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AHIP 2024 final exam already graded A+
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AHIP2024
final
exam
M r s .
P a r k
i s
a n
e l d e r l y
r e t i r e e .
M r s .
P a r k
h a s
a
l o w
f i x e d
i n c o m e .
W h a t
c o u l d
y o u
t e l l
M r s .
P a r k
t h a t
m i g h t
b e
o f
a s s i s t a n c e ?
-
A N S S h e
s h o u l d
c o n t a c t
h e r
s t a t e
M e d i c a i d
a g e n c y
t o
s e e
i f
s h e
q u a l i f i e s
f o r p r o g r a m s
t h a t
c a n
h e l p
w i t h
M e d i c a r e
c o s t s
f o r
w h i c h
s h e
i s
r e s p o n s i b l e .
M a d e l i n e
M a r t i n e z
w a s
w i d o w e d
s e v e r a l
y e a r s
a g o .
H e r
h u s b a n d
w o r k e d
f o r
m a n y
y e a r s
a n d
c o n t r i b u t e d
i n t o
t h e
M e d i c a r e
s y s t e m .
H e
a l s o
l e f t
a
s u b s t a n t i a l
e s t a t e
w h i c h
p r o v i d e s
M a d e l i n e
w i t h
a n
a n n u a l
i n c o m e
o f
a p p r o x i m a t e l y
$ 1 3 0 , 0 0 0 .
M a d e l i n e ,
w h o
h a s
o n l y
w o r k e d
p a r t - t i m e
f o r
t h e
l a s t
t h r e e
y e a r s ,
w i l l
s o o n
t u r n
a g e
6 5
a n d
h o p e s
t o
e n r o l l
i n
O r i g i n a l
M e d i c a r e .
S h e
c o m e s
t o
y o u
f o r
a d v i c e .
W h a t
s h o u l d
y o u
t e l l
h e r ?
-
A N S Y o u
s h o u l d
t e l l
M a d e l i n e
t h a t
s h e
w i l l
b e
a b l e
t o
e n r o l l
i n
M e d i c a r e
P a r t
A
w i t h o u t
p a y i n g
m o n t h l y
p r e m i u m s
d u e
t o
h e r
h u s b a n d ' s
l o n g
w o r k
r e c o r d
a n d
p a r t i c i p a t i o n
i n
t h e
M e d i c a r e
s y s t e m .
Y o u
s h o u l d
a l s o
t e l l
M a d e l i n e
t h a t
s h e
w i l l
p a y
P a r t
B
p r e m i u m s
a t
m o r e
t h a n
t h e
s t a n d a r d
l o w e s t
r a t e
b u t
l e s s
t h a n
t h e
h i g h e s t
r a t e
d u e
h e r
s u b s t a n t i a l
i n c o m e .
M r .
B a u e r
i s
4 9
y e a r s
o l d ,
b u t
e i g h t e e n
m o n t h s
a g o
h e
w a s
d e c l a r e d
d i s a b l e d
b y
t h e
S o c i a l
S e c u r i t y
A d m i n i s t r a t i o n
a n d
h a s
b e e n
r e c e i v i n g
d i s a b i l i t y
p a y m e n t s .
H e
i s
w o n d e r i n g
w h e t h e r
h e
c a n
o b t a i n
c o v e r a g e
u n d e r
M e d i c a r e .
W h a t
s h o u l d
y o u
t e l l
h i m
-
A N S A f t e r
r e c e i v i n g
s u c h
d i s a b i l i t y
p a y m e n t s
f o r
2 4
m o n t h s ,
h e
w i l l
b e
a u t o m a t i c a l l y
e n r o l l e d
i n
M e d i c a r e ,
r e g a r d l e s s
o f
a g e .
M r .
S c h m i d t
w o u l d
l i k e
t o
p l a n
f o r
r e t i r e m e n t
a n d
h a s
a s k e d
y o u
w h a t
i s
c o v e r e d
u n d e r
O r i g i n a l
F e e - f o r - S e r v i c e
( F F S )
M e d i c a r e ?
