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AHIP TRAINING MEDICARE FRAUD, WASTE, AND ABUSE TRAINING EXAM QUESTIONS AND ANSWERS
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AHIP TRAINING MEDICARE FRAUD, WASTE, AND ABUSE TRAINING EXAM QUESTIONS AND ANSWERS
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AHIP TRAINING MEDICARE FRAUD,WASTE, AND ABUSE TRAINING EXAM
QUESTIONS AND ANSWERS
Ms. Jensen has heard about "Original Fee-for-Service Medicare" and "Private Fee-for-
Service" plans. She wants to know what the difference is if any. What should you tell
her? - Answer-PFFS plans are a type of Medicare Advantage plan offered by private
companies.
This year you decide to focus your efforts on marketing to employer and union groups.
Which of the following statements best describes what you can and cannot do in order
to stay in compliance? - Answer-You are not required to submit communication and
marketing materials specific only to those employer plans to CMS at the time of use, but
CMS may request and review copies if employee complaints occur.
Agent Suma has recently had several clients request his assistance in completing their
paper enrollment form. What advice would you give him? - Answer-Agent Suma is only
permitted to fill out the applicant's name and contact information. The applicant must fill
in the remaining information in order to protect his or her privacy.
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? - Answer-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. 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? - Answer-Original Medicare
covers ambulance services.
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? - Answer-Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
Anita Magri will turn age 65 in August 2020. 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 -
Answer-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.
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? - Answer-Medicare
Supplemental Insurance would help cover his Part A and Part B cost sharing in Original
Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does
not cover.
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? -
Answer-After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
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? - Answer-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.
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? - 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.
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? - Answer-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.
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? - Answer-Beneficiaries under
Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
, 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? - Answer-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.
What impact, if any, will recent regulatory changes have upon Medigap plans? -
Answer-The Part B deductible will no longer be covered for individuals newly eligible for
Medicare starting January 1, 2020.
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? - Answer-Mr. Wu may still qualify for help in paying Part D costs through his
State Pharmaceutical Assistance Program.
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? -
Answer-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.
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? - Answer-Tell
prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
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? - Answer-Medigap plans help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services
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? - Answer-He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
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
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