Ahip 2025 Final
Mrs. Paterson is concerned about the deductibles and copayments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - ANS- Medigap plans help beneficiaries cover Original Medicare benefits, but
they coordinate with Original Medicare coverage.
Anita Magri will turn 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 Supplement (Medigap) plan.
Anita's older neighbor Mel has told her about the Medigap 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? - ANS- 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 offer
foreign travel benefits but do not cover the Part B deductible.
What impact, if any, have recent regulatory changes had on Medigap plans? - ANS- b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
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? - ANS- Medicare will
cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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? - ANS-
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? - ANS- Medicare does not
cover massage therapy, or, in general, glasses or dentures.
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell her
about obtaining drug coverage? - ANS- She can enroll in the PPO, but she will not be
able to purchase a stand-alone Medicare Part D prescription drug plan.
, Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - ANS- Mrs. Radford must be entitled to Part A and
enrolled in Part B to enroll in Medicare Advantage.
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? - ANS- You
can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B
because he has coverage through an employer plan. If he wants to enroll in a Medicare
Advantage plan, what will he have to do? - ANS- He will have to enroll in Part B.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How
much may Dr. Brennan charge? - ANS-
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not
include drug coverage. She wants to enroll in the plan and enroll in a stand-alone
prescription drug plan. What should you tell her? - ANS- She could enroll in a PFFS plan
and a stand-alone Medicare prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility? - ANS-
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the
PFFS plan's service area.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her
own home. She is attracted by the idea of maintaining control over a Medical Savings
Account (MSA), but is not sure if the plan associated with the account will fit her needs.
What specific piece of information about a Medicare MSA plan would it be important for
her to know, prior to enrolling in such a plan? - ANS- All MSAs cover Part A and Part B
benefits, but not Part D prescription drug benefits, which could be obtained by also
enrolling in a separate prescription drug plan.
Who is most likely to benefit from the Medicare Prescription Payment Plan? - ANS-
Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled
under Medicare Part B. What should you tell her? - ANS- An individual who is entitled to
Mrs. Paterson is concerned about the deductibles and copayments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - ANS- Medigap plans help beneficiaries cover Original Medicare benefits, but
they coordinate with Original Medicare coverage.
Anita Magri will turn 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 Supplement (Medigap) plan.
Anita's older neighbor Mel has told her about the Medigap 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? - ANS- 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 offer
foreign travel benefits but do not cover the Part B deductible.
What impact, if any, have recent regulatory changes had on Medigap plans? - ANS- b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
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? - ANS- Medicare will
cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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? - ANS-
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? - ANS- Medicare does not
cover massage therapy, or, in general, glasses or dentures.
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell her
about obtaining drug coverage? - ANS- She can enroll in the PPO, but she will not be
able to purchase a stand-alone Medicare Part D prescription drug plan.
, Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - ANS- Mrs. Radford must be entitled to Part A and
enrolled in Part B to enroll in Medicare Advantage.
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? - ANS- You
can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B
because he has coverage through an employer plan. If he wants to enroll in a Medicare
Advantage plan, what will he have to do? - ANS- He will have to enroll in Part B.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How
much may Dr. Brennan charge? - ANS-
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not
include drug coverage. She wants to enroll in the plan and enroll in a stand-alone
prescription drug plan. What should you tell her? - ANS- She could enroll in a PFFS plan
and a stand-alone Medicare prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility? - ANS-
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the
PFFS plan's service area.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her
own home. She is attracted by the idea of maintaining control over a Medical Savings
Account (MSA), but is not sure if the plan associated with the account will fit her needs.
What specific piece of information about a Medicare MSA plan would it be important for
her to know, prior to enrolling in such a plan? - ANS- All MSAs cover Part A and Part B
benefits, but not Part D prescription drug benefits, which could be obtained by also
enrolling in a separate prescription drug plan.
Who is most likely to benefit from the Medicare Prescription Payment Plan? - ANS-
Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled
under Medicare Part B. What should you tell her? - ANS- An individual who is entitled to