W h a t
c o u l d
y o u
t e l l
h i m ?
-
A N S P a r t
A ,
w h i c h
c o v e r s
h o s p i t a l ,
s k i l l e d
n u r s i n g
f a c i l i t y ,
h o s p i c e
a n d
h o m e
h e a l t h
s e r v i c e s
a n d
P a r t
B ,
w h i c h
c o v e r s
p r o f e s s i o n a l
s e r v i c e s
s u c h
a s
t h o s e
p r o v i d e d
b y
a
d o c t o r
a r e
c o v e r e d
u n d e r
O r i g i n a l
M e d i c a r e .
M r s .
P e ň a
i s
6 6
y e a r s
o l d ,
h a s
c o v e r a g e
u n d e r
a n
e m p l o y e r
p l a n ,
a n d
w i l l
r e t i r e
n e x t
y e a r .
S h e
h e a r d
s h e
m u s t
e n r o l l
i n
P a r t
B
a t
t h e
b e g i n n i n g
o f
t h e
y e a r
t o
e n s u r e
n o
g a p
i n
c o v e r a g e .
W h a t
c a n
y o u
t e l l
h e r ?
-
A N S S h e
m a y
e n r o l l
a t
a n y
t i m e
w h i l e
s h e
i s
c o v e r e d
u n d e r
h e r
e m p l o y e r
p l a n ,
b u t
s h e
w i l l
h a v e
a
s p e c i a l
e i g h t
m o n t h
e n r o l l m e n t
p e r i o d
t h a t
d i f f e r s
f r o m
t h e
s t a n d a r d
g e n e r a l
e n r o l l m e n t
p e r i o d ,
d u r i n g
w h i c h
s h e
m a y
e n r o l l
i n
M e d i c a r e
P a r t
B .
A g e n t
J o h n
M i l l e r
i s
m e e t i n g
w i t h
J e r r y
S m i t h ,
a
n e w
p r o s p e c t .
J e r r y
i s
c u r r e n t l y
e n r o l l e d
i n
M e d i c a r e
P a r t s
A
a n d
B .
J e r r y
h a s
a l s o
p u r c h a s e d
a
M e d i c a r e
S u p p l e m e n t
( M e d i g a p )
p l a n
w h i c h
h e
h a s
h a d
f o r
s e v e r a l
y e a r s .
H o w e v e r ,
t h e
p l a n
d o e s
n o t
p r o v i d e
d r u g
b e n e f i t s .
H o w
w o u l d
y o u
a d v i s e
A g e n t
J o h n
M i l l e r
t o
p r o c e e d ?
-
A N S T e l l
p r o s p e c t
J e r r y
S m i t h
t h a t
h e
s h o u l d
c o n s i d e r
a d d i n g
a
s t a n d a l o n e
P a r t
D
p r e s c r i p t i o n
d r u g
c o v e r a g e
p o l i c y
t o
h i s
p r e s e n t
c o v e r a g e .
M r .
D i a z
c o n t i n u e d
w o r k i n g
w i t h
h i s
c o m p a n y
a n d
w a s
i n s u r e d
u n d e r
h i s
e m p l o y e r ' s
g r o u p
p l a n
u n t i l
h e
r e a c h e d
a g e
6 8 .
H e
h a s
h e a r d
t h a t
t h e r e
i s
a
p r e m i u m
p e n a l t y
f o r
t h o s e
w h o d i d
n o t
s i g n
u p
f o r
P a r t
B
w h e n
f i r s t
e l i g i b l e
a n d
w a n t s
t o
k n o w
h o w
m u c h
h e
w i l l
h a v e
t o
p a y .
W h a t
s h o u l d
y o u
t e l l
h i m ?
