AHIP EXAM SCRIPT SET 4 UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
⩥ 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? Answer: Medicare does not cover massage therapy,
or, in general, glasses or dentures.
⩥ 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? Answer: Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she
received the MSN in the mail.
⩥ 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? Answer: Medicare will cover a total of 190
days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
⩥ 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? Answer: Medigap plans do not
,cover Original Medicare benefits, but they coordinate with Original
Medicare coverage.
⩥ 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? 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.
⩥ 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? 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. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him? 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?
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.
⩥ 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 Medigap Plan F 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? Answer: You are sorry to disappoint Anita, but a Medigap 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.
⩥ 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? 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
QUESTIONS AND CORRECT ANSWERS
⩥ 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? Answer: Medicare does not cover massage therapy,
or, in general, glasses or dentures.
⩥ 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? Answer: Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she
received the MSN in the mail.
⩥ 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? Answer: Medicare will cover a total of 190
days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
⩥ 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? Answer: Medigap plans do not
,cover Original Medicare benefits, but they coordinate with Original
Medicare coverage.
⩥ 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? 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.
⩥ 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? 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. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him? 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?
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.
⩥ 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 Medigap Plan F 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? Answer: You are sorry to disappoint Anita, but a Medigap 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.
⩥ 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? 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
