AHIP 2025 Final Test
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 help beneficiaries cover Original Medicare benefits, but they
coordinate with Original Medicare coverage.
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.
What impact, if any, have recent regulatory changes had on Medigap plans? – ANSWER B.
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting
January 1, 2020.
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. 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? –
ANSWER Original Medicare will cover her stay in a skilled nursing facility for up to 100 days,
with some out-of-pocket costs for days 21-100. If she needs care beyond that, she would be
responsible for the full cost.
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.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage? – ANSWER She can enroll in the PPO, but she will not be able to purchase a
stand-alone Medicare Part D prescription drug plan.
, Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? – ANSWER Mrs. Radford must be entitled to Part A and
enrolled in Part B to enroll in Medicare Advantage.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that
he would have certain services and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However, when he received the bill, he was
surprised to see large charges in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called you to ask what he could do?
What could you tell him? – ANSWER You can offer to review the plans appeal process to help
him ask the plan to review the coverage decision.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he
has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do? – ANSWER He will have to enroll in Part B.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms
and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr.
Brennan charge? – ANSWER Dr. Brennan is allowed to charge Mary Rodgers the difference
between what the plan pays and what the actual cost of the services is, as long as the plan’s terms
and conditions allow for it.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include
drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan.
What should you tell her? – ANSWER She could enroll in a PFFS plan and a stand-alone
Medicare prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? – ANSWER You would
need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's
service area.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA), but is not sure if the plan associated with the account will fit her needs. What specific
piece of information about a Medicare MSA plan would it be important for her to know, prior to
enrolling in such a plan? – ANSWER All MSAs cover Part A and Part B benefits, but not Part D
prescription drug benefits, which could be obtained by also enrolling in a separate prescription
drug plan.
Who is most likely to benefit from the Medicare Prescription Payment Plan? – ANSWER
Medicare Part D benefits those with high prescription drug costs, low-income beneficiaries, and
individuals who need medications regularly for chronic conditions.
Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled under
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 help beneficiaries cover Original Medicare benefits, but they
coordinate with Original Medicare coverage.
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.
What impact, if any, have recent regulatory changes had on Medigap plans? – ANSWER B.
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting
January 1, 2020.
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. 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? –
ANSWER Original Medicare will cover her stay in a skilled nursing facility for up to 100 days,
with some out-of-pocket costs for days 21-100. If she needs care beyond that, she would be
responsible for the full cost.
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.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage? – ANSWER She can enroll in the PPO, but she will not be able to purchase a
stand-alone Medicare Part D prescription drug plan.
, Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? – ANSWER Mrs. Radford must be entitled to Part A and
enrolled in Part B to enroll in Medicare Advantage.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that
he would have certain services and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However, when he received the bill, he was
surprised to see large charges in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called you to ask what he could do?
What could you tell him? – ANSWER You can offer to review the plans appeal process to help
him ask the plan to review the coverage decision.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he
has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do? – ANSWER He will have to enroll in Part B.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms
and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr.
Brennan charge? – ANSWER Dr. Brennan is allowed to charge Mary Rodgers the difference
between what the plan pays and what the actual cost of the services is, as long as the plan’s terms
and conditions allow for it.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include
drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan.
What should you tell her? – ANSWER She could enroll in a PFFS plan and a stand-alone
Medicare prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? – ANSWER You would
need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's
service area.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA), but is not sure if the plan associated with the account will fit her needs. What specific
piece of information about a Medicare MSA plan would it be important for her to know, prior to
enrolling in such a plan? – ANSWER All MSAs cover Part A and Part B benefits, but not Part D
prescription drug benefits, which could be obtained by also enrolling in a separate prescription
drug plan.
Who is most likely to benefit from the Medicare Prescription Payment Plan? – ANSWER
Medicare Part D benefits those with high prescription drug costs, low-income beneficiaries, and
individuals who need medications regularly for chronic conditions.
Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled under