-
A N S T h e
p e n a l t y
w i l l
b e
a
p e r m a n e n t
1 0 %
i n c r e a s e
i n
h i s
P a r t
B
p r e m i u m
f o r
e v e r y
1 2 - m o n t h
p e r i o d
t h a t
p a s s e d
d u r i n g
w h i c h
h e
c o u l d
h a v e
e n r o l l e d
a n d
d i d
n o t .
M s .
M o o r e
p l a n s
t o
r e t i r e
w h e n
s h e
t u r n s
6 5
i n
a
f e w
m o n t h s .
S h e
i s
i n
e x c e l l e n t
h e a l t h
a n d
w i l l
h a v e
c o n s i d e r a b l e
i n c o m e
w h e n
s h e
r e t i r e s .
S h e
i s
c o n c e r n e d
t h a t
h e r
i n c o m e
w i l l
m a k e
i t
i m p o s s i b l e
f o r
h e r
t o
q u a l i f y
f o r
M e d i c a r e .
W h a t
c o u l d
y o u
t e l l
h e r
t o
a d d r e s s
h e r
c o n c e r n ?
-
A N S M e d i c a r e
i s
a
p r o g r a m
f o r
p e o p l e
a g e
6 5
o r
o l d e r
a n d
t h o s e
u n d e r
a g e
6 5
w i t h
c e r t a i n
d i s a b i l i t i e s ,
e n d - s t a g e
r e n a l
d i s e a s e ,
a n d
L o u
G e h r i g ' s
d i s e a s e
s o
s h e
w i l l
b e
e l i g i b l e
f o r
M e d i c a r e .
M i l d r e d
S a v a g e
e n r o l l e d
i n
A l l c a r e
M e d i c a r e
A d v a n t a g e
p l a n
s e v e r a l
y e a r s
a g o .
M i l d r e d
r e c e n t l y
l e a r n e d
t h a t
s h e
i s
s u f f e r i n g
f r o m
i n o p e r a b l e
c a n c e r
a n d
h a s
j u s t
a
f e w
m o n t h s
t o
l i v e .
S h e
w o u l d
l i k e
t o
s p e n d
t h e s e
f i n a l
m o n t h s
i n
h o s p i c e
c a r e .
M i l d r e d ' s
f a m i l y
a s k s
y o u
w h e t h e r
h o s p i c e
b e n e f i t s
w i l l
b e
p a i d
f o r
u n d e r
t h e
A l l c a r e
M e d i c a r e
A d v a n t a g e
p l a n .
W h a t
s h o u l d
y o u
s a y ?
-
A N S M i l d r e d
m a y
r e m a i n
e n r o l l e d
i n
A l l c a r e
a n d
m a k e
a
h o s p i c e
e l e c t i o n .
H o s p i c e
b e n e f i t s
w i l l
b e
p a i d
f o r
b y
O r i g i n a l
M e d i c a r e
u n d e r
P a r t
A
a n d
A l l c a r e
w i l l
c o n t i n u e
t o
p a y
f o r
a n y
n o n - h o s p i c e
s e r v i c e s .
M r .
G o m e z
n o t e s
t h a t
a
P r i v a t e
F e e - f o r - S e r v i c e
( P F F S )
p l a n
a v a i l a b l e
i n
h i s
a r e a
h a s
a n
a t t r a c t i v e
p r e m i u m .
H e
w a n t s
t o
k n o w
i f
h e
m u s t
u s e
d o c t o r s
i n
a
n e t w o r k
a s
h i s
c u r r e n t
H M O
p l a n
r e q u i r e s
h i m
t o
d o .
W h a t
s h o u l d
y o u
t e l l
h i m ?
-
A N S H e
m a y
r e c e i v e
h e a l t h
c a r e
s e r v i c e s
f r o m
a n y
d o c t o r
a l l o w e d
t o
b i l l
M e d i c a r e ,
a s
l o n g
a s
h e
s h o w s
t h e
d o c t o r
t h e
p l a n ' s
i d e n t i f i c a t i o n
c a r d
a n d
t h e
d o c t o r
a g r e e s
t o
a c c e p t
t h e
P F F S
p l a n ' s
p a y m e n t
t e r m s
a n d
c o n d i t i o n s ,
w h i c h
c o u l d
i n c l u d e
b a l a n c e
b i l l i n g .
