AHIP MEDICARE TRAINING 2021 Study Guide Graded A+
Ms. Jensen has heard about "Original Fee-for-Service Medicare" and "Private Fee-for-Service" plans. She wants to know what the difference is if any. What should you tell her?
This year you decide to focus your efforts on marketing to employer and ...
1). Ms. jensen has heard about "original fee-for-service medicare" and "private fee-for-service"
plans. she wants to know what the difference is if any. what should you tell her?
Ans: PFFS plans are a type of Medicare Advantage plan offered by private companies.
2). This year you decide to focus your efforts on marketing to employer and union groups.
which of the following statements best describes what you can and cannot do in order to
stay in compliance?
Ans: You are not required to submit communication and marketing materials specific
only to those employer plans to CMS at the time of use, but CMS may request and review
copies if employee complaints occur.
3). Agent suma has recently had several clients request his assistance in completing their
paper enrollment form. what advice would you give him?
Ans: Agent Suma is only permitted to fill out the applicant's name and contact
information. The applicant must fill in the remaining information in order to protect his or
her privacy.
4). 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?
Ans: 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.
5). 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?
Ans: Original Medicare covers ambulance services.
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, 6). 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?
Ans: Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
7). Anita magri will turn age 65 in august 2020. 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
Ans: 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.
8). 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 cost
sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that
Medicare does not cover.
9). 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.
10). 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.
11). 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
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, 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.
12). 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?
Ans: 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.
13). 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.
14). 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?
Ans: 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.
15). What impact, if any, will recent regulatory changes have upon medigap plans?
Ans: The Part B deductible will no longer be covered for individuals newly eligible for
Medicare starting January 1, 2020.
16). 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?
Ans: Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
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