AHIP CWA EXAM MODULE 1-5, NONDISCRIMINATION, FWA, COMPLIANCE ACTUAL EXAM 100
QUESTIONS AND CORRECT DETAILED ANSWERS (100% CORRECT AND VERIFIED ANSWERS) A
GRADE 2025-2026
Anita Magri will turn age 65 in August 2020. Anita wants to sign up for Original Medicare
Part A and Part B. She also wants to sign up for 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 do 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 would like to know what coverage
Medicare Supplemental Insurance would provide as 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.
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What do you have to tell her about Medigap as an option to help
resolve her concern? - ANSWER Medigap plans help beneficiaries pay for coinsurance,
co-payments, and/or deductibles for medically necessary services.
Mrs. Quinn recently turned 66 and decided, after many years of work, to begin receiving
Social Security benefits. Shortly thereafter, Mrs. Quinn receives a letter indicating that
she has been automatically enrolled in Medicare Part B. She asks you what this means.
What do you tell Mrs. Quinn? - ANSWER Part B primarily covers physician services. She
will have a monthly premium paid, and-unless many of the preventive and screening
tests are performed-will be responsible for 20% coinsurance for these services, in
addition to an annual deductible.
Mr. Bauer is 49, but he has received disability payments from the Social Security
Administration for eighteen months because he was declared disabled. He wonders
whether he is eligible for Medicare. What would you say? ANSWER He will automatically
,be enrolled in Medicare after receiving such disability payments for 24 months
regardless of age.
What, if any, impact do the recent regulatory changes have on the Medigap plans? - ANS
The Part B deductible cannot be covered for persons who become newly eligible for
Medicare on or after January 1, 2020.
Ms. Moore will retire upon attainment of age 65 in a few months. She is in good health
and will have substantial income during her retirement. 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.
Mr. Xi will turn age 65 soon and comes to you looking for advice about what is covered
under Original Medicare. What do you tell Mr. Xi that most describes the health
coverage afforded Medicare beneficiaries? - ANSWER Beneficiaries under Original
Medicare pay no cost-sharing for most preventive services which include, but are not
limited to, such immunizations as annual flu shots.
Madeline Martinez was widowed several years ago. Her husband was a worker all his
life and paid into the Medicare program. He also left a sizable estate that pays Madeline
an income of approximately $130,000 a year. Madeline has worked only part-time hours
the last three years and is approaching age 65 so she would like to enroll into Original
Medicare. She seeks your advice. What do you advise her? - ANSWER You would need
to inform Madeline that she would be eligible to sign up for Medicare Part A with no
monthly premiums based on her husband's long work history and his participation in the
Medicare system. You would also need to inform Madeline that her Part B premiums
would be assessed at a rate higher than the lowest standard rate but less than the
highest rate based on her substantial income.
Juan Perez is reaching age 65 next month and would like to continue working for several
more years at Smallcap, Incorporated. Smallcap employs 15 employees and provides
employer-sponsored health care coverage. Juan is a naturalized citizen and has paid
into the Medicare system for more than 20 years. Juan asks you whether he will be
eligible for Medicare and if he enrolls how that will affect his employer sponsored health
care coverage. How would you respond? - ANSWER Juan will most likely be Medicare
eligible upon reaching age 65 and by enrolling Medicare will become the primary payor
of his healthcare claims and Smallcap does not have to continue to offer him coverage
comparable to those under age 65 under its employer-sponsored group health plan.
, Mr. Diaz continued working with his company and was covered under his employer's
group plan until he was 68. He has since heard that there is some premium penalty for
those who did not sign up when first eligible and wants to know how much he will have
to pay. What would you tell him? - ANSWER Mr. Diaz will not be subject to any penalty
because he had continuous coverage under his employer's plan.
Mr. Davis is a 52-year-old who has just been diagnosed with ESRD and is about to start
dialysis. He asks if he can get coverage under Medicare. What do 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. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What would you say? - ANSWER 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. Geisler's neighbor mentioned to her that she should review her Part D options
during the annual Medicare enrollment period because features of Part D may have
changed. Mrs. Geisler doesn't recall what Part D is so she calls you and asks what her
neighbor was referring to. What do you tell her? - ANSWER Part D covers prescription
drugs and she should review premiums, formulary and cost-sharing among other
factors to see if they have changed.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
she'd 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. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service FFS Medicare? What might you tell him? ANSWER Under
Original Medicare, both Part A, that covers hospital, skilled nursing facility, hospice, and
home health services and Part B, that covers professional services such as those
provided by a doctor are covered.
Original Medicare covers Mrs. Shields. She has fractured her hip, and is getting
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