AHIP Medicare Training Module 1 Final Review

Mrs. West 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 does not cover massage therapy, or, in general, glasses or dentures. B. Medicare covers 80% of the cost of these three services. C. Medicare covers glasses, but not dentures or massage therapy. D. Medicare covers 50% of the cost of these three services.

A. Medicare does not cover massage therapy, or, in general, glasses or dentures. Explanation: Neither Medicare Part A nor Part B covers massage therapy, dentures, or routine eye examinations to prescribe eyeglasses.

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. Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with Original Medicare coverage. 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. 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.

A. Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate with Original Medicare coverage. Explanation: Medigap plans coordinate coverage and works only with Original Medicare.

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. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. 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. 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. D. Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of coverage.

A. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. Explanation: Individuals with coverage based on their own current employment are not subject to the late enrollment penalty.

Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? A. 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. B. Mr. Singh must leave Original Medicare to receive drug coverage. C. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Advantage plan that also covers Part A and Part B services. D. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Advantage plan.

A. 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. Explanation: Prescription drug coverage is available to those who enroll in a stand-alone Part D prescription drug plan and continue coverage under Original Medicare Part A and Part B.

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 Part D costs through his State Pharmaceutical Assistance Program. B. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. C. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state's Medicaid program. D. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging.

A. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Explanation: A State Pharmaceutical Assistance Program may be able to provide assistance with prescription drug costs for those who are of limited means but do not qualify for the Part D low-income subsidy.

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 or several programs that can help with Medicare costs for which she is responsible. B. She should only seek help from private organizations to cover her Medicare costs. C. She should not sign up for a Medicare Advantage plan. D. She can apply to the Medicare agency for lower premiums and cost-sharing.

A. She should contact her state Medicaid agency to see if she qualifies for one or several programs that can help with Medicare costs for which she is responsible. Explanation: Mrs. Park can apply for programs through her State Medicaid office that could assist with her Medicare costs, such as Medicare Savings Programs, Part D low-income subsidies, and Medicaid.

Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn 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 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. B. 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% coinsurance for these services, in addition to an annual deductible. C. Part B will cover her dental and vision needs. D. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage in doing so.

B. 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% coinsurance for these services, in addition to an annual deductible. Explanation: Medicare Part B primarily covers physician services. Enrollees pay a monthly premium based on their income level and have 20% coinsurance cost-sharing with the exception of preventive benefits.

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, 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. B. 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. C. 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. 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.

B. 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. Explanation: Beneficiaries are responsible for a single deductible amount for each benefit period, followed by a per-day coinsurance amount through day 90. For day 91 and beyond, there is a charge for each "lifetime reserve day" up to 60 days over a beneficiary's lifetime. After this, he would be responsible for all costs.

Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her? A. You would be happy to help Anita enroll in a Medigap Part F plan that will provide foreign travel benefits as well as cover her Part B deductible. B. You are sorry to disappoint Anita but a Medigap Part F plan is no longer available to those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. C. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. Anita should instead consider a Medicare Advantage plan. D. You would be happy to help Anita enroll in a Medigap plan but before she can do so, she must also enroll in a Medicare Part D prescription drug plan.

B. You are sorry to disappoint Anita but a Medigap Part F plan is no longer available to those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. Explanation: Individuals who attain age 65 on or after January 1, 2020 cannot purchase a Medigap plan that pays the Part B deductible. Generally, these are plans C, F, or high deductible F. Anita can still purchase a Medigap plan that provides foreign travel emergency benefits such as plan G.

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 monthly premium and deductible. 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 per-prescription co-payment. Medicare covers all other costs.

C. He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing. Explanation: Costs for Part D beneficiaries typically include a monthly premium, annual deductible, and per-prescription cost-sharing.

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 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. B. Medicare covers all screening tests that have been approved by the FDA on a frequency determined by the treating physician. C. Medicare covers the 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. D. 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.

C. Medicare covers the 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. Explanation: Original Medicare and Medicare Advantage plans cover most preventive services, such as screening tests, but beneficiaries must confirm coverage of specific tests with their plans.

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. Medicare inpatient psychiatric coverage is limited to the same number of days covered for typical inpatient stays. B. Inpatient psychiatric services are not covered under Original Medicare. 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.

C. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. Explanation: Medicare Part A provides coverage for inpatient psychiatric care for up to 190 lifetime days.

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 routine dental care. B. Original Medicare covers cosmetic surgery. C. Original Medicare covers ambulance services. D. Original Medicare covers routine long-term custodial care.

C. Original Medicare covers ambulance services. Explanation: Original Medicare does cover ambulance services.

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 hospital and home health services and the cost-sharing has changed this year. 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 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.

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. Explanation: Part D provides prescription drug coverage. Premiums, plan formularies, and cost-sharing, among other factors, may change from one plan year to another.

What impact, if any, have recent regulatory changes had upon Medigap plans? A. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. B. The Part A deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020. C. The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020. D. The Part B deductible is now covered for some newly eligible individuals depending on their financial status.

C. The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020. Explanation: Starting January 1, 2020, Medigap plans sold to individuals who are newly eligible to Medicare are no longer allowed to cover the Part B deductible. If an individual already had one of the plans before January 1, 2020, they can keep their plan. If an individual was eligible for Medicare before January 1, 2020, but are not yet enrolled, he or she may be able to purchase one of these plans.

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 that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries. B. Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Advantage plan. C. To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. D. 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.

C. To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. Explanation: Typically, people eligible for Medicare pay the standard monthly premium rate for Part B. However, this amount may vary based on an individual's income.

Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you tell her? A. You should tell Madeline that she will be able to enroll in both Medicare Part A and Part B without paying monthly premiums due to her husband's long work record and participation in the Medicare system. B. You should tell Madeline that she will need to pay premiums for Part A because of her short work history. You should also tell Madeline that she will pay part B premiums at the highest rate because her income over the last several years has exceeded $100,000. C. You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due to her substantial income. D. You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at the highest rate because her income over the last several years has exceeded $100,000.

C. You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due to her substantial income. Explanation: Madeline will be able to enroll in premium-free Part A due to her husband's work record. She will pay a premium for Part B coverage based on her income level (her income-related monthly adjustment amount [IRMMA]). An income level of $100,000 would mean Mrs. Martinez would pay a premium more than the standard (lowest) amount but not the highest level which looks at incomes above $500,000 for those filing individual income tax returns.

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. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed. B. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. C. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shield's long-term care costs. D. Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days.

D. Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days. Explanation: Mrs. Shields has experienced a long hospital stay, over the 3-day time period to qualify for skilled nursing and rehabilitative care benefits under Medicare.

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? A. 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 the mail. B. Mrs. Duarte has no right to appeal this determination since her claim has been partially paid. C. 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. D. Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail.

D. Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. Explanation: Beneficiaries must file an appeal related to Part A or Part B services within 120 days of the date they get the MSN in the mail.

Mrs. Pena 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 only enroll in Part B during the general enrollment period whether she is retired or not. b. 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. c. She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B. D. 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.

D. 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. Explanation: As long as Mrs. Pena is covered under her employer's plan, she can enroll in Part B at any time. If she retires, she will be able to enroll in Part B during a special enrollment period that lasts 8 months following the last month of her employer coverage.