AHIP FWA 2023
1. 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?: Original Medicare covers ambulance services.
2. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?: 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.
3. 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?: 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.
4. Madeline Martinez was widowed several years ago. Her husband worked
for many years and contributed into the Medicare system. He also left a
,substan- tial 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?: 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.
5. 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?: Medicare does not cover massage therapy, or, in general,
glasses or dentures.
6. 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?: 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.
7. 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?: 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.
8. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with a
determi- nation that partially denied one of her claims for services. What
advice would you give her?: Mrs. Duarte should file an appeal of this
initial determination within 120 days of the date she received the MSN
in the mail.
9. Mr. Rainey is experiencing paranoid delusions and his physician feels
that he should be hospitalized. What should you tell Mr. Rainey (or his
representa- tive) about the length of an inpatient psychiatric hospital stay
that Medicare will cover?: Medicare will cover a total of 190 days of
inpatient psychiatric care during Mr. Rainey's entire lifetime.
10.Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance?: 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
1. 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?: Original Medicare covers ambulance services.
2. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?: 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.
3. 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?: 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.
4. Madeline Martinez was widowed several years ago. Her husband worked
for many years and contributed into the Medicare system. He also left a
,substan- tial 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?: 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.
5. 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?: Medicare does not cover massage therapy, or, in general,
glasses or dentures.
6. 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?: 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.
7. 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?: 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.
8. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with a
determi- nation that partially denied one of her claims for services. What
advice would you give her?: Mrs. Duarte should file an appeal of this
initial determination within 120 days of the date she received the MSN
in the mail.
9. Mr. Rainey is experiencing paranoid delusions and his physician feels
that he should be hospitalized. What should you tell Mr. Rainey (or his
representa- tive) about the length of an inpatient psychiatric hospital stay
that Medicare will cover?: Medicare will cover a total of 190 days of
inpatient psychiatric care during Mr. Rainey's entire lifetime.
10.Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance?: 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
