospice services in case she needs them. What should you tell her? -
CORRECT ANSWER - Medicare covers hospice services, and they will be
available for her.
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? -
CORRECT ANSWER - Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer's plan.
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
WELL DETAILED ANSWERS | ALREADY GRADED A+ | LATEST
UPDATE
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? - CORRECT ANSWER -
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.
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? -
CORRECT ANSWER - Medicare does not cover massage therapy, or, in
general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance? - CORRECT ANSWER - She
should contact her state Medicaid agency to see if she qualifies for one of
several programs that can help with Medicare costs for which she is responsible.
Mr. Alonso receives some help paying for his two generic prescription drugs
from his employer's retiree coverage, but he wants to compare it to a Part D
prescription drug plan. He asks you what costs he would generally expect to
encounter when enrolling into a standard Medicare Part D prescription drug
plan. What should you tell him? - CORRECT ANSWER - He generally would
pay a monthly premium, annual deductible, and per-prescription cost-sharing.
,Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as
well, but it provides no drug coverage. She would like to keep the coverage she
has but replace her existing Medigap plan with one that provides drug coverage.
What should you tell her? - CORRECT ANSWER - Mrs. Gonzalez cannot
purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan.
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? - CORRECT ANSWER -
He may sign-up for Medicare at any time however coverage usually begins on
the fourth month after dialysis treatments start.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her? - CORRECT ANSWER - Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she received the
MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because the 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? - CORRECT
ANSWER - 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.
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? - CORRECT ANSWER - Medicare will cover a total of 190 days of
inpatient psychiatric care during Mr. Rainey's entire lifetime.
,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? - CORRECT
ANSWER - Beneficiaries under Original Medicare have no cost-sharing for
most preventive services.
Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him? - CORRECT ANSWER
- 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.
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? - CORRECT ANSWER - 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.
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? - CORRECT ANSWER - 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.
Mr. Patel is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he
might be exposed to under Medicare if he were to require hospitalization
because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare? - CORRECT
ANSWER - Under Original Medicare, there is a single deductible amount due
for the first 60 days of any inpatient hospital stay, after which it converts into a
, per-day coinsurance amount through day 90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for
all costs.
What impact, if any, have recent regulatory changes had on Medigap plans? -
CORRECT ANSWER - The Part B deductible is no longer covered for
individuals newly eligible for Medicare starting January 1, 2020.
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? - CORRECT ANSWER - Medigap plans do not cover
Original Medicare benefits, but they coordinate with Original Medicare
coverage.
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? - CORRECT
ANSWER - Original Medicare covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will
cover hospice services in case she needs them. What should you tell her? -
CORRECT ANSWER - Medicare covers hospice services, and they will be
available for her.
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? -
CORRECT ANSWER - Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer's plan.
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
