2025 AHIP Final Exam Already Rated A+
Assessing Medicare Coverage for Various Scenarios
Mrs. Shields:
Medicare will cover Mrs. Shields' skilled nursing services for the first 20 days of her stay. After
that, she'll have a copay until she's been in the facility for 100 days.
Mrs. West:...
Mrs. Shields:
Medicare will cover Mrs. Shields' skilled nursing services for the first 20 days of her stay. After
that, she'll have a copay until she's been in the facility for 100 days.
Mrs. West:
Medicare generally doesn't cover massage therapy, glasses, or dentures.
Mrs. Park:
Mrs. Park should contact her state Medicaid agency to see if she qualifies for programs that
can help with Medicare costs.
Mr. Alonso:
Mr. Alonso can expect to pay a monthly premium, annual deductible, and per-prescription
cost-sharing when enrolling in a standard Medicare Part D prescription drug plan.
Mrs. Gonzalez:
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs. She can keep her
Medigap policy and enroll in a Part D prescription drug plan.
Mr. Davis:
Mr. Davis may sign up for Medicare at any time, but coverage usually begins on the fourth
month after dialysis treatments start.
Mrs. Duarte:
Mrs. Duarte should file an appeal of the initial determination within 120 days of receiving the
MSN.
Mrs. Geisler:
Part D covers prescription drugs. Mrs. Geisler should review premiums, formulary, and cost-
sharing to see if they've changed.
Mr. Rainey:
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mr. Xi:
, Beneficiaries under Original Medicare have no cost-sharing for most preventive services.
Mr. Singh:
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for
Part A and Part B services through Original Fee-for-Service Medicare.
Mrs. Chen:
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of
having paid Medicare taxes while working.
Mrs. Quinn:
Part B primarily covers physician services. She will pay a monthly premium and generally
have 20% co-payments, in addition to an annual deductible.
Mr. Patel:
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.
Medigap Plans:
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting
January 1, 2020.
Medigap plans coordinate with Original Medicare coverage.
Other Services:
Original Medicare covers ambulance services and hospice services.
Mr. Diaz will not pay any penalty for not signing up for Part B when first eligible due to
continuous employer coverage.
Anita Magri should consider other Medigap plans that offer foreign travel benefits but do not
cover the Part B deductible.
Hank's Fish Store can continue to offer William the same employee health benefit plan or enroll
him in a Medicare Advantage plan.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has
coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he
have to do? ✔️He will have to enroll in Part B.
, Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Carolina. She is worried that
without additional support, her mother will need to go into a nursing home. Mrs. Velasquez asks you if
there is any Medicare plan that might allow her mother to remain in the community rather than going
into a nursing home. How should you advise Mrs. Velasquez? ✔️There are Programs of All-Inclusive
Care for the Elderly (PACE) for frail elderly beneficiaries certified as needing a nursing home level of care
but are able to live safely in the community at the time of enrolment.
Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed
for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as
payment in full. ✔️I, II, and IV only
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in
a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug
coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled
in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? ✔️Mrs. Chi may
enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is
attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the
plan associated with the account will fit her needs. What specific piece of information about a Medicare
MSA plan would it be important for her to know, prior to enrolling in such a plan? ✔️All MSAs cover
Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also
enrolling in a separate 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 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.
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