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AHIP FWA 2024/2025 already graded A+
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AHIP FWA 2024/2025 already graded A+
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AHIP FWA 2024Mrs. 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? - ANSOriginal 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? - ANSMr. 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? -
ANSMedicare 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? - ANSYou 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? - ANSMedicare 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? - ANSPart 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? - ANSPart 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? - ANSMrs. 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? - ANSMedicare 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? - ANSShe 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? - ANSYou 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? - ANSTo 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? - ANSHe
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? - ANSMedicare 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? - ANSMr. 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? - ANSThe
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? -
ANS*** 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? -
ANSUnder 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.
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? - ANSShe 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.
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? -
ANSMr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program.
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? - ANSHe 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.
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What
should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? -
ANSShe cannot enroll in an MA Medical Savings Account (MSA) plan.
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