2025 AHIP – Module 1 Final Review

Question 1

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?

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.

Inpatient psychiatric services are not covered under Original Medicare.

Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey’s entire lifetime.

Medicare inpatient psychiatric coverage is limited to the same number of days covered for typical inpatient stays.

Question 2

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?

Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of coverage.

Mr. Diaz will not pay any penalty because he had continuous coverage under his employer’s plan.

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.

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.

Question 3

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?

Medicare covers 50% of the cost of these three services.

Medicare covers glasses, but not dentures or massage therapy.

Medicare does not cover massage therapy, or, in general, glasses or dentures.

Medicare covers 80% of the cost of these three services.

Question 4

Anita Magri will turn age 65 in August 2023. 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 Plan F 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?

You would be happy to help Anita enroll in a Medigap F plan that will provide foreign travel benefits as well as cover her Part B deductible.

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.

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.

You are sorry to disappoint Anita, but a Medigap 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.

Question 5

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?

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.

Mrs. Duarte has no right to appeal this determination since her claim has been partially paid.

Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail.

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.

Question 6

Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries?

Beneficiaries under Original Medicare have no cost-sharing for most preventive services.

Medicare Part B generally provides prescription drug coverage.

Medicare Part A generally covers medically necessary physician and other health care professional services.

Benefits covered by Medicare Parts A and B include routine dental care, hearing aids, and routine eye care.

Question 7

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?

Original Medicare covers routine dental care.

Original Medicare covers cosmetic surgery.

Original Medicare covers routine long-term custodial care.

Original Medicare covers ambulance services.

Question 8

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?

Medigap plans are not sold by private companies and are a government insurance product.

Medigap plans do not cover Original Medicare benefits, but they coordinate with Original Medicare coverage.

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.

All costs not covered by Medicare are covered by some Medigap plans.

Question 9

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?

Most individuals who are citizens and age 65 or over and wish to be covered under Part A must enroll in a Medicare Advantage Plan.

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.

Most individuals who are citizens and age 65 or over and are covered under Part A must pay a monthly premium for that coverage.

All individuals who are citizens and age 65 or over will be covered under Part A.

Question 10

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?

Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up.

Part D covers long-term care services, and she should not worry because there has been no change in coverage.

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.

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

Question 11

Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn?

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.

She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage in doing so.

Part B primarily covers physician services. She will be paying a monthly premium and, except for many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible.

Part B will cover her routine dental and vision needs.

Question 12

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?

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.

Medicare will cover an unlimited number of days in a skilled nursing facility, as long as a physician certifies that such care is needed.

Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit.

Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shield’s long-term care costs.

Question 13

Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him?

Mr. Singh must leave Original Medicare to receive drug coverage.

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.

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.

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.

Question 14

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?

He may sign-up for Medicare at any time and coverage usually begins immediately.

He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments start.

He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start.

He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits.

Question 15

What impact, if any, have recent regulatory changes had on Medigap plans?

The Part B deductible is now covered for some newly eligible individuals depending on their financial status.

The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020.

The Part A deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020.

The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020.

Question 16

Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance?

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.

She should not sign up for a Medicare Advantage plan.

She can apply to the Medicare agency for lower premiums and cost-sharing.

She should only seek help from private organizations to cover her Medicare costs.

Question 17

Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in case she needs them. What should you tell her?

Medicare does not cover hospice services. Hospice services are only available through state Medicaid programs if the state offers such coverage.

Hospice services are currently only offered under a limited demonstration project. Whether they will eventually become available nationally depends on the outcome of the demonstration.

Medicare covers hospice services, and they will be available for her.

The Federal government facilitates competition between hospice programs to lower the price of their services for Medicare beneficiaries but does not offer coverage for hospice services through the Medicare program.

Question 18

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?

He generally would pay only a monthly premium. Medicare covers all other costs.

He generally would pay only a per-prescription co-payment. Medicare covers all other costs.

He generally would pay only a monthly premium and deductible. Medicare covers all other costs.

He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.

Question 19

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 because of an illness. In general terms, what could you tell him about his costs for inpatient hospital services under Original Medicare?

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.

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.

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.

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.

Question 20

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?

Medigap is a replacement for Original Medicare and she has been paying for double coverage. She should simply drop her Medigap policy.

Mrs. Gonzalez should purchase a K or L Medigap plan.

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.

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.

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