AHIP Review UNIT 1 2022/2023 Medicare Basics Exam Completed A+++
2022 Ahip Review
UNIT 1 Medicare Basics
Queston 1
Mr. Buck has several family
... [Show More] members who died from different cancers. He wants to know if Medicare
covers cancer screening. What should you tell him?
a. Medicare covers all screening tests that have been approved by the FDA on a frequency determined
by the treatng physician.
b.Medicare covers treatments for existng disease, injury, and malformed limbs or body parts. As such, it
does not cover any screening tests and these must be paid for by the benefciary out-of-pocket.
c.Medicare covers some screening tests that must be performed within the frst year afer enrollment.
Beyond that point expenses for screening tests are the responsibility of the benefciary.
d.Medicare covers the periodic performance of a range of screening tests that are meant to provide
early detecton of disease. Mr. Buck will need to check specifc tests before obtaining them to see if they
will be covered.
Source: Module 1, Slide - Medicare Part B Benefts - Preventve Services and Screenings
Queston 2
Mr. Schmidt would like to plan for retrement and has asked you what is covered under Original Fee-forService (FFS) Medicare? What could you tell him?
a.Part C, which always covers dental and vision services, is covered under Original Medicare.
b.Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B,
which covers professional services such as those provided by a doctor are covered under Original
Medicare.
c.Part A, which covers long-term custodial care services, is covered under Original Medicare.
d.Part D, which covers prescripton drug services, is covered under Original Medicare.
Source: Module 1, Slide - Overview of Medicare Benefts and Coverage - Parts A, B, C, and Slide -
Overview of Different Ways to Get Medicare
Queston 3
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare
coverage. Juan is a naturalized citzen and has contributed to the Medicare system for over 20 years.
Juan asks you if he will be enttled to Medicare and if he enrolls how that will impact his employersponsored healthcare coverage. How would you respond?
a.Juan is likely to be ineligible for Medicare since he was born outside the United States and has only
contributed to the Medicare system for 20 years.b. 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 but Smallcap must contnue to offer him coverage
under its employer-sponsored group health plan and would become a secondary payor.
c.Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-sponsored
coverage would contnue to be the primary payor while Medicare would be considered a secondary
payor of his healthcare claims.
Incorrect: Medicare is the primary payor for individuals who have group health coverage due to their
contnued employment with a small employer. A small group health plan is one offered by a company
with fewer than 20 employees.
d. 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 contnue to offer him
coverage comparable to those under age 65 under its employer-sponsored group health plan.
Source: Module 1, Slide - Eligibility for Part A and Part B Benefts and Slide - Medicare for Individuals
Who Are Stll Working - Small GHPs and Slide - Medicare Coordinaton with Employer Group Health Plans
Queston 4
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
Administraton and has been receiving disability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him?
a.Afer receiving such disability payments for 24 months, he will be automatcally enrolled in Medicare,
regardless of age.
b.Individuals who become eligible for such disability payments only have to wait 12 months before they
can apply for coverage under Medicare.
c.Individuals receiving such disability payments from the Social Security Administraton contnue to
receive those payments but only become eligible for Medicare upon reaching age 65.
d.He became eligible for Medicare when his disability eligibility determinaton was frst made.
Source: Module 1, Slide - Medicare Enrollment Part A & B
Queston 5
Ms. Moore plans to retre when she turns 65 in a few months. She is in excellent health and will have
considerable income when she retres. She is concerned that her income will make it impossible for her
to qualify for Medicare. What could you tell her to address her concern?
a.Medicare is a program for people who have incomes and assets below specifc limits, so you will have
to fnd out her exact fnancial situaton before telling her whether she can obtain Medicare coverage.
b.Eligibility for Medicare is based on whether or not a person has ever been employed by the federal
government. If she or her husband were ever employed by the federal government, she can enroll in
Medicare.c.Medicare is a program for people of all ages with specifc mental health disabilites. Since she is in
excellent health, she would not qualify, but should instead look into her state’s Medicaid program if she
wants further coverage.
d.Medicare is a program for people age 65 or older and those under age 65 with certain disabilites, endstage renal disease, and Lou Gehrig’s disease so she will be eligible for Medicare.
Source: Module 1, Slide - Eligibility for Part A and Part B Benefts
Queston 6
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
Summary Notce (MSN) and disagrees with a determinaton that partally denied one of her claims for
services. What advice would you give her?
a. Mrs. Duarte should fle an appeal of this inital determinaton within 120 days of the date she received
the MSN in the mail.
b.Mrs. Duarte has no right to appeal this determinaton since her claim has been partally paid.
c. Mrs. Duarte should fle an appeal of this inital determinaton within 90 days of the date she received
the MSN in the mail. If she stll disagrees with Medicare Administratve Contractor's (MAC's) further
decision she should request a reconsideraton by a qualifed independent party within 10 days.
Incorrect: Benefciaries must fle an appeal related to Part A or B services within 120 days of the date
they get the MSN in the mail. If a benefciary disagrees with the Medicare Administratve Contractor’s
decision, he/she has 180 days afer getng the decision notce to request a reconsideraton by a
Qualifed Independent Contractor.
d.Mrs. Duarte should request a reconsideraton of the decision by a qualifed independent party within
60 days of the date she received the MSN in the mail.
Source: Module 1, Slide - Appeals related to Part A and Part B Coverage and Payment Determinatons.
Queston 7
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?
a.Medicare Supplemental Insurance would cover his dental, vision and hearing services only.
b.Medicare Supplemental Insurance would help cover his Part A and Part B deductbles or coinsurance in
Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
c.Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not
covered under Original Fee-for-Service (FFS) Medicare.
d.Medicare Supplemental Insurance would cover his long-term care services.
Source: Module 1, Slide - Medigap (Medicare Supplement Insurance)Queston 8
Agent John Miller is meetng with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare
Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for
several years. However, the plan does not provide drug benefts. How would you advise Agent John
Miller to proceed?
a.Tell prospect Jerry Smith that Medigap is simply a variaton of a Medicare Advantage plan and the
companies John represents offer more comprehensive coverage for a lower price.
b.Tell prospect Jerry Smith that he should consider adding a standalone Part D prescripton drug [Show Less]