AHIP Final Exam 50 Questions and Answers
1. 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.
2. 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?
Answer Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she
received the MSN in the mail.
3. 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?
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.
4. 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
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,that can help with Medicare costs for which she is responsible.
5. 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.
6. 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 Supple- ment (Medigap) plan. Anita's older neighbor Mel has told
her about the Medi- gap 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?
Answer 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 otter
foreign travel benefits but do not cover the Part B deductible.
7. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
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.
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, 8. 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.
9. 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.
10. 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 otter to review the plans appeal process to help him ask the plan to review the coverage
decision.
11. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan
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1. 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.
2. 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?
Answer Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she
received the MSN in the mail.
3. 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?
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.
4. 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
1/
16
,that can help with Medicare costs for which she is responsible.
5. 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.
6. 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 Supple- ment (Medigap) plan. Anita's older neighbor Mel has told
her about the Medi- gap 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?
Answer 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 otter
foreign travel benefits but do not cover the Part B deductible.
7. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
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.
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16
, 8. 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.
9. 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.
10. 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 otter to review the plans appeal process to help him ask the plan to review the coverage
decision.
11. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan
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