2022 NURSING 412 AHIP FINAL EXAM TEST Questions and Answers 100%Correct/Verified, Exams of Nursing

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2022 NURSING 412 AHIP FINAL EXAM

TEST Questions and Answers

100%Correct/Verified

Questions and Answers 100%Correct/Verified

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 ensureno gap in coverage. What can you tell her? ✓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. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employedfull 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 are covered under Part A by virtue of having paid Medicare taxes whileworking, though some may be covered as a result of paying monthly premiums. 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 butreplace her existing Medigap plan

2022 NURSING 412 AHIP FINAL EXAM TEST

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up to 60 days over his lifetime, after which he wouldbe responsible for all costs. 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 yearsand paying Medicare taxes. What should you tell her? ✓✓To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes. 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 however coverage usually begins on the fourth month afterdialysis treatments start. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and has

2022 NURSING 412 AHIP FINAL EXAM TEST

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contributed to the Medicare system for over 20 years. Juan asks you if he willbe entitled to Medicare and if he enrolls how that will impact his employer- sponsored healthcare coverage. How would you respond? ✓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 continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan. 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? ✓Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly someservices that Medicare does not cover. Mr. Alonso receives some help paying for his two generic prescription drugs fromhis employer's retiree coverage, but he wants to compare it to a Part D prescriptiondrug plan. He asks you what costs he would generally expect to encounter when enrolling

2022 NURSING 412 AHIP FINAL EXAM TEST

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Ms. Moore plans to retire when she turns 65 in a few months. She is in excellenthealth and will have considerable income when she retires. She is concerned thather income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern? ✓✓Medicare is a program for people age 65or 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. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? ✓✓Dr. Brennan can charge MaryRogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to 15% of the Medicare rate. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him? ✓✓He may receive

2022 NURSING 412 AHIP FINAL EXAM TEST

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health care services from any doctor allowed to bill Medicare, as longas he shows the doctor the plan's identification card and the doctor agrees to acceptthe PFFS plan's payment terms and conditions, which could include balance billing. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description? ✓✓Medicare Advantage is a way of covering all the Original Medicare benefits through privatehealth insurance companies.

2022 NURSING 412 AHIP FINAL EXAM TEST

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✓✓She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost- sharing amounts and Mr. Greco would like to join that plan. What should you tell him? ✓✓SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in theSNP. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? ✓✓Mrs. Radford must be entitledto Part A and enrolled in Part B to enroll in Medicare Advantage. Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State. What should you tell her? Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with Medicaid participating providers.

2022 NURSING 412 AHIP FINAL EXAM TEST

Castillo is still covered by Part A.

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Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. Mr.

2022 NURSING 412 AHIP FINAL EXAM TEST

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Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excessof his maximum out-of-pocket limit that included some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? ✓✓You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the carehe has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him? ✓✓SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful aswell. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage"but is not sure about what type of plan designs are available through this program. What should you tell

2022 NURSING 412 AHIP FINAL EXAM TEST

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him about the types of health plans that are available through the Medicare Advantage program? ✓✓They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.

2022 NURSING 412 AHIP FINAL EXAM TEST

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Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious tohave their Medicare prescription drug plan cover these drug needs. What should you tell them? ✓✓Medicare prescription drug plans are not permitted to cover theprescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughn's could look into that possibility. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition to drugs on his plan's formulary he takes several other medications. These include a prescription drug not on his plan's formulary, over- the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP and he asksyou if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you say? ✓✓None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he maywish to ask his plan for

2022 NURSING 412 AHIP FINAL EXAM TEST

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an exception to cover the prescription not on its formulary.

2022 NURSING 412 AHIP FINAL EXAM TEST

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needs. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. She currently does not have creditable coverage. What could you tell her about the implications of such a decision? ✓✓If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium forevery month that she was not covered. Mr. Shultz was still working when he first qualified for Medicare. At that time, hehad employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. How would you advise him? ✓✓Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order toavoid a premium penalty.

2022 NURSING 412 AHIP FINAL EXAM TEST

What should you tell her? ✓✓ An individual

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Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she isnot enrolled under Medicare Part B.

2022 NURSING 412 AHIP FINAL EXAM TEST