Facilitating State Health Exchange Communication Through the Use of Health Literate Practices
AHIP 2020 Exam bank 2 (answered) explained.
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1. Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that he...
ms moore plans to retire when she turns 65 in a few months she is in excellent health and will have considerable income when she retires she is concerned th
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AHIP 2020 Exam bank 2 (answered) explained.
1. Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires. She is
concerned that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern?
- Medicare is a program for people age 65 or older and those under age 65
with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so
she will be eligible for Medicare.
2. Mr. Schmidt would like to plan for retirement and has asked you want is
covered under Original Fee-for-Service (FFS) Medicare? What could you
tell him？
- Part A, which covers hospital, skilled nursing facility, hospice, and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
3. Mr. Hernandez is concerned that if he signs up for a Medicare Advantage
plan, the health plan may, at some time in the future, reduce his benefits
below what is available in Original Medicare. What should you tell him
about his concern?
- Medicare Advantage plans must cover all benefits available under
medicare Part A and Part B. Many also cover Part D prescription drugs.
4. Mrs. Roberts has just received a new Medicare identity card in the mail. She
is concerned that it is a forgery since it does not have her Social Security
number on it. What should you tell her?
- The card she received is valid, the change has been made to protect
Medicare beneficiaries from identity theft, and she should now destroy her
old card.
5. Mrs. Willard wants to know generally how the benefits under Original
Medicare might compare to the benefit package of a Medicare Health Plan
before she starts looking at specific plans. What could you tell her?
- Medicare Health Plans may offer extra benefits that original Medicare does
not offer such as vision, hearing, and dental services and must include a
maximum out-of-pocket limit on Part A and Part B services.
6. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand
what coverage Medicare Supplemental Insurance provides since his health
, care needs are different from his wife's needs. What could you tell Mr. Moy?
- Medicare Supplemental insurance would help covers his part A and Part B
cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly
some services that medicare does not cover.
7. 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?
- Most individuals who are citizens and over age 65 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.
8. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled
by the Social Security Administration and has been receiving disability
payments. He is wondering whether he can obtain coverage under Medicare.
What should you tell him?
- After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
9. Mr. Denton is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
obtain coverage under Medicare. What should you tell him?
- He may sign-up for Medicare at any time however coverage usually begins
on the fourth month after dialysis treatments start.
10.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?
- In order to obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
11.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?
- Mr. Diaz will not pay any penalty because she had continuous coverage
under his employer's plan.
,12.Mrs. Pena is 66 years old, had coverage under an employer plan and will
retire next year. She heard she must enroll in Part B at the beginning of the
year to ensure no gap in coverage. What can you tell her?
- She may enroll at any time while she is covered under her employer plan,
but she will have a special eight-month enrollment period that differs from
the standard general enrollment period, during which she may enroll in
Medicare Part B.
13.Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B.
She is considering enrollment in a Medicare health plan (Part C). What
should you advise her to do before she will be able to enroll into a Medicare
Health Plan?
- In order to Join a Medicare health plan, she also must enroll in Part B.
14.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
responsible.
15.Mr. Wu is eligible for Medicare. He has limited financial resources but
failed to qualify for the Part D low-income subsidy. Where might he turn for
help with his prescription drug costs?
- Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
16.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?
- 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.
17.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.
18.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?
- Medicare will cover a total of 190 days of inpatient psychiatric care during
Mr. Rainey's entire lifetime.
19.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 his 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% co-payments for these services, in addition to an
annual deductible.
20.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?
- 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.
21.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.
22.Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through acupuncture. She is concerned about whether or
not Medicare will cover these items and services. What should you tell her?
- Medicare does not cover acupuncture, or, in general, glasses or dentures.
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