M r .
K e l l y
w a n t s
t o
k n o w
w h e t h e r
h e
i s
e l i g i b l e
t o
s i g n
u p
f o r
a
P r i v a t e
f e e - f o r - s e r v i c e
( P F F S )
p l a n .
W h a t
q u e s t i o n s
w o u l d
y o u
n e e d
t o
a s k
t o
d e t e r m i n e
h i s
e l i g i b i l i t y ?
-
A N S Y o u
w o u l d
n e e d
t o
a s k
M r .
K e l l y
i f
h e
i s
e n r o l l e d
i n
P a r t
A
a n d
P a r t
B
a n d
i f
h e
l i v e s
i n
t h e
P F F S
p l a n ' s
s e r v i c e
a r e a .
M r s .
W a n g
w a n t s
t o
k n o w
g e n e r a l l y
h o w
t h e
b e n e f i t s
u n d e r
O r i g i n a l
M e d i c a r e
m i g h t
c o m p a r e
t o
t h e
b e n e f i t s
p a c k a g e
o f
a
M e d i c a r e
A d v a n t a g e
P l a n
b e f o r e
s h e
s t a r t s
l o o k i n g
a t
s p e c i f i c
p l a n s .
W h a t
c o u l d
y o u
t e l l
h e r ?
-
A N S M e d i c a r e
A d v a n t a g e
P l a n s
m a y
o f f e r
e x t r a
b e n e f i t s
t h a t
O r i g i n a l
M e d i c a r e
d o e s
n o t
o f f e r
s u c h
a s
v i s i o n ,
h e a r i n g ,
a n d
d e n t a l
s e r v i c e s .
I t
m u s t
i n c l u d e
a
m a x i m u m
o u t - o f - p o c k e t
l i m i t
o n
P a r t
A
a n d
P a r t
B
s e r v i c e s .
M r .
C a s t i l l o ,
a
n a t u r a l i z e d
c i t i z e n ,
p r e v i o u s l y
e n r o l l e d
i n
M e d i c a r e
P a r t
B
b u t
h a s
r e c e n t l y
s t o p p e d
p a y i n g
h i s
P a r t
B
p r e m i u m .
M r .
C a s t i l l o
i s
s t i l l
c o v e r e d
b y
P a r t
A .
H e
w o u l d
l i k e
t o
e n r o l l
i n
a
M e d i c a r e
A d v a n t a g e
( M A )
p l a n
a n d
i s
s t i l l
c o v e r e d
b y
P a r t
A .
W h a t
s h o u l d
y o u
t e l l
h i m ?
-
A N S H e
i s
n o t
e l i g i b l e
t o
e n r o l l
i n
a
M e d i c a r e
A d v a n t a g e
p l a n
u n t i l
h e
r e - e n r o l l s
i n
M e d i c a r e
P a r t
B .
M r .
B a r k e r
e n j o y s
a
c o m f o r t a b l e
r e t i r e m e n t
i n c o m e .
H e
r e c e n t l y
h a d
s u r g e r y
a n d
e x p e c t e d
t h a t
h e
w o u l d
h a v e
c e r t a i n
s e r v i c e s
a n d
i t e m s
c o v e r e d
b y
t h e
p l a n
w i t h
m i n i m a l
o u t - o f - p o c k e t
c o s t s
b e c a u s e
h i s
M A - P D
c o v e r a g e
h a s
b e e n
v e r y
g o o d .
H o w e v e r ,
w h e n
h e
r e c e i v e d
t h e
b i l l ,
h e
w a s
s u r p r i s e d
t o
s e e
l a r g e
c h a r g e s
i n
e x c e s s
o f
h i s
m a x i m u m
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