AHIP 100% CORRECT QUESTIONS
AND ANSWERS
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 can obtain coverage under Medicare.
What should you tell him? - CORRECT ANSWER-He may sign
up for Medicare...
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 can obtain coverage under Medicare.
What should you tell him? - CORRECT ANSWER-He may sign-
up for Medicare at any time however coverage usually begins
on the fourth month after dialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work
for several more years at Smallcap, Incorporated. Smallcap has
a workforce of15 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? - CORRECT ANSWER-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.
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? - CORRECT
,ANSWER-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.
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? - CORRECT ANSWER-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.
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? - CORRECT 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
monthly premiums.
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? - CORRECT ANSWER-Mrs. Gonzalez cannot purchase a
Medigap plan that covers drugs, but she could keep her
Medigap policy and enroll in a Part D prescription drug plan.
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? -
,CORRECT ANSWER-Medicare does not cover massage
therapy, or, in general, glasses or dentures.
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? - CORRECT ANSWER-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 coinsurance 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.
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? - CORRECT ANSWER-To obtain
Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
Alonso receives some help paying for his two 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 MedicarePart D prescription drug plan.
What should you tell him? - CORRECT ANSWER-He generally
would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
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? - CORRECT ANSWER-Medicare
, is a program for people age 65 or older and those under age 65
with certain disabilities, end-stage renal disease, and Lou
Gehrig's disease so she will be eligible for Medicare.
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? - CORRECT ANSWER-
Beneficiaries under Original Medicare have no cost-sharing for
most preventive services which include immunizations such as
annual flu shots.
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? -
CORRECT ANSWER-Mrs. Duarte should file an appeal of this
initial determination within 120 days of the date she received
the MSN in the mail.
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? - CORRECT ANSWER-It is illegal 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.
Park is an elderly retiree. Mrs. Park has a low fixed income.
What could you tell Mrs. Park that might be of assistance? -
CORRECT 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.
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
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