AHIP Module 1 Final Review
1. Mrs. Durante 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. Durante should file an appeal of this initial determination within 120 days of the date she
received the MSN in the mail.
2. 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 facility for 100 days.
3. 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.
4. Mrs. Geisler’s neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because 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.
5. 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.
6. 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.
7. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has
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 with the
exception of many preventative and screening tests, generally will have 20% coinsurance for these
services, in addition to and annual deductible.
8. 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?
Answer:
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program.
9. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
1. Mrs. Durante 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. Durante should file an appeal of this initial determination within 120 days of the date she
received the MSN in the mail.
2. 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 facility for 100 days.
3. 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.
4. Mrs. Geisler’s neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because 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.
5. 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.
6. 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.
7. Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has
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 with the
exception of many preventative and screening tests, generally will have 20% coinsurance for these
services, in addition to and annual deductible.
8. 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?
Answer:
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program.
9. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
