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 can obtain coverage under Medicare. What should you tell him? He may sign-up for Medicare at any time however coverage usually begins on the fourth month...
2022 AHIP FINAL EXAM TEST
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 can obtain
coverage under Medicare. What should you tell him? 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? 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.
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. 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? 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.
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.
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 coverage she has but
replace her existing Medigap plan with one that provides drug coverage. What
should you tell her? 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.
Mrs. 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?
Medicare does not cover massage therapy, or, in general, glasses or dentures.
Mr. 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? 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.
Ms. 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? To obtain Part B
coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
Mr. 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? He generally would pay a monthly premium, annual deductible, and
per-prescription cost-sharing.
,Ms. 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? 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.
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. 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? Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
Mr. 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? 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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park that might be of assistance? 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.
Mr. 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 psychiatric hospital stay that Medicare will cover?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey's entire lifetime.
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.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare
Supplement (Medigap) plan which he has had for several years. However, the plan
does not provide drug benefits. How would you advise Agent John Miller to
proceed? Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
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. Buck has several family members who died from different cancers. He wants
to know if Medicare covers cancer screening.
What should you tell him? Medicare covers the periodic performance of a
range of screening tests that are meant to provide early detection of disease. Mr.
Buck will need to check specific tests before obtaining them to see if they will be
covered.
Which of the following statement 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
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
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