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.
This study source was downloaded by 100000861960176 from CourseHero.com on 03-10-2023 02:15:54 GMT -06:00
https://www.coursehero.com/file/159674341/2023-AHIP-Module-1-Final-Reviewdocx/
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.
This study source was downloaded by 100000861960176 from CourseHero.com on 03-10-2023 02:15:54 GMT -06:00
https://www.coursehero.com/file/159674341/2023-AHIP-Module-1-Final-Reviewdocx/
