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2022 AHIP Exam With Correct Questions And Answers
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2022 AHIP Exam With Correct Questions And Answers
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2022 AHIP Exam With Correct QuestionsAnd Answers
Mr. tDavis tis t52 tyears told tand thas trecently tbeen tdiagnosed twith tend-stage trenal tdisease
t(ESRD) tand twill tsoon tbegin tdialysis. tHe tis twondering tif the tcan tobtain tcoverage tunder
tMedicare. tWhat tshould tyou ttell thim? t- tcorrect tanswer.He tmay tsign-up tfor tMedicare tat
tany ttime thowever tcoverage tusually tbegins ton tthe tfourth tmonth tafter tdialysis ttreatments
tstart.
Juan tPerez, twho tis tturning tage t65 tnext tmonth, tintends tto twork tfor tseveral tmore tyears tat
tSmallcap, tIncorporated. tSmallcap thas ta tworkforce tof15 temployees tand toffers temployer-
sponsored thealthcare tcoverage. tJuan tis ta tnaturalized tcitizen tand thas tcontributed tto tthe
tMedicare tsystem tfor tover t20 tyears. tJuan tasks tyou tif the twill tbe tentitled tto tMedicare tand tif
the tenrolls thow tthat twill timpact this temployer-sponsored thealthcare tcoverage. tHow twould
tyou trespond? t- tcorrect tanswer.Juan tis tlikely tto tbe teligible tfor tMedicare tonce the tturns tage
t65 tand tif the tenrolls tMedicare twould tbecome tthe tprimary tpayor tof this thealthcare tclaims
tand tSmallcap tdoes tnot thave tto tcontinue tto toffer thim tcoverage tcomparable tto tthose
tunder tage t65 tunder tits temployer-sponsored tgroup thealth tplan.
Mr. tMoy's twife thas ta tMedicare tAdvantage tplan, tbut the twants tto tunderstand twhat
tcoverage tMedicare tSupplemental tInsurance tprovides tsince this thealth tcare tneeds tare
tdifferent tfrom this twife's tneeds. tWhat tcould tyou ttell tMr. tMoy? t- tcorrect tanswer.Medicare
tSupplemental tInsurance twould thelp tcover this tPart tA tand tPart tB tdeductibles tor
tcoinsurance tin tOriginal tFee-for-Service t(FFS) tMedicare tas twell tas tpossibly tsome
tservices tthat tMedicare tdoes tnot tcover.
Mrs. tPeňa tis t66 tyears told, thas tcoverage tunder tan temployer tplan, tand twill tretire tnext
tyear. tShe theard tshe tmust tenroll tin tPart tB tat tthe tbeginning tof tthe tyear tto tensure tno tgap tin
tcoverage. tWhat tcan tyou ttell ther? t- tcorrect tanswer.She tmay tenroll tat tany ttime twhile tshe
tis tcovered tunder ther temployer tplan, tbut tshe twill thave ta tspecial teight-month tenrollment
tperiod tafter tthe tlast tmonth ton ther temployer tplan tthat tdiffers tfrom tthe tstandard tgeneral
tenrollment tperiod, tduring twhich tshe tmay tenroll tin tMedicare tPart tB.
Mrs. tChen twill tbe t65 tsoon, thas tbeen ta tcitizen tfor ttwelve tyears, thas tbeen temployed tfull
ttime, tand tpaid ttaxes tduring tthat tentire tperiod. tShe tis tconcerned tthat tshe twill tnot tqualify
tfor tcoverage tunder tpart tA tbecause tshe twas tnot tborn tin tthe tUnited tStates. tWhat tshould
tyou ttell ther? t- tcorrect tanswer.Most tindividuals twho tare tcitizens tand tage t65 tor tover tare
,tcovered tunder tPart tA tby tvirtue tof thaving tpaid tMedicare ttaxes twhile tworking, tthough
tsome tmay tbe tcovered tas ta tresult tof tpaying tmonthly tpremiums.
