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AHIP Final Exam Questions 8
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AHIP Final Exam Questions 8
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10/19/23, 12:29 AM AHIP Final Exam Questions 82022 AHIP
Mr. Davis 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? - ANS He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers
employer-sponsored healthcare coverage. Juan is a naturalized citizen and has
contributed to the Medicare system for over 20 years. Juan asks you if he will be
entitled to Medicare and if he enrolls how that will impact his employer-sponsored
healthcare coverage. How would you respond? - ANS Juan is likely to be eligible for
Medicare once he turns age 65 and if he enrolls Medicare would become the primary
payor of his healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under its employer-sponsored group health
plan. 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? - ANS Medicare
Supplemental Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover. Mrs. Peňa is 66 years old, has 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? - ANS She
may enroll at any time while she is covered under her employer plan, but she will have a
special eight-month enrollment period after the last month on her employer plan that
differs from the standard general enrollment period, during which she may enroll in
Medicare Part B. 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? - ANS 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. 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? - ANS
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. Mrs. West wears
glasses and dentures and has enjoyed considerable pain relief from arthritis through
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massage therapy. She is concerned about whether or not Medicare will cover these
items and services. What should you tell her? - ANS Medicare does not cover massage
therapy, or, in general, glasses or dentures. 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? - ANS 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. 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? - ANS
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 MedicarePart D
prescription drug plan. What should you tell him? - ANS He generally would pay a
monthly premium, annual deductible, and per-prescription cost-sharing. 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? - ANS 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. 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? - ANS
Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots. 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? - ANS Mrs. Duarte should file an appeal
of this initial determination within 120 days of the date she received the MSN in the mail.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap
plan to pick up costs not covered by that plan. What should you tell him? - ANS It is
illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
besides, Medigap only works with Original Medicare. Mrs. Park is an elderly retiree.
Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of
assistance? - ANS She should contact her state Medicaid agency to see if she qualifies
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for one of several programs that can help with Medicare costs for which she is
responsible. 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? - ANS
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime. Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare? What could you tell him? -
ANS 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. Agent John Miller is meeting with Jerry
Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A and B. Jerry has
also purchased a Medicare Supplement (Medigap) plan which he has had for several
years. However, the plan does not provide drug benefits. How would you advise Agent
John Miller to proceed? - ANS Tell prospect Jerry Smith that he should consider adding
a standalone Part D prescription drug coverage policy to his present coverage. 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? - ANS After
receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age. 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? - ANS 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. Which of the following
statement is/are correct about a Medicare Savings Account (MSA) Plans? I. MSAs may
have either a partial network, full network, or no network of providers. II. MSA plans
cover Part A and Part B benefits but not Part D prescription drug benefits. III. An
individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation. IV. Non-network providers must accept the same amount that
Original Medicare would pay them as payment in full. - ANS I, II, and IV only Mr.
Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is
one of three plans operated by the same organization in Mr. Lombardi's area. The MA
PPO plan does not include drug coverage, but the other two plans do. Mr. Lombardi
likes the PPO plan that does not include drug coverage and intends to obtain his drug
coverage through a stand-alone Medicare prescription drug plan. What should you tell
him about this situation? - ANS He could enroll either in one of the MA plans that
include prescription drug coverage or Original Medicare with a Medigap plan and
standalone Part D prescription drug coverage, but he cannot enroll in the MA-only PPO
plan and a stand-alone prescription drug plan. Mrs. Ramos is considering a Medicare
Advantage PPO and has questions about which providers she can go to for her health
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care. What should you tell her? - ANS Mrs. Ramos can obtain care from any provider
who participates in Original Medicare, but generally will have a higher cost-sharing
amount if she sees a provider who/that is not a part of the PPO network. Mr. Romero is
64, retiring soon, and considering enrollment in his employer-sponsored retiree group
health plan that includes drug coverage with nominal copays. He heard about a
neighbor's MA-PD plan that you represent and because he takes numerous prescription
drugs, he is considering signing up for it. What should you tell him? - ANS He should
compare the benefits in his employer-sponsored retiree group health plan with the
benefits in his neighbor's MA-PD plan to determine which one will provide sufficient
coverage for his prescription needs. 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? - ANS Dr.
Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS
plan's terms and condition of payment which may include balance billing up to 15% of
the Medicare rate. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan
available in his area has an attractive premium. He wants to know if he must use
doctors in a network as his current HMO plan requires him to do. What should you tell
him? - ANS He may receive health care services from any doctor allowed to bill
Medicare, as long as he shows the doctor the plan's identification card and the doctor
agrees to accept the PFFS plan's payment terms and conditions, which could include
balance billing. Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be the correct description? - ANS
Medicare Advantage is a way of covering all the Original Medicare benefits through
private health insurance companies. Mrs. Chi is age 75 and enjoys a comfortable but
not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard
about from her neighbor. She also wants to have prescription drug coverage since her
doctor recently prescribed several expensive medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? -
ANS Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan. Daniel is a middle-income Medicare beneficiary. He has chronic
bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most appropriate for him? - ANS . C-SNP
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician
because she was told she would have to wait five weeks to get an appointment when
she was feeling ill. She called you to ask what she could do so she would not have to
put up with such poor access to care. What could you tell her? - ANS She could file a
grievance with her plan to complain about the lack of timeliness in getting an
appointment. Mr. Greco is in excellent health, lives in his own home, and has a sizeable
income from his investments. He has a friend enrolled in a Medicare Advantage Special
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