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AHIP FINAL EXAM REVIEW QUESTIONS WITH COMPLETE SOLUTIONS
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AHIP FINAL EXAM REVIEW QUESTIONS WITH COMPLETE SOLUTIONS
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AHIP FINAL EXAM REVIEW QUESTIONSWITH COMPLETE SOLUTIONS
What impact, if any, have recent regulatory changes had on Medigap plans? - Answer-
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
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.
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.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter
informing her that she had 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, except
for many preventive and screening tests, generally will have 20% co-payments 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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance? - Answer-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.
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? - Answer-Medicare does not
cover massage therapy, or, in general, glasses or dentures.
, 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? - Answer-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.
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.
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 prescription drug plan. What should you tell
him about this situation? - Answer-He could enroll either in one of the MA plans that
include prescription drug coverage or Original Medicare with a Medigap plan and
standalone Part D prescription drug coverage, but he cannot enroll in the MA-only PPO
plan and a stand-alone prescription drug plan.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but
is not sure about what type of plan designs are available through this program. What
should you tell him about the types of health plans that are available through the
Medicare Advantage program? - Answer-There are Medicare health plans such as
HMOs, PPOs, PFFS, and MSAs.
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? -
Answer-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.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - Answer-You can offer to review the plans appeal process to help him ask the
plan to review the coverage decision.
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