Mrs. tGonzalez tis tenrolled tin tOriginal tMedicare tand thas ta tMedigap tpolicy tas twell, tbut tit
tprovides tno tdrug tcoverage. tShe twould tlike tto tkeep tthe tcoverage tshe thas tbut treplace ther
texisting tMedigap tplan twith tone tthat tprovides tdrug tcoverage. tWhat tshould tyou ttell ther? t-
tcorrect tanswer.Mrs. tGonzalez tcannot tpurchase ta tMedigap tplan tthat tcovers tdrugs, tbut
tshe tcould tkeep ther tMedigap tpolicy tand tenroll tin ta tPart tD tprescription tdrug tplan.
Mrs. tWest twears tglasses tand tdentures tand thas tenjoyed tconsiderable tpain trelief tfrom
tarthritis tthrough tmassage ttherapy. tShe tis tconcerned tabout twhether tor tnot tMedicare twill
tcover tthese titems tand tservices. tWhat tshould tyou ttell ther? t- tcorrect tanswer.Medicare
tdoes tnot tcover tmassage ttherapy, tor, tin tgeneral, tglasses tor tdentures.
Mr. tPatel tis tin tgood thealth tand tis tpreparing ta tbudget tin tanticipation tof this tretirement twhen
the tturns t66. tHe twants tto tunderstand tthe thealth tcare tcosts the tmight tbe texposed tto tunder
tMedicare tif the twere tto trequire thospitalization tas ta tresult tof tan tillness. tIn tgeneral tterms,
twhat tcould tyou ttell thim tabout this tcosts tfor tinpatient thospital tservices
under tOriginal tMedicare? t- tcorrect tanswer.Under tOriginal tMedicare, tthere tis ta tsingle
tdeductible tamount tdue tfor tthe tfirst t60 tdays tof tany tinpatient thospital tstay, tafter twhich tit
tconverts tinto ta tper-day tcoinsurance tamount tthrough tday t90. tAfter tday t90, the twould tpay
ta tdaily tamount tup tto t60 tdays tover this tlifetime, tafter twhich the twould tbe tresponsible tfor tall
tcosts.
Ms. tHenderson tbelieves tthat tshe twill tqualify tfor tMedicare tCoverage twhen tshe tturns t65,
twithout tpaying tany tpremiums, tbecause tshe thas tbeen tworking tfor t40 tyears tand tpaying
tMedicare ttaxes. tWhat tshould tyou ttell ther? t- tcorrect tanswer.To tobtain tPart tB tcoverage,
tshe tmust tpay ta tstandard tmonthly tpremium, tthough tit tis thigher tfor tindividuals twith thigher
tincomes.
Mr. tAlonso treceives tsome thelp tpaying tfor this ttwo tgeneric tprescription tdrugs tfrom this
temployer's tretiree tcoverage, tbut the twants tto tcompare tit tto ta tPart tD tprescription tdrug
tplan. tHe tasks tyou twhat tcosts the twould tgenerally texpect tto tencounter twhen tenrolling tinto
ta tstandard tMedicarePart tD tprescription tdrug tplan. tWhat tshould tyou ttell thim? t- tcorrect
tanswer.He tgenerally twould tpay ta tmonthly tpremium, tannual tdeductible, tand tper-
prescription tcost-sharing.
Ms. tMoore tplans tto tretire twhen tshe tturns t65 tin ta tfew tmonths. tShe tis tin texcellent thealth
tand twill thave tconsiderable tincome twhen tshe tretires. tShe tis tconcerned tthat ther tincome
twill tmake tit timpossible tfor ther tto tqualify tfor tMedicare. tWhat tcould tyou ttell ther tto taddress
ther tconcern? t- tcorrect tanswer.Medicare tis ta tprogram tfor tpeople tage t65 tor tolder tand
tthose tunder tage t65 twith tcertain tdisabilities, tend-stage trenal tdisease, tand tLou tGehrig's
tdisease tso tshe twill tbe teligible tfor tMedicare.
Mr. tXi twill tsoon tturn tage t65 tand thas tcome tto tyou tfor tadvice tas tto twhat tservices tare
tprovided tunder tOriginal tMedicare. tWhat tshould tyou ttell tMr. tXi tthat tbest tdescribes tthe
,thealth tcoverage tprovided tto tMedicare tbeneficiaries? t- tcorrect tanswer.Beneficiaries
tunder tOriginal tMedicare thave tno tcost-sharing tfor tmost tpreventive tservices twhich tinclude
timmunizations tsuch tas tannual tflu tshots.
