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AHIP FWA 2024/2025 A+ SCORE ASSURED
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AHIP FWA 2024/2025 A+ SCORE ASSURED
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AHIP FWA 2023Mrs. 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.
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