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AHIP FWA 2023/2024| Latest Update| Questions with Correct Answers/ Verified
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AHIP FWA 2023/2024| Latest Update| Questions with Correct Answers/ Verified
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AHIP FWA 2023/2024| LatestUpdate| Questions with Correct
Answers/ Verified
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare
and would like to know which of the following services Original Medicare will
cover if the appropriate criteria are met? What could you tell her? - -Original
Medicare covers ambulance services.
-Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him? - -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. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for that condition. However, she and her physicians feel
that after her lengthy hospital stay she will need a month or two of nursing and
rehabilitative care. What should you tell them about Original Medicare's coverage
of care in a skilled nursing facility? - -Medicare will cover Mrs. Shield's skilled
nursing services provided during the first 20 days of her stay, after which she
would have a copay until she has been in the facility for 100 days.
-Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substantial
estate which provides Madeline with an annual income of approximately
$130,000. Madeline, who has only worked part-time for the last three years, will
soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for
advice. What should you tell her? - -You should tell Madeline that she will be able
to enroll in Medicare Part A without paying monthly premiums due to her
husband's long work record and participation in the Medicare system. You should
also tell Madeline that she will pay Part B premiums at more than the standard
lowest rate but less than the highest rate due her substantial income.
-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.
-Mrs. Quinn recently turned 66 and decided after many years of work to begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter
informing her that she has been automatically enrolled in Medicare Part B. She
wants to understand what this means. What should you tell Mrs. Quinn? - -Part B
primarily covers physician services. She will be paying a monthly premium and,
with the exception of many preventive and screening tests, generally will have 20%
coinsurance for these services, in addition to an annual deductible.
-Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because features of Part D might have
,changed. Mrs. Geisler can't remember what Part D is so she called you to ask what
her neighbor was talking about. What could you tell her? - -Part D covers
prescription drugs and she should look at her premiums, formulary, and cost-
sharing among other factors to see if they have changed.
-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. 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.
-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.
-Anita Magri will turn age 65 in August 2022. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare
Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the
Medigap Part F plan in which he is enrolled. It not only provides foreign travel
emergency benefits but also covers his Medicare Part B deductible. Anita comes to
you for advice. What should you tell her? - -You are sorry to disappoint Anita but a
Medigap Part F plan is no longer available to those who turn age 65 after January
1,2020. Anita might instead consider other Medigap plans that offer foreign travel
benefits but do not cover the Part B deductible.
-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 Medicare Part D prescription drug plan. What should you
tell him? - -He generally would pay a monthly premium, annual deductible, and
per-prescription cost-sharing.
-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.
, -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.
-What impact, if any, have recent regulatory changes had upon Medigap plans? - -
The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
-Mrs. Paterson is concerned about the deductibles and co-payments associated
with Original Medicare. What can you tell her about Medigap as an option to
address this concern? - -*** Medigap plans help beneficiaries cover Original
Medicare benefits, but they coordinate with Original Medicare coverage.
-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.
-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.
-Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs? - -Mr. Wu may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program.
-Mr. Romero is 64, retiring soon, and considering enrollment in his employer-
sponsored retiree group health plan that includes drug coverage with nominal
copays. He heard about a neighbor's MA-PD plan that you represent and because
he takes numerous prescription drugs, he is considering signing up for it. What
should you tell him? - -He should compare the benefits in his employer-sponsored
retiree group health plan with the benefits in his neighbor's MA-PD plan to
determine which one will provide sufficient coverage for his prescription needs.
-Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare.
What should she be aware of when considering enrollment in a Medicare
Advantage (MA) plan? - -She cannot enroll in an MA Medical Savings Account
(MSA) plan.
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