Mrs. tDuarte tis tenrolled tin tOriginal tMedicare tParts tA tand tB. tShe thas trecently treviewed ther
tMedicare tSummary tNotice t(MSN) tand tdisagrees twith ta tdetermination tthat tpartially
tdenied tone tof ther tclaims tfor tservices. tWhat tadvice twould tyou tgive ther? t- tcorrect
tanswer.Mrs. tDuarte tshould tfile tan tappeal tof tthis tinitial tdetermination twithin t120 tdays tof
tthe tdate tshe treceived tthe tMSN tin tthe tmail.
Mr. tCapadona twould tlike tto tpurchase ta tMedicare tAdvantage t(MA) tplan tand ta tMedigap
tplan tto tpick tup tcosts tnot tcovered tby tthat tplan.
What tshould tyou ttell thim? t- tcorrect tanswer.It tis tillegal tfor tyou tto tsell tMr. tCapadona ta
tMedigap tplan tif the tis tenrolled tin tan tMA tplan, tand tbesides, tMedigap tonly tworks twith
tOriginal tMedicare.
Mrs. tPark tis tan telderly tretiree. tMrs. tPark thas ta tlow tfixed tincome. tWhat tcould tyou ttell tMrs.
tPark tthat tmight tbe tof tassistance? t- tcorrect tanswer.She tshould tcontact ther tstate tMedicaid
tagency tto tsee tif tshe tqualifies tfor tone tof tseveral tprograms tthat tcan thelp twith tMedicare
tcosts tfor twhich tshe tis tresponsible.
Mr. tRainey tis texperiencing tparanoid tdelusions tand this tphysician tfeels tthat the tshould tbe
thospitalized. tWhat tshould tyou ttell tMr. tRainey t(or this trepresentative) tabout tthe tlength tof
tan tinpatient tpsychiatric thospital tstay tthat tMedicare twill tcover? t- tcorrect tanswer.Medicare
twill tcover ta ttotal tof t190 tdays tof tinpatient tpsychiatric tcare tduring tMr. tRainey's tentire
tlifetime.
Mr. tSchmidt twould tlike tto tplan tfor tretirement tand thas tasked tyou twhat tis tcovered tunder
tOriginal tFee-for-Service t(FFS) tMedicare? tWhat tcould tyou ttell thim? t- tcorrect tanswer.Part
tA, twhich tcovers thospital, tskilled tnursing tfacility, thospice, tand thome thealth tservices tand
tPart tB, twhich tcovers tprofessional tservices tsuch tas tthose tprovided tby ta tdoctor tare
tcovered tunder tOriginal tMedicare.
Agent tJohn tMiller tis tmeeting twith tJerry tSmith, ta tnew tprospect. tJerry tis tcurrently tenrolled
tin tMedicare tParts tA tand tB. tJerry thas talso tpurchased ta tMedicare tSupplement t(Medigap)
tplan twhich the thas thad tfor tseveral tyears. tHowever, tthe tplan tdoes tnot tprovide tdrug
tbenefits. tHow twould tyou tadvise tAgent tJohn tMiller tto tproceed? t- tcorrect tanswer.Tell
tprospect tJerry tSmith tthat the tshould tconsider tadding ta tstandalone tPart tD tprescription
tdrug tcoverage tpolicy tto this tpresent tcoverage.
Mr. tBauer tis t49 tyears told, tbut teighteen tmonths tago the twas tdeclared tdisabled tby tthe
tSocial tSecurity tAdministration tand thas tbeen treceiving tdisability tpayments. tHe tis
twondering twhether the tcan tobtain tcoverage tunder tMedicare. tWhat tshould tyou ttell thim? t-
tcorrect tanswer.After treceiving tsuch tdisability tpayments tfor t24 tmonths, the twill tbe
tautomatically tenrolled tin tMedicare, tregardless tof tage.
, Mr. tBuck thas tseveral tfamily tmembers twho tdied tfrom tdifferent tcancers. tHe twants tto tknow
tif tMedicare tcovers tcancer tscreening.
