AHIP FWA | 2025/2026 LATEST UPDATE | QUESTIONS
AND ANSWERS | WITH COMPLETE SOLUTION!!
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? Answer -
Original Medicare covers ambulance services.
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. 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 - 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.
Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substantial
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? Answer - 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.
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. 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?
Answer - 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.
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? 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.
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. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance? Answer - 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 responsible.
Anita Magri will turn age 65 in August 2022. 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 Part F plan 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 Part 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.
Ms. Henderson believes that she will qualify for Medicare Coverage when she
turns 65, without paying any premiums, because she has been working for 40
years and paying Medicare taxes. What should you tell her? Answer - To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher
for individuals with higher incomes.
Mr. Alonso 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 prescription drug
plan. What should you tell him? Answer - He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
Mr. Buck has several family members who died from different cancers. He
wants to know if Medicare covers cancer screening. What should you tell him?
Answer - Medicare covers the periodic performance of a range of screening
tests that are meant to provide early detection of disease. Mr. Buck will need to
check specific tests before obtaining them to see if they will be covered.
Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. 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 how much he will have to pay. What should you tell him?
Answer - Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
What impact, if any, have recent regulatory changes had upon Medigap plans?
Answer - The Part B deductible is no longer covered for individuals newly
eligible for Medicare starting January 1, 2020.
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.
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 as a
result 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
AND ANSWERS | WITH COMPLETE SOLUTION!!
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? Answer -
Original Medicare covers ambulance services.
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. 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 - 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.
Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substantial
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? Answer - 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.
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. 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?
Answer - 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.
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? 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.
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. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance? Answer - 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 responsible.
Anita Magri will turn age 65 in August 2022. 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 Part F plan 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 Part 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.
Ms. Henderson believes that she will qualify for Medicare Coverage when she
turns 65, without paying any premiums, because she has been working for 40
years and paying Medicare taxes. What should you tell her? Answer - To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher
for individuals with higher incomes.
Mr. Alonso 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 prescription drug
plan. What should you tell him? Answer - He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
Mr. Buck has several family members who died from different cancers. He
wants to know if Medicare covers cancer screening. What should you tell him?
Answer - Medicare covers the periodic performance of a range of screening
tests that are meant to provide early detection of disease. Mr. Buck will need to
check specific tests before obtaining them to see if they will be covered.
Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. 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 how much he will have to pay. What should you tell him?
Answer - Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
What impact, if any, have recent regulatory changes had upon Medigap plans?
Answer - The Part B deductible is no longer covered for individuals newly
eligible for Medicare starting January 1, 2020.
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.
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 as a
result 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
