AHIP Certification - Part 1
c
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? a. He generally would pay only a monthly premium. Medicare covers all other costs. b. He generally would pay only a per-prescription co-payment. Medicare covers all other costs. c. He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing. d. He generally would pay only a monthly premium and deductible. Medicare covers all other costs.
c
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him? a. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. b. He became eligible for Medicare when his disability eligibility determination was first made. c. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. d. Individuals receiving such disability payments from the Social Security Administration continue to receive those payments, but only become eligible for Medicare upon reaching age 65.
b
Mr. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him? a. Medicare covers some screening tests that must be performed within the first year after enrollment. Beyond that point expenses for screening tests are the responsibility of the beneficiary. b. Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. c. Medicare covers all screening tests that have been approved by the FDA on a frequency determined by the treating physician. d. Medicare covers treatments for existing 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 beneficiary out of pocket. Incorrect
d
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him? a. Medigap policies designed to cover costs not paid for by a MA plan can be purchased, but only if the MA plan's design is considered to be the "defined standard benefit." b. Medigap plans are a form of Medicare Advantage, so purchasing both would be redundant coverage. c. Medigap plans that cover costs not paid for by a MA plan are available only in Massachusetts, Minnesota, and Wisconsin. d. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
c
Mr. Denton 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? a. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments start. b. He may sign-up for Medicare at any time and coverage usually begins immediately. c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. d. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits
d
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. 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. 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. Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of coverage. d. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
c
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. What should you tell him about his concern? a. He should not be concerned because Medicare health plans must cover all IRS-approved health care expenses, which means that all of them provide substantially greater benefits than are available under Medicare Part A and Part B. b. Medicare health plans offer a menu of benefits, from which he may choose, so if he ever wants to increase his coverage, he need only contact the plan and select other options. c. Medicare health plans must cover all benefits available under Medicare Part A and Part B. Many also cover Part D prescription drugs. d. Medicare health plans have the option of deciding, each year, what services they will cover. He is correct that the health plan could eliminate some benefits covered by Medicare and he should think carefully before enrolling in a Medicare health plan.
a
Mr. Kelly has substantial financial means. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D? a. He will incur a late enrollment penalty. b. He will not be able to enroll in Part D unless he decides to also enroll in a Medicare Advantage plan. c. He will incur a one-time financial penalty equal to 30 percent of the annual Part D premium. d. He will avoid any financial penalty or late enrollment fee under the grandfathering provisions of Medicare Part D.
d
Mr. Meoni'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.Meoni? a. Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee-for-Service (FFS) Medicare. b. Medicare Supplemental Insurance would cover his dental, vision and hearing services only. c. Medicare Supplemental Insurance would cover his long-term care services. d. Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
c
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? a. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary's stay. After day 60 the amount gradually increases until day 90. After 90 days he would pay the full amount of all costs. b. Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a non-participating provider. c. 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 d. Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The percentage increases after 60 days and again after 90 days.
c
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? a. Inpatient psychiatric services are not covered under Original Medicare. b. Medicare inpatient psychiatric coverage is limited to the same number of days covered for typical inpatient stays. c. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. d. 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.
b
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? What could you tell him? a. Part D, which covers prescription drug 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 C, which always covers dental and vision services, is covered under Original Medicare. d. Part A, which covers long term custodial care services, is covered under Original Medicare.
b
Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should you tell him? a. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan. b. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. c. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Health Plan that also covers Part A and Part B services. d. Mr. Singh must leave Original Medicare to receive drug coverage.
d
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 for Part D costs through the local Office of the Aging. b. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state's Medicaid program. c. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. d. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
c
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? a. All individuals who are citizens and over age 65 will be covered under Part A. b. Most individuals who are citizens and over age 65 and are covered under Part A must pay a monthly premium for that coverage. c. Most individuals who are citizens and over age 65 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. d. Most individuals who are citizens and over age 65 and wish to be covered under Part A must enroll in a Medicare Health Plan.
c
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because 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? a. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. b. Part D covers hospital and home health services and the cost sharing has changed this year. c. 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. d. Part D covers long-term care services and she shouldn't worry because there has been no change in coverage.