What tshould tyou ttell thim? t- tcorrect tanswer.Medicare tcovers tthe tperiodic tperformance tof
ta trange tof tscreening ttests tthat tare tmeant tto tprovide tearly tdetection tof tdisease. tMr. tBuck
twill tneed tto tcheck tspecific ttests tbefore tobtaining tthem tto tsee tif tthey twill tbe tcovered.
Which tof tthe tfollowing tstatement tis/are tcorrect tabout ta tMedicare tSavings tAccount t(MSA)
tPlans?
I. tMSAs tmay thave teither ta tpartial tnetwork, tfull tnetwork, tor tno tnetwork tof tproviders.
II. tMSA tplans tcover tPart tA tand tPart tB tbenefits tbut tnot tPart tD tprescription tdrug tbenefits.
III. tAn tindividual twho tis tenrolled tin tan tMSA tplan tis tresponsible tfor ta tminimal tdeductible tof
t$500 tindexed tfor tinflation.
IV. tNon-network tproviders tmust taccept tthe tsame tamount tthat tOriginal tMedicare twould
tpay tthem tas tpayment tin tfull. t- tcorrect tanswer.I, tII, tand tIV tonly
Mr. tLombardi tis tinterested tin ta tMedicare tAdvantage t(MA) tPPO tplan tthat tyou trepresent. tIt
tis tone tof tthree tplans toperated tby tthe tsame torganization tin tMr. tLombardi's tarea. tThe tMA
tPPO tplan tdoes tnot tinclude tdrug tcoverage, tbut tthe tother ttwo tplans tdo. tMr. tLombardi tlikes
tthe tPPO tplan tthat tdoes tnot tinclude tdrug tcoverage tand tintends tto tobtain this tdrug
tcoverage tthrough ta tstand-alone tMedicare tprescription tdrug tplan. tWhat tshould tyou ttell
thim tabout tthis tsituation? t- tcorrect tanswer.He tcould tenroll teither tin tone tof tthe tMA tplans
tthat tinclude tprescription tdrug tcoverage tor tOriginal tMedicare twith ta tMedigap tplan tand
tstandalone tPart tD tprescription tdrug tcoverage, tbut the tcannot tenroll tin tthe tMA-only tPPO
tplan tand ta tstand-alone tprescription tdrug tplan.
Mrs. tRamos tis tconsidering ta tMedicare tAdvantage tPPO tand thas tquestions tabout twhich
tproviders tshe tcan tgo tto tfor ther thealth tcare. tWhat tshould tyou ttell ther? t- tcorrect
tanswer.Mrs. tRamos tcan tobtain tcare tfrom tany tprovider twho tparticipates tin tOriginal
tMedicare, tbut tgenerally twill thave ta thigher tcost-sharing tamount tif tshe tsees ta tprovider
twho/that tis tnot ta tpart tof tthe tPPO tnetwork.
Mr. tRomero tis t64, tretiring tsoon, tand tconsidering tenrollment tin this temployer-sponsored
tretiree tgroup thealth tplan tthat tincludes tdrug tcoverage twith tnominal tcopays. tHe theard
tabout ta tneighbor's tMA-PD tplan tthat tyou trepresent tand tbecause the ttakes tnumerous
tprescription tdrugs, the tis tconsidering tsigning tup tfor tit. tWhat tshould tyou ttell thim? t- tcorrect
tanswer.He tshould tcompare tthe tbenefits tin this temployer-sponsored tretiree tgroup thealth
tplan twith tthe tbenefits tin this tneighbor's tMA-PD tplan tto tdetermine twhich tone twill tprovide
tsufficient tcoverage tfor this tprescription tneeds.
Dr. tElizabeth tBrennan tdoes tnot tcontract twith tthe tABC tPFFS tplan tbut taccepts tthe tplan's
tterms tand tconditions tfor tpayment. tMary tRodgers tsees tDr. tBrennan tfor ttreatment. tHow
tmuch tmay tDr. tBrennan tcharge? t- tcorrect tanswer.Dr. tBrennan tcan tcharge tMary tRogers
tno tmore tthan tthe tcost tsharing tspecified tin tthe tPFFS tplan's tterms tand tcondition tof
tpayment twhich tmay tinclude tbalance tbilling tup tto t15% tof tthe tMedicare trate.
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