Exam (elaborations)
AHIP 2024 Module 1 – 5 Exam Questions with Correct Verified Answers
- Course
- Institution
AHIP 2024 Module 1 – 5 Exam Questions with Correct Verified Answers/ Latest Update 2024/ Rated A+
[Show more]
Content preview
1AHIP 2024 Module 1 – 5 Exam Questions
with Correct Verified Answers/ Latest
Update 2024/ Rated A+
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare. What could you tell him?
✓ 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.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise
her to do before she will be able to enroll in a Medicare Advantage plan?
✓ To join a Medicare Advantage plan, she also must enroll in Part B.
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access
to services since she receives some assistance for her health care costs from the State.
What should you tell her? - ANS –
✓ Medicaid may provide additional benefits, but Medicaid will only pay for these
services if they are furnished by Medicaid participating providers.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - ANS –
✓ In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his
services only from providers within the plan's network (except in an emergency or
where care is unavailable within the network).
, 2
Juan Perez, who is turning age 65 next month, intends to work for several more years at
small cap, Incorporated. Small cap 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 employer-sponsored
healthcare coverage. How would you respond? - ANS –
✓ 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 small
cap does not have to continue to offer him coverage comparable to those under
age 65 under its employer-sponsored group health plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How
much may Dr. Brennan charge? - ANS –
✓ Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in
the PFFS plan's terms and condition of payment which may include balance
billing up to 15%of the Medicare rate.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him
at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him? - ANS –
✓ C-SNP
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent.
It is one of three plans operated by the same organization in Mr. Lombardi's area. The
MA PPO plan does not include drug coverage, but the other two plans do. Mr. Lombardi
likes the PPO plan that does not include drug coverage and intends to obtain his drug
coverage through a stand-alone Medicare prescription drug plan. What should you tell
him about this situation? - ANS –
✓ He could enroll either in one of the MA plans that include prescription drug
coverage or Original Medicare with a Medigap plan and standalone Part D
prescription drug coverage, but he cannot enroll in the MA-only PPO plan and a
stand-alone prescription drug plan.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician
because she was told she would have to wait five weeks to get an appointment when
, 3
she was feeling ill. She called you to ask what she could do so she would not have to
put up with such poor access to care. What could you tell her?
✓ She could file a grievance with her plan to complain about the lack of timeliness
in getting an appointment.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12 months ago.
Edward is now age 50 and asks you if his Medicare coverage will continue, what should
you say?
✓ Individuals eligible for Medicare based on ESRD generally lose eligibility 36
months after the month in which the individual receives a kidney transplant
unless they are eligible for Medicare on another basis such as age or disability.
Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would
cover the drugs.
Mildred Savage enrolled in All care Medicare Advantage plan several years ago. Mildred
recently learned that she is suffering from inoperable cancer and has just a few months
to live. She would like to spend these final months in hospice care. Mildred's family asks
you whether hospice benefits will be paid for under the All-care Medicare Advantage
plan. What should you say?
✓ Mildred may remain enrolled in All care and make a hospice election. Hospice
benefits will be paid for by Original Medicare under Part A and All care will
continue to pay for any non-hospice services.
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.
, 4
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?
✓ Medicare Supplemental Insurance would help cover his Part A and Part B
deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as
possibly some services that Medicare does not cover.
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 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 monthly premiums.
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.
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?
✓ Beneficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
Mrs. Peña 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?
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller ASSIGNMENT7. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $20.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
79223 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now