2023 AHIP FINAL EXAM (ACTUAL TEST)
Mr. Davis is 52 years old and has recently been diagnosed with endstage renal disease (ESRD) and will soon begin dialys... [Show More] is. He is
wondering if he can obtain coverage under Medicare. What should
you tell him? Correct Ans - He may sign-up for Medicare at any
time however coverage usually begins on the fourth month after
dialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for
several more years at Smallcap, Incorporated. Smallcap has a
workforce of15 employees and offers employer-sponsored
healthcare coverage. Juan is a naturalized citizen and has
contributed to the Medicare system for over 20 years. Juan asks you
if he will be entitled to Medicare and if he enrolls how that will
impact his employer-sponsored healthcare coverage. How would you
respond? Correct Ans - Juan is likely to be eligible for Medicare
once he turns age 65 and if he enrolls Medicare would become the
primary payor of his healthcare claims and Smallcap does not have
to continue to offer him coverage comparable to those under age 65
under its employer-sponsored group health plan.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to
understand what coverage Medicare Supplemental Insurance
provides since his health care needs are different from his wife's
needs. What could you tell Mr. Moy? Correct Ans - Medicare
Supplemental Insurance would help cover his Part A and Part B
deductibles or coinsurance in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not
cover.
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? Correct Ans - She may enroll at any time while she is
covered under her employer plan, but she will have a special eightmonth enrollment period after the last month on her employer plan
that differs from the standard general enrollment period, during
which she may enroll in Medicare Part B.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has
been employed full time, and paid taxes during that entire period.
She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell
her? Correct Ans - Most individuals who are citizens and age 65or over are covered under Part A by virtue of having paid Medicare
taxes while working, though some may be covered as a result of
paying monthly premiums.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap
policy as well, but it provides no drug coverage. She would like to
keep the coverage she has but replace her existing Medigap plan
with one that provides drug coverage. What should you tell her?
Correct Ans - Mrs. Gonzalez cannot purchase a Medigap plan that
covers drugs, but she could keep her Medigap policy and enroll in a
Part D prescription drug plan.
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? Correct Ans - Medicare does not cover
massage therapy, or, in general, glasses or dentures.
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? Correct Ans - 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.
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? Correct Ans - 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 MedicarePart D prescription drug plan. What should
you tell him? Correct Ans - He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing. [Show Less]
