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AHIP 2022 Question And Answers With Complete Solution Rated A.
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AHIP 2022 Question And AnswersMr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure
about what type of plan designs are available through this program. What should you tell him about
the types of health plans that are available through the Medicare Advantage program? –
They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - Medicare Advantage is a way of covering all of
the Original Medicare benefits through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans? - A PFFS plan is one of various types of
Medicare Advantage plans offered by private entities and she may enroll in one if it is available in
her area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - Mrs. Radford must be entitled to Part A and enrolled in Part
B to enroll in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped
paying his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still
covered by Part A. What should you tell him? - He is not eligible to enroll in a Medicare Advantage
plan until he re-enrolls in Medicare Part B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings
have in regard to her MA plan during the next open enrollment season? - She may remain in her
ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - In most Medicare Advantage HMOs, Mr. Kumar must obtain
,his services only from providers who have a contractual relationship with the plan (except in an
emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she
can go to for her health care. What should you tell her? - Mrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will be charged a lower co-payment if
she goes to one of the plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received
under Original Medicare, but he would like to know more about Medicare Advantage Special Needs
Plans (SNPs). What could you tell him? - SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful
as well
(W) 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 Needs Plan (SNP). His friend
has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join
that plan. What should you tell him? - SNPs limit enrollment to certain sub-populations of
beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in
the SNP.
(W) 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? - Most individuals
who are citizens and over age 65 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.
(W) 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? - After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug
,policy? - No, he cannot purchase a Medicare Advantage or Part D policy because he has not received
Social Security or Railroad Retirement disability benefits for 24 months.
(W) 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? - In order to obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes
(W) 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? - Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
(W) 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? - She may enroll at any time while she is covered under her employer plan, but she will
have a special eight-month enrollment period that differs from the standard general enrollment
period, during which she may enroll in Medicare Part B
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in
a Medicare health plan. What should you advise her to do before she will be able to enroll into a
Medicare health plan? - In order to join a Medicare health plan, she also must enroll in Part B
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance? - She 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
(W) Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for
some type of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to
know what the assistance could do for him if he qualifies. What could you tell him? - He might
qualify for help with Part D prescription drug costs and help paying Part A and/or Part B premiums,
deductibles, and/or cost sharing.
, (W) 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? - 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 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
(W) 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? - Medicare will cover a total of 190
days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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? - Medicare will cover Mrs. Shields'
skilled nursing services provided during the first 20 days of her stay, after which she would have a
coinsurance until she has been in the facility for 100 days.
Mrs. Quinn has just turned 65 and 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? - 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% co-payments
for these services, in addition to an annual deductible.
(W) 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? - Medicare covers 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.
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? - Original Medicare covers ambulance services
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