2022 AHIP UNIT 1 Medicare Basics

2022 AHIP UNIT 1 Medicare Basics Question 1 Mr. Buck hasseveral family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him? a. Medicare covers allscreening tests that have been approved by the FDA on a frequency determined by the treating physician. b.Medicare covers treatments for existing disease, injury, and malformed limbs or body parts. As such, it does not cover any screening tests and these must be paid for by the beneficiary out-of-pocket. c.Medicare covers some screening teststhat must be performed within the first year after enrollment. Beyond that point expenses for screening tests are the responsibility of the beneficiary. d.Medicare 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. Source: Module 1, Slide - Medicare Part B Benefits - Preventive Services and Screenings Question 2 Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-forService (FFS) Medicare? What could you tell him? a.Part C, which always covers dental and vision services, is covered under Original Medicare. b.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. c.Part A, which covers long-term custodial care services, is covered under Original Medicare. d.Part D, which covers prescription drug services, is covered under Original Medicare. Source: Module 1, Slide - Overview of Medicare Benefits and Coverage - Parts A, B, C, and Slide - Overview of Different Ways to Get Medicare Question 3 Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employersponsored healthcare coverage. How would you respond? a.Juan is likely to be ineligible for Medicare since he was born outside the United States and has only contributed to the Medicare system for 20 years. b. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims but Smallcap must continue to offer him coverage under its employer-sponsored group health plan and would become a secondary payor. c.Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-sponsored coverage would continue to be the primary payor while Medicare would be considered a secondary payor of his healthcare claims. Incorrect: Medicare is the primary payor for individuals who have group health coverage due to their continued employment with a small employer. A small group health plan is one offered by a company with fewer than 20 employees. d. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan. Source: Module 1, Slide - Eligibility for Part A and Part B Benefits and Slide - Medicare for Individuals Who Are Still Working - Small GHPs and Slide - Medicare Coordination with Employer Group Health Plans Question 4 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? a.After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. b.Individuals who become eligible forsuch disability payments only have to wait 12 months before they can apply for coverage under Medicare. c.Individualsreceiving such disability payments from the Social Security Administration continue to receive those payments but only become eligible for Medicare upon reaching age 65. d.He became eligible for Medicare when his disability eligibility determination was first made. Source: Module 1, Slide - Medicare Enrollment Part A & B Question 5 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 make it impossible for her to qualify for Medicare. What could you tell her to address her concern? a.Medicare is a program for people who have incomes and assets below specific limits, so you will have to find out her exact financial situation before telling her whethershe can obtain Medicare coverage. b.Eligibility for Medicare is based on whether or not a person has ever been employed by the federal government. If she or her husband were ever employed by the federal government, she can enroll in Medicare. c.Medicare is a program for people of all ages with specific mental health disabilities. Since she is in excellent health,she would not qualify, but should instead look into her state’s Medicaid program ifshe wants further coverage. d.Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, endstage renal disease, and Lou Gehrig’s disease so she will be eligible for Medicare. Source: Module 1, Slide - Eligibility for Part A and Part B Benefits Question 6 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? a. Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. b.Mrs. Duarte has no right to appeal this determination since her claim has been partially paid. c. Mrs. Duarte should file an appeal of this initial determination within 90 days of the date she received the MSN in the mail. If she still disagrees with Medicare Administrative Contractor's (MAC's) further decision she should request a reconsideration by a qualified independent party within 10 days. Incorrect: Beneficiaries must file an appeal related to Part A or B services within 120 days of the date they get the MSN in the mail. If a beneficiary disagrees with the Medicare Administrative Contractor’s decision, he/she has 180 days after getting the decision notice to request a reconsideration by a Qualified Independent Contractor. d.Mrs. Duarte should request a reconsideration of the decision by a qualified independent party within 60 days of the date she received the MSN in the mail. Source: Module 1, Slide - Appeals related to Part A and Part B Coverage and Payment Determinations. Question 7 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? a.Medicare Supplemental Insurance would cover his dental, vision and hearing services only. Original Fee-for-Service (FFS) Medicare as well as possibly some servicesthat Medicare does not cover. c.Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee-for-Service (FFS) Medicare. d.Medicare Supplemental Insurance would cover hislong-term care services. Source: Module 1, Slide - Medigap (Medicare Supplement Insurance) b.Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or coinsurance in Question 8 Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? a.Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the companies John represents offer more comprehensive coverage for a lower price. b.Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. c.Tell prospect Jerry Smith that he should drop his Medigap coverage and put those premium dollars toward the purchase of a standalone Part D prescription drug plan because he can always reactivate his Medigap policy on a guaranteed issue basis. Furthermore, because he has had Medigap Jerry will not incur a Part D late enrollment penalty. d.Tell prospect Jerry Smith that he should keep his Medigap plan but he should supplement his healthcare coverage by purchasing a Medicare Advantage plan that offers prescription drug coverage (MA-PD). Source: Module 1, Slide - Medigap (Medicare Supplement Insurance) and Slide - Medigap is NOT Question 9 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? a. She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B. b.She 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. c.She may not enroll in Part B while covered under an employer group health plan and must wait until the standard general enrollment period after she retires. d.She may only enroll in Part B during the general enrollment period whether she is retired or not. Source: Module 1, Slide - Enrollment in Parts A & B After the Initial Enrollment Period Question 10 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? a.Most individuals who are citizens and age 65 or over and are covered under Part A must pay a monthly premium for that coverage. b.Most individuals who are citizens and age 65 or over and wish to be covered under Part A must enroll in a Medicare Advantage Plan. d.All individuals who are citizens and age 65 or over will be covered under Part A. Source: Module 1, Slide - Eligibility for Part A & B Benefits and Slide - Medicare Premiums Part A Question 11 Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance? a.She can apply to the Medicare agency for lower premiums and cost-sharing. b.She should only seek help from private organizationsto cover her Medicare costs. c.She should contact her state Medicaid agency to see if she qualifiesfor one of several programs that can help with Medicare costs for which she is responsible. d.She should not sign up for a Medicare Advantage plan. Source: Module 1, Slide - Help for Individuals with Limited Income/Resources Question 12 Mr. Davisis 52 years old and hasrecently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? a.He may sign-up for Medicare at any time and coverage usually beginsimmediately. Incorrect: Medicare coverage for individuals with ESRD typically begins on the fourth month after dialysis treatments start. b.He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits. c.He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments start. d.He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Source: Module 1, Slide - Medicare Enrollment Part A & B Question 13 Mr. Rainey is experiencing paranoid delusions and his physician feelsthat 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 taxes while working, though some may be covered as a result of paying monthly premiums. c.Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid a.Medicare inpatient psychiatric coverage islimited to the same number of days covered for typical inpatient stays. b.Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey’s entire lifetime. c.Medicare will cover, at its allowable amount, as many stays as are needed throughout Mr. Rainey’slife, as long as no single stay exceeds 190 days. d.Inpatient psychiatric services are not covered under Original Medicare. Source: Module 1, Slide - Medicare Part A provides coverage for inpatient psychiatric care for up to 190 lifetime days. Question 14 Mr. Alonso receives some help paying for histwo 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? a. He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing. b.He generally would pay only a monthly premium and deductible. Medicare covers all other costs. c.He generally would pay only a per-prescription co-payment. Medicare covers all other costs. d. He generally would pay only a monthly premium. Medicare covers all other costs. Source: Module 1, Slide - Original Medicare and Part D Prescription Drug Coverage. Question 15 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. Whatshould you tell her? a.Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Advantage plan. b.She is correct because she will be covered under Part A, without paying premiums and she has worked for 40 years so she will not have to pay Part B premiums. c.She is correct that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries. d.To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. Source: Module 1, Slide - Medicare Premiums for Part B Question 16 Mr. Patel is in good health and is preparing a budget in anticipation of hisretirement 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? a.Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a non-participating provider. b.Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospitalstay, after which it convertsinto a per-day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over hislifetime, after which he would be responsible for all costs. c.Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases until day 90. After 90 days he would pay the full amount of all costs. d.Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The percentage increases after 60 days and again after 90 days. Source: Module 1, Slide - Medicare Part A - Original Medicare Cost-Sharing for Inpatient Hospital Care Question 17 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? a.Medicare does not cover massage therapy, or, in general, glasses or dentures. b.Medicare covers 80% of the cost of these three services. c.Medicare covers 50% of the cost of these three services. d.Medicare covers glasses, but not dentures or massage therapy. Source: Module 1, Slide - Not Covered by Medicare Part A & b Question 18 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? a.Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. b.Medicare Part A generally covers medically necessary physician and other health care professional services. c.Benefits covered by Medicare Parts A and B include routine dental care, hearing aids, and routine eye care. d.Medicare Part B generally provides prescription drug coverage. Source: Module 1, Slide - Medicare Part A & B Benefits, Slide - Medicare Part B Benefits: Preventive Services and Screening, and Slide - Not Covered by Medicare Part A & B Question 19 Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him? a. Medigap plans that cover costs not paid for by an MA plan are available only in Massachusetts,Minnesota, and Wisconsin. b. It isillegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides,Medigap only works with Original Medicare. c.Medigap plans are a form of Medicare Advantage, so purchasing both would be redundant coverage. d. Medigap policies designed to cover costs not paid for by an MA plan can be purchased, but only if the MA plan’s design is considered to be the “defined standard benefit.” Source: Module 1, Slide - Medigap is NOT Question 20 Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her? a.Medigap is a replacement for Original Medicare and she has been paying for double coverage. She should simply drop her Medigap policy. b. Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, butshe could keep her Medigappolicy and enroll in a Part D prescription drug plan. c. Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it likely won’t offer coverage that is equivalent to that provided under Part D. d.Mrs. Gonzalez should purchase a K or L Medigap plan. Source: Module 1, Slide - Beneficiaries with Medigap Plans with Drug Coverage