AHIP 2027 Study Guide | Medicare Certification Training | Exam Review & Practice Questions

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1. Mrs../Andrews./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./tel


l./her?:./Original./Medicare./covers./ambulance./services.
2. What./impact,./if./any,./have./recent./regulatory./changes./had./on./Medigap./plans?-
:. / The./Part./B./deductible./is./no./longer./covered./for./individuals./newly./eligible./for./Medicare./starting./January./1,./2020.
3. Joan. / and. / Loretta. / are. / both. / enrolled. / in. / Medicare.. / Joan. / pays. / a. / premium. / for. /
Part./A./coverage../Loretta./does./not../Which./of./the./following./statements./best./expla
ins./this./difference?:. / Joan./worked./only./a./short./time./and./did./not./accumulate./suflcient./work./credits../Loretta./
worked./for./well./over./10./years./accumulating./credit./for./more./than./40./quarters./of./contributions./to./the./Medicare./p
rogram.
4. Larry./Miller./is./an./Original./Medicare./beneficiary./with./Parts./A./and./B./coverage..
/Larry./is./admitted./to./Good./Care./Hospital./in./January./with./pneumonia./and./stays.


/for./three./days./before./being./discharged../Six./months./later./in./July,./Larry./takes


./a./bad./fall./and./is./admitted./to./Good./Care./Hospital./with./a./broken./leg../After./e


mergency./surgery./to./repair./his./broken./leg,./Larry./is./hospitalized./for./a./week./
before./being./discharged./home../In./December,./Larry./is./admitted./to./Mount./W
ellness./Hospital./once./again./with./a./serious./case./of./the./flu../For./how./many./Part
./A./deductibles./will./Larry./be./responsible./for?:./Larry./will./be./responsible./for./three./Part./A./de

ductibles.
5. Kevin./Birch./enrolled./in./Original./Medicare./(Parts./A./and./B)../Mr../Birch./has./bee
n./receiving./rehabilitation./services./in./a./skilled./nursing./facility../He./calls./you./to./s
ay./that./he./has./just./received./a./notice./that./Medicare./will./no./longer./cover./his./s
tay./and./he./still./cannot./walk./properly../He./thinks./they./are./ending./his./services./
too./soon../What./do./you./tell./him?:./He./should./follow./the./directions./on./the./notice./to./file./a./fast./appea
l../Mr../Birch./should./file./it./by./noon./of./the./calendar./day./following./receipt./of./the./provider's./notice./of./termination./o
f./services.
6. Mr.. / Ray. / would. / like. / drug. / coverage. / but. / does. / not. / want. / to. / be. / enrolled. / in.
/ a./Medicare./Advantage./plan../What./should./you./tell./him?:./Mr../Ray./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.
7. Mrs../Sanders./will./be./65./soon,./has./been./a./citizen./for./twelve./years,./has./been.

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/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

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in. / the. / United. / States.. / What. / should. / you. / tell. / her?:. / Most./individuals./who./are./citizens./and./ag
e./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.


8. Mrs../Carpenter./is./enrolled./in./Original./Medicare./Parts./A./and./B../She./has./rece
ntly./reviewed./her./Medicare./Summary./Notice./(MSN)./and./disagrees./with./a. / det
ermination./that./partially./denied./one./of./her./claims./for./services../What./advice./w
ould./you./give./her?:./Mrs../Carpenter./should./file./an./appeal./of./this./initial./determination./within./120./days./of
./the./date./she./received./the./MSN./in./the./mail.


9. Mr../Hoffman./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./prescrip
-
tion./ drug./ plan../ What./ should./ you./ tell./ him?:./ He./generally./would./pay./a./monthly./premium,./ann
ual
deductible,. / and. / per-prescription. / cost-sharing.
10. Mrs../Larson./is./enrolled./in./Original./Medicare./and./has./a./Medigap./policy./a
s./well,./but./it./provides./no./drug./coverage../She./would./like./to./keep./the./covera
ge./she./has./but./replace./her./existing./Medigap./plan./with./one./that./provides./d
rug./coverage../What./should./you./tell./her?:./Mrs../Larson./cannot./purchase./a./Medigap./plan./that.
/covers./drugs,./but./she./could./keep./her./Medigap./policy./and./enroll./in./a./Part./D./prescription./drug./plan.


11. Mary./Alice./is./covered./by./Original./Medicare./Parts./A./and./B../During./her./initia
l./enrollment./period./she./purchased./a./standard./Medigap./Plan./A./policy./from./y
ou./because./of./its./relatively./low./cost../After./speaking./to./her./friend./Stan,./she./a
sks./whether./any./of./the./following./are./"core./benefits"./covered./in./her./plan?:./I../Cove
rage./for./Part./A./hospital./coinsurance./amount
II../Coverage./for./365./additional./days./during./an./insured's./lifetime./after./Medicare./benefits./end
III../Coverage./for./3./pints./of./blood
12. Mr../Ellis./continued./working./with./his./company./and./was./insured./under./his./
employer's./group./plan./until./he./reached./age./68./when./he./retired../Five./months.
/later./Mr../Ellis./enrolled./in./Part./B../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.

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/how./much./he./will./have./to./pay../What./should./you./tell./him?:. / Mr../Ellis./will./not./pay./any./penal
ty