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? a. 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 won't offer coverage that is equivalent to that provided under Part D. d. Mrs. Gonzalez should purchase a K or L Medigap plan.
a
Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. She is considering enrollment in a Medicare health plan (Part C). What should you advise her to do before she will be able to enroll into a Medicare health plan? a. In order to join a Medicare health plan, she also must enroll in Part B. b. Since she is age 65 she may enroll in any Medicare health plan, regardless of whether she is entitled to Part A or Part B coverage. c. To enroll in a Medicare health plan, she need only be entitled to Part A, so she does not need to take any further steps. d. In order to join a Medicare health plan, she must be enrolled in Parts A, B and D.
a
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA), but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? a. All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan. b. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services. c. All beneficiaries enrolled in an MSA pay a plan premium in addition to their Part B premium. d. MSA enrollees may only receive covered health care services from a limited panel of network providers because otherwise some providers may charge more than Original Medicare rates.
a
Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that might be of assistance? a. 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. Correct b. She can apply to the Medicare agency for lower premiums and cost-sharing. Incorrect c. She should not sign up for a Medigap or Medicare Advantage plan. Incorrect d. She should only seek help from private organizations to cover her Medicare costs.
b
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. 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 help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. c. All costs not covered by Medicare are covered by some Medigap plans. d. Medigap plans are not sold by private companies and are a government insurance product.
c
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? a. She may not enroll in Part B while covered under an employer group health plan and must wait until the standard general enrollment period after she retires. b. She may only enroll in Part B during the general enrollment period whether she is retired or not. c. She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. d. She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B.
d
Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn and received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? a. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage to doing so. b. Part B will cover her dental and vision needs. c. She will need to pay no premiums for Part B as she qualifies for premium free coverage due to the number of quarters she has worked. d. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible.
b
Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that it is a forgery since it does not have her Social Security number on it. What should you tell her? a. The card is indeed a forgery since newly issued Medicare cards will have both a beneficiary's Social Security number and date of birth imprinted on them. b. The card she received I valid, the change has been made to protect Medicare beneficiaries from identity theft, and she should now destroy her old card. c. The card is indeed a forgery since all identity cards are being phased-out in favor of a new electronic identity system developed by the Social Security Administration. d. The card she received is valid but she should keep her old card for at least two years and present it whenever she receives health care.
b
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? a. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term care costs. b. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days. c. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. d. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed.
d
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 orthopedic shoes. b. Original Medicare covers cosmetic surgery. c. Original Medicare covers routine foot care. d. Original Medicare covers ambulance services.
a
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific plans. What could you tell her? a. Medicare Health Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services. b. Medicare Health Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services, but must include a maximum out-of-pocket limit. c. Medicare Health Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare. d. All Medicare Health Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare.
c
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her? a. Medicare covers 50% of the cost of these three services. b. Medicare covers 80% of the cost of these three services. c. Medicare does not cover acupuncture, or, in general, glasses or dentures. d. Medicare covers glasses, but not dentures or acupuncture.
d
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? a. She is correct because she will be covered under Part A, without paying premiums and she has worked for 40 years so she will not have to pay Part B premiums. b. Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Health Plan. c. She is correct that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries. d. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes.
d
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. 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. 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. b. Medicare is a program for people of all ages with specific mental health disabilities. 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. c. Medicare is a program for people who have incomes and assets below specific limits, so you will have to find out her exact financial situation before telling her whether she can obtain Medicare coverage. d. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end stage renal disease and Lou Gehrig's disease, so she will be eligible for Medicare.
d
What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? a. The Part A deductible is no longer covered under Medigap plans for all enrollees staring January 1, 2020. b. MACRA provides funding to help individuals age 59 and above enroll in Medigap plans. c. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. d. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020.
