AHIP FWA 2023 Questions and Answers
with Verified Solutions
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? ✔✔Original Medicare covers ambulance services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? ✔✔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. 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?
✔✔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.
Madeline Martinez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also left a substantial estate which provides Madeline
,with an annual income of approximately $130,000. Madeline, who has only worked part-time for
the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to
you for advice. What should you tell her? ✔✔You should tell Madeline that she will be able to
enroll in Medicare Part A without paying monthly premiums due to her husband's long work
record and participation in the Medicare system. You should also tell Madeline that she will pay
Part B premiums at more than the standard lowest rate but less than the highest rate due her
substantial income.
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? ✔✔Medicare does not cover massage therapy, or, in
general, glasses or dentures.
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? ✔✔Part B primarily covers physician services. She will be paying a
monthly premium and, with the exception of many preventive and screening tests, generally will
have 20% coinsurance for these services, in addition to an annual deductible.
,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? ✔✔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. 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? ✔✔Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she received the MSN in the mail.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover? ✔✔Medicare will cover a total of
190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance? ✔✔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.
, Anita Magri will turn age 65 in August 2022. 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 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 should you tell her? ✔✔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.
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes.
What should you tell her? ✔✔To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's
retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what
costs he would generally expect to encounter when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him? ✔✔He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
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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? ✔✔Original Medicare covers ambulance services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? ✔✔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. 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?
✔✔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.
Madeline Martinez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also left a substantial estate which provides Madeline
,with an annual income of approximately $130,000. Madeline, who has only worked part-time for
the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to
you for advice. What should you tell her? ✔✔You should tell Madeline that she will be able to
enroll in Medicare Part A without paying monthly premiums due to her husband's long work
record and participation in the Medicare system. You should also tell Madeline that she will pay
Part B premiums at more than the standard lowest rate but less than the highest rate due her
substantial income.
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? ✔✔Medicare does not cover massage therapy, or, in
general, glasses or dentures.
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? ✔✔Part B primarily covers physician services. She will be paying a
monthly premium and, with the exception of many preventive and screening tests, generally will
have 20% coinsurance for these services, in addition to an annual deductible.
,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? ✔✔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. 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? ✔✔Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she received the MSN in the mail.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover? ✔✔Medicare will cover a total of
190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance? ✔✔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.
, Anita Magri will turn age 65 in August 2022. 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 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 should you tell her? ✔✔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.
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes.
What should you tell her? ✔✔To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's
retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what
costs he would generally expect to encounter when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him? ✔✔He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
