Ahip Exam Review Unit 1 – 5 Latest Updated 2024
Overview of medicare program basics: choice,eligibility and benefits module 1
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.
Correct
Part C, which always covers dental and vision services, is covered under Original Medicare. Incorrect
Part A, which covers long term custodial care services, is covered under Original Medicare. Incorrect
Part D, which covers prescription drug services, is covered under Original Medicare. Incorrect
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. Correct
Medicare covers all screening tests that have been approved by the FDA on a frequency determined by the
treating physician. Incorrect
Medicare covers some screening tests that must be performed within the first year after enrollment.
Beyond that point expenses for screening tests is the responsibility of the beneficiary. Incorrect
Medicare covers treatments for existing disease, injury and malformed limbs or body parts. As such, it
does not cover any screening tests and these must be paid for by the beneficiary out of pocket. Incorrect
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, the inpatient hospital co-payment is a flat per-day amount that remains the
same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases until
day 90. After 90 days he would pay the full amount of all costs. Incorrect
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 of all ages with specific mental health disabilities. Since she is in
excellent health, she would not qualify, but should instead look into her state’s Medicaid program if she
wants further coverage. Incorrect
Eligibility for Medicare is based on whether or not a person has ever been employed by the federal
government. If she or her husband were ever employed by the federal government, she can enroll in
Medicare. Incorrect
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. Correct
Medicare is a program for people who have incomes and assets below specific limits, so you will have to
find out her exact financial situation before telling her whether she can obtain Medicare coverage.
,Incorrect
Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that might be of
assistance?
She should not sign up for a Medigap or Medicare Advantage plan. Incorrect
She should only seek help from private organizations to cover her Medicare costs. Incorrect
She can apply to the Medicare agency for lower premiums and cost-sharing. Incorrect
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. Correct
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 for Part D costs through the local Office of the Aging.
Incorrect
Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state’s
Medicaid program. Incorrect
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program. Correct
Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance
Program. Incorrect
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
Correct
Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The
percentage increases after 60 days and again after 90 days. Incorrect
Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider,
the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a
non-participating provider. Incorrect
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?
Individuals who become eligible for such disability payments only have to wait 12 months before they can
apply for coverage under Medicare. Incorrect
He became eligible for Medicare when his disability eligibility determination was first made. Incorrect
After receiving such disability payments for 24 months he will be automatically enrolled in Medicare,
regardless of age. Correct
Individuals receiving such disability payments from the Social Security Administration continue to receive
those payments, but only become eligible for Medicare upon reaching age 65. Incorrect
Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that it is a
forgery since it does not have her Social Security number on it. What should you tell her?
The card is indeed a forgery since all identity cards are being phased out in favor of a new electronic
identity system developed by the Social Security Administration. Incorrect
The card she received is valid but she should keep her old card for at least two years and present it
whenever she receives health care. Incorrect
The card she received is valid, the change has been made to protect Medicare beneficiaries from identity
theft, and she should now destroy her old card. Correct
The card is indeed a forgery since newly issued Medicare cards will have both a beneficiary’s Social
,Security number and date of birth imprinted on them. Incorrect
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in a
Medicare health plan (Part C). What should you advise her to do before she will be able to enroll in a
Medicare health plan?
To enroll in a Medicare health plan, she need only be entitled to Part A, so she does not need to take any
further steps. Incorrect
In order to join a Medicare health plan, she must be enrolled in Parts A, B, and D. Incorrect
Since she is age 65 she may enroll in any Medicare health plan, regardless of whether she is entitled to
Part A or Part B coverage. Incorrect
In order to join a Medicare health plan, she also must enroll in Part B. Correct
, 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 cover his dental, vision and hearing services only. Incorrect
Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not
covered under Original Fee-for-Service (FFS) Medicare. Incorrect
c. 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. Correct
d. Medicare Supplemental Insurance would cover his long-term care services. Incorrect
MEDICARE HEALTH PLANS PART 2
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him?
Mr. Kumar will be able to obtain routine care outside of the plan’s service area, but will pay a higher co-
payment (except in an emergency). Incorrect
In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who
have a contractual relationship with the plan (except in an emergency or where care is unavailable within
the network). Correct
In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%, but
those of specialists are covered at 80%. Incorrect
With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as that
provider participates in Original Medicare. Incorrect
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What
should you tell her?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
Correct
Even if Mrs. Radford has end-stage renal disease, she will be able to enroll in any Medicare Advantage plan
in her service area. Incorrect
Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to
being accepted and enrolled. Incorrect
Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. Incorrect
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be the correct description?
Medicare Advantage is designed to pick up where Original Medicare leaves off, covering those health care
services that would not normally be covered by Original Medicare. Incorrect
Medicare Advantage is a health insurance program operated jointly by the states with the Federal
government. Incorrect
Medicare Advantage is a new name for the Original Medicare program. Incorrect
Medicare Advantage is a way of covering all the Original Medicare benefits through private health
insurance companies. Correct
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under
Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs).
What could you tell him?
SNPs are essentially the same as Original Medicare and are not likely to have a noticeable impact on how
Mr. Sinclair receives his care. Incorrect
