Ahip 2025 final
1. 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?: Medigap plans help beneficiaries cover
Original Medicare benefits, but they coordinate with Original Medicare coverage.
2. Anita Magri will turn age 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?: 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.
3. What impact, if any, have recent regulatory changes had on Medigap
plans?-
: b.
The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
4. 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.
5. 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?:
6. 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.
7. 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?: She can enroll in the
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, Ahip 2025 final
PPO, but she will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.
8. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?: Mrs. Radford must be
entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
9. 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?: You can
offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
10. 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?: He
will have to enroll in Part B.
11. 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?:
12. 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?: She could enroll in a PFFS plan and a stand-alone Medicare prescription
drug plan.
13. 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?: 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.
14. 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?: All MSAs cover Part A and Part B
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1. 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?: Medigap plans help beneficiaries cover
Original Medicare benefits, but they coordinate with Original Medicare coverage.
2. Anita Magri will turn age 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?: 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.
3. What impact, if any, have recent regulatory changes had on Medigap
plans?-
: b.
The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
4. 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.
5. 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?:
6. 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.
7. 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?: She can enroll in the
1/5
, Ahip 2025 final
PPO, but she will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.
8. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?: Mrs. Radford must be
entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
9. 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?: You can
offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
10. 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?: He
will have to enroll in Part B.
11. 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?:
12. 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?: She could enroll in a PFFS plan and a stand-alone Medicare prescription
drug plan.
13. 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?: 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.
14. 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?: All MSAs cover Part A and Part B
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