AHIP Final Exam Practice Test (200 Questions and Answers100%
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Correct) Latest (2023 - 2024) (Verified Answers)
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Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about
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what type of plan designs are available through this program. What should you tell him about the types
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of health plans that are available through the Medicare Advantage program? - ANS They are Medicare
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health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
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(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare
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Advantage. What would be a correct description? - ANS Medicare Advantage is a way of covering all of
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the Original Medicare benefits through private health insurance companies.
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During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of
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Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
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available to her. What should you tell her about PFFS plans? - ANS A PFFS plan is one of various types of
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Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her
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area.
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(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
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BWhat should you tell her? - ANS Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
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in Medicare Advantage
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Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
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his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by
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Part A. What should you tell him? - ANS He is not eligible to enroll in a Medicare Advantage plan until
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he re-enrolls in Medicare Part B
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(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
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recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings have
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in regard to her MA plan during the next open enrollment season? - ANS She may remain in her ABC MA
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plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her
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area
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Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
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providers. What should you tell him? - ANS In most Medicare Advantage HMOs, Mr. Kumar must obtain
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his services only from providers who have a contractual relationship with the plan (except in an
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emergency).
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Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
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go to for her health care. What should you tell her? - ANS Mrs. Ramos can obtain care from any
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,provider who participates in Original Medicare, but generally will be charged a lower co-payment if she
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goes to one of the plan's preferred providers.
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Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under
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Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans
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(SNPs). What could you tell him? - ANS SNPs have special programs for enrollees with chronic
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conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as
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well
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(W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his
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investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has
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mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that
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plan. What should you tell him? - ANS SNPs limit enrollment to certain sub-populations of beneficiaries.
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Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP.
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(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
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paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A
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because she was not born in the United States. What should you tell her? - ANS Most individuals who
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are citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while
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working, though some may be covered as a result of paying monthly premiums.
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(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
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Administration and has been receiving disability payments. He is wondering whether he can obtain
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coverage under Medicare. What should you tell him? - ANS After receiving such disability payments for
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24 months, he will be automatically enrolled in Medicare, regardless of age.
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(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
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Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug
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policy? - ANS No, he cannot purchase a Medicare Advantage or Part D policy because he has not
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received Social Security or Railroad Retirement disability benefits for 24 months.
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(W) Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without
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paying any premiums, because she has been working for 40 years and paying Medicare taxes. What
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should you tell her? - ANS In order to obtain Part B coverage, she must pay a standard monthly
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premium, though it is higher for individuals with higher incomes
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(W) Mr. Diaz continued working with his company and was insured under his employer's group plan
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until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for
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Part B when first eligible and wants to know how much he will have to pay. What should you tell him? -
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ANS Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
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(W) Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next year. She heard
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she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell
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her? - ANS She may enroll at any time while she is covered under her employer plan, but she will have a
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, special eight-month enrollment period that differs from the standard general enrollment period, during
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which she may enroll in Medicare Part B
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(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in a
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Medicare health plan. What should you advise her to do before she will be able to enroll into a Medicare
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health plan? - ANS In order to join a Medicare health plan, she also must enroll in Part B
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Mrs. Park has a low, fixed income. What could you tell her that might be of assistance? - ANS She
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should contact her state Medicaid agency to see if she qualifies for one of several programs that can
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help with Medicare costs for which she is responsible
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(W) Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for some
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type of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to know what
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the assistance could do for him if he qualifies. What could you tell him? - ANS He might qualify for help
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with Part D prescription drug costs and help paying Part A and/or Part B premiums, deductibles, and/or
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cost sharing.
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(W) Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns
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66. He wants to understand the health care costs he might be exposed to under Medicare if he were to
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require hospitalization as a result of an illness. In general terms, what could you tell him about his costs
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for inpatient hospital services under Original Medicare? - ANS Under Original Medicare, there is a single
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deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a
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per-day amount through day 90. After day 90, he would pay a daily amount up to 60 days over his
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lifetime, after which he would be responsible for all costs
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(W) Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized.
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What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric
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hospital stay that Medicare will cover? - ANS Medicare will cover a total of 190 days of inpatient
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psychiatric care during Mr. Rainey's entire lifetime.
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Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
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treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she
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will need a month or two of nursing and rehabilitative care. What should you tell them about Original
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Medicare's coverage of care in a skilled nursing facility? - ANS Medicare will cover Mrs. Shields' skilled
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nursing services provided during the first 20 days of her stay, after which she would have a coinsurance
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until she has been in the facility for 100 days.
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Mrs. Quinn has just turned 65 and received a letter informing her that she has been automatically
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enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs.
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Quinn? - ANS Part B primarily covers physician services. She will be paying a monthly premium and, with
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the exception of many preventive and screening tests, generally will have 20% co-payments for these
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services, in addition to an annual deductible.
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