2025 AHIP - Final Exam

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 Medicare Part D prescription drug plan. What should you tell him? Question 5Answera.He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.b.He generally would pay only a per-prescription co-payment. Medicare covers all other costs.c.He generally would pay only a monthly premium. Medicare covers all other costs.d.He generally would pay only a monthly premium and deductible. Medicare covers all other costs.

a

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? Question 1Answera.Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.b.Medicare will cover, at its allowable amount, as many stays as are needed throughout Mr. Rainey's life, as long as no single stay exceeds 190 days.c.Medicare inpatient psychiatric coverage is limited to the same number of days covered for typical inpatient stays.d.Inpatient psychiatric services are not covered under Original Medicare.

a

Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? Question 2Answera.Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing among other factors to see if they have changed.b.Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up.c.Part D covers long-term care services, and she should not worry because there has been no change in coverage. d.Part D covers hospital and home health services and the cost-sharing has changed this year.

a

Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance? Question 8Answera.She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible.b.She should not sign up for a Medicare Advantage plan.c.She should only seek help from private organizations to cover her Medicare costs.d.She can apply to the Medicare agency for lower premiums and cost-sharing.

a

Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? Question 4Answera.He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits.b.He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start.c.He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments start.d.He may sign-up for Medicare at any time and coverage usually begins immediately.

b

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? Question 7Answera.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.b.Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail.c.Mrs. Duarte has no right to appeal this determination since her claim has been partially paid.d.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 t

b

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? Question 3Answera.Medigap is a replacement for Original Medicare and she has been paying for double coverage. She should simply drop her Medigap policy.b.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.c.Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it likely will not offer coverage that is equivalent to that provided under Part D.d.Mrs. Gonzalez should purchase a K or L Medigap plan.

b

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? Question 9Answera.Medicare covers 50% of the cost of these three services.b.Medicare covers glasses, but not dentures or massage therapy.c.Medicare does not cover massage therapy, or, in general, glasses or dentures.d.Medicare covers 80% of the cost of these three services.

c

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? Question 6Answera.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.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.Medigap plans do not cover Original Medicare benefits, but they coordinate with Original Medicare coverage.

d