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AHIP Medicare Training Module 1 Final
Review
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. - ANSWER>>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.
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. - ANSWER>>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.
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 f - ANSWER>>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.
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. - ANSWER>>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.
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. - ANSWER>>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.
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. - ANSWER>>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.
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. - ANSWER>>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. - ANSWER>>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. 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. - ANSWER>>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. 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. - ANSWER>>C. Original Medicare covers ambulance services.
Explanation: Original Medicare does cover ambulance services.
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.
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. - ANSWER>>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.
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. - ANSWER>>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.
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. - ANSWER>>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
- After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all cost - ANSWER>>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.
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.
