AHIP FWA 2023-2024 complete solution
A+ graded
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.
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.
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 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? -
answer 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? - answer 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? - answer 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? - 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.
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.
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? - answer 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? - answer 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? -
answer 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? - answer 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? -
answer He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - answer
Medicare covers the periodic performance of a range of screening tests that are meant
to provide early detection of disease. Mr. Buck will need to check specific tests before
obtaining them to see if they will be covered.
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.
What impact, if any, have recent regulatory changes had upon Medigap plans? -
answer The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - answer *** Medigap plans help beneficiaries cover Original Medicare
benefits, but they coordinate with Original Medicare coverage.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
when he turns 66. He wants to understand the health care costs he might be exposed to
under Medicare if he were to require hospitalization as a result of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare? - answer Under Original Medicare, there is a single deductible
amount due for the first 60 days of any inpatient hospital stay, after which it converts
into a per-day coinsurance amount through day 90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for all costs.
Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next
year. She heard she must enroll in Part B at the beginning of the year to ensure no gap
in coverage. What can you tell her? - answer She may enroll at any time while she is
covered under her employer plan, but she will have a special eight-month enrollment
A+ graded
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.
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.
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 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? -
answer 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? - answer 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? - answer 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? - 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.
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.
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? - answer 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? - answer 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? -
answer 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? - answer 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? -
answer He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - answer
Medicare covers the periodic performance of a range of screening tests that are meant
to provide early detection of disease. Mr. Buck will need to check specific tests before
obtaining them to see if they will be covered.
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.
What impact, if any, have recent regulatory changes had upon Medigap plans? -
answer The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - answer *** Medigap plans help beneficiaries cover Original Medicare
benefits, but they coordinate with Original Medicare coverage.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
when he turns 66. He wants to understand the health care costs he might be exposed to
under Medicare if he were to require hospitalization as a result of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare? - answer Under Original Medicare, there is a single deductible
amount due for the first 60 days of any inpatient hospital stay, after which it converts
into a per-day coinsurance amount through day 90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for all costs.
Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next
year. She heard she must enroll in Part B at the beginning of the year to ensure no gap
in coverage. What can you tell her? - answer She may enroll at any time while she is
covered under her employer plan, but she will have a special eight-month enrollment
