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  • September 23, 2024
  • 178
  • 2024/2025
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AHIP Module 1




By ExamNavigator

, Ahip 2025 Module 1

1. 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 thatbest describes the health
coverage provided to Medicare beneficiaries?
Answer: Beneficiaries under Original Medicare have no cost-sharing for most preventive
services

2. Mrs. Quinn recently turned 66 and decided after many years of work to beginreceiving 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?
Answer: Part B primarily covers physician services. She will be paying a monthly premium
and, except for many preventive screening and tests, generally will have 20 percent co-
payments for these services in addition to an annual deductible

3. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he canobtain coverage under
Medicare. What should you tell him?
Answer: He may sign up for Medicare at any time however coverage usually begins on the
fourth month afterdialysis treatment

4. Mr. Alonso receives some help paying for his two generic prescription drugsfrom 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 toencounter when enrolling into a standard
Medicare Part D prescription drug plan. What should you tell him?
Answer: He generally would pay a monthly premium, annual deductible, and per-prescription
cost sharing.

5. Ms. Brooks has an aggressive cancer and would like to know if Medicarewill cover hospice
services in case she needs them. What should you tell her?
Answer: Medicare covers hospice services and they will be available to her.

6. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What couldyou tell Mrs.
Park that might be of assistance?
Answer: 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.

7. 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 wouldyou give her?
Answer: Mrs. Duarte should file an appeal of this initial determination within120 days of the
date she received the MSN in the mail.

,8. 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 concernedthat she will not qualify for
coverage under part A because she was not born inthe United States. What should you tell her?
Answer: Most individuals who are citizens and age 65 or over are covered under Part A by
virtue of having paid Medicare taxes while working, though some may be covered as a result
of paying monthlypremiums.

9. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him?
Answer: Mr. Singh can enroll in astand-alone prescription drug plan and continue to be
covered for Part A and PartB services through Original Fee-for-Service Medicare.

10. What impact, if any, have recent regulatory changes had on Medigap plans?
Answer: The Part B deductible is no longer covered for individuals newly eligible forMedicare
starting January 1, 2020.

11. Mrs. West wears glasses and dentures and has enjoyed considerable painrelief from
arthritis through massage therapy. She is concerned about whetheror not Medicare will cover
these items and services. What should you tell her?
Answer: Medicare does not cover massage therapy, or, in general, glasses or dentures.

12. 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 coverageshe has but replace her existing
Medigap plan with one that provides drug coverage. What should you tell her?
Answer: Mrs. Gonzalez cannot purchase a Medigapplan that covers drugs, but she could keep
her Medigap policy and enroll in a Part D prescription drug plan.

13. Mrs. Shields is covered by Original Medicare. She sustained a hip fractureand 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?
Answer: Medicare will cover Mrs. Shield's skilled nursing services provided during the first
20 days ofher stay, after which she would have a copay until she has been in the facility for 100
days.

14. Mrs. Turner is comparing her employer's retiree insurance to OriginalMedicare and would
like to know which of the following services OriginalMedicare will cover if the appropriate
criteria are met. What could you tellher?
Answer: Original Medicare covers ambulance services.

15. 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?
Answer: Mr. Diaz will not pay any penalty because he had continuous coverageunder his

, employer's plan.

16. Mrs. Paterson is concerned about the deductibles and co-payments as-sociated with
Original Medicare. What can you tell her about Medigap as an
option to address this concern?
Answer: All costs not covered by Medicare are coveredby some Medigap plans.

17. Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because the features of Part Dmight have changed. Mrs. Geisler
can't remember what Part D is so she calledyou to ask what her neighbor was talking about.
What could you tell her?
Answer: PartD covers prescription drugs and she should look at her premiums, formulary,
and cost-sharing among other factors to see if they have changed.

18. 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 because of an illness. In general terms, what
could you tell him about his costs for inpatient hospital services under Original Medicare?
Answer: Under OriginalMedicare, there is a single deductible amount due for the first 60 days of
any inpatienthospital 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, afterwhich
he would be responsible for all costs.

19. Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a MedicareSupplement (Medigap) plan.
Anita's older neighbor Mel has told her about theMedigap Plan F 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?
Answer: You are sorry to disappointAnita, but a Medigap 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 foreigntravel benefits but do not cover the Part B deductible.

20. Mr. Rainey is experiencing paranoid delusions and his physician feels thathe 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?
Answer: Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey's entire lifetime.

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