2023 AHIP EXAM 2023 A+
Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is
... [Show More] wondering if he can obtain coverage under
Medicare. What should you tell him? - 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? - 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.
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? - 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.
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? - ANS-She may enroll at any time while she is
covered under her employer plan, but she will have a special eight-month 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.
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? - ANS-Most individuals who are citizens and age 65 or 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.
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? - 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.
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.
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? - [Show Less]