AHIP 2025 FINAL EXAM 50 QUESTIONS AND EXPERT
VERIFIED ANSWERS
Anita Magri will turn age 65 in August 2023. 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 Plan F 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? - ANS...... -You are sorry to disappoint
Anita, but a Medigap 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. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him? - ANS...... -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. 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? - ANS...... -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.
offer to review the plans appeal process to 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? - ANS...... -Beneficiaries under Original Medicare have no
cost-sharing for most preventive services.
, 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? - ANS...... -You can help him ask the plan to review the
coverage decision.
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? - ANS...... -
Original Medicare covers ambulance services.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her? - ANS...... -Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because the 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? - ANS...... -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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park that might be of assistance? - ANS...... -She should contact her state
VERIFIED ANSWERS
Anita Magri will turn age 65 in August 2023. 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 Plan F 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? - ANS...... -You are sorry to disappoint
Anita, but a Medigap 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. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him? - ANS...... -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. 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? - ANS...... -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.
offer to review the plans appeal process to 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? - ANS...... -Beneficiaries under Original Medicare have no
cost-sharing for most preventive services.
, 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? - ANS...... -You can help him ask the plan to review the
coverage decision.
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? - ANS...... -
Original Medicare covers ambulance services.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her? - ANS...... -Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because the 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? - ANS...... -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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park that might be of assistance? - ANS...... -She should contact her state
