AHIP FINAL EXAM PREP TEST BANK 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 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.
◉ 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? Answer: Beneficiaries
under Original Medicare have no cost-sharing for most
preventive services.
◉ 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? 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.
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 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.
◉ 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? Answer: Beneficiaries
under Original Medicare have no cost-sharing for most
preventive services.
◉ 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? 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.
