AHIP MODULE 1 VERSIONS 1-6 COMPLETE STUDY SET WITH VERIFIED ANSWERS LATEST 2025, EXAMS OF NURSING

AHIP MODULE 1 VERSIONS 1-6 COMPLETE STUDY SET WITH VERIFIED ANSWERS LATEST 2025, EXAMS OF NURSING 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? A. Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with Original Medicare coverage. B. Medigap plans are not sold by private companies and are a government insurance product. C. All costs not covered by Medicare are covered by some Medigap plans. D. If Mrs. Paterson applies during the Medigap open enrollment period, she will have to undergo a medical review to determine if she has a pre-existing condition that would increase the premium for a Medigap policy. - ANSWER-A. Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with Original Medicare coverage. Explanation: Medigap plans coordinate coverage and works only with Original Medicare. 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? A. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. B. The penalty will be a permanent 10% increase in his Part B premium for every 12-month period that passed during which he could have enrolled and did not. C. During the first year, he is covered under Part B, his premiums will be 10% higher than they otherwise would be, after which point they will return to normal. 2 | P a g e D. Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of coverage. - ANSWER-A. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. Explanation: Individuals with coverage based on their own current employment are not subject to the late enrollment penalty. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs? A. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. B. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. C. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state's Medicaid program. D. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging. - ANSWER-A. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Explanation: A State Pharmaceutical Assistance Program may be able to provide assistance with prescription drug costs for those who are of limited means but do not qualify for the Part D low income subsidy. 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? A. Original Medicare covers routine dental care. B. Original Medicare covers cosmetic surgery. C. Original Medicare covers ambulance services. 3 | P a g e D. Original Medicare covers routine long-term custodial care. - ANSWER-C. Original Medicare covers ambulance services. Explanation: Original Medicare does cover ambulance services. 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? A. Mrs. Duarte should request a reconsideration of the decision by a qualified independent party within 60 days of the date she received the MSN in the mail. B. Mrs. Duarte has no right to appeal this determination since her claim has been partially paid. C. Mrs. Duarte should file an appeal of this initial determination within 90 days of the date she received the MSN in the mail. If she still disagrees with Medicare Administrative Contractor's (MAC's) further decision she should request a reconsideration by a qualified independent party within 10 days. D. Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. - ANSWER-D. Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. Explanation: Beneficiaries must file an appeal related to Part A or Part B services within 120 days of the date they get the MSN in the mail. Anita Magri will turn age 65 in August 2020. 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?