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Medicare- Ahip Training Question And Solved Solution, Exams of Advanced Education

University of LimpopoAdvanced Education

Medicare- Ahip Training Question And Solved Solution

Typology: Exams

2025/2026

Available from 02/14/2026

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Medicare- Ahip Training
Eligibility for Medicare
- Over 65
- Be disabled
- Have permanent kidney failure
What is not taken into consideration for eligibility?
individual income
individuals with higher income pay
higher premiums
individuals with lower income may qualify
for additional benefits
What are the ways for individuals to receive Medicare coverage
Direct from federal government and through private health plans
most outpatient Medicare drug benefits are through
private company
Part A of Medicare
helps pay for care in a hospital or skilled nursing facility or for care from a home health
agency or hospice
Part B Medicare
supplemental includes a broad range of coverage ( Physician care, drugs administered
by physician, vaccines and IV Meds)
Part C (Medicare Advantage)
regulates and authorizes Medicare advantage plans, which must cover (A & B) Benefits
Part D Medicare
Prescription drug coverage ( Must be covered by A&B) also must live in covered area
Part E Medicare
Miscellaneous Programs
Including: Medicare cost plans (Cover A & B Benefits)
Are Medicare cost plans offered in all states?
no, they are only offered in a limited number of states, mostly rural areas
Medicare supplement plans are also called
Medigap
Original medicare ( A&B) can be combined with
Medicare supplement plan and/or Medicare Prescription drug plan
Eligibility for A&B
-Must be 65 yrs. old or be under 65 with certain disabilities including all who get benefits
from ss or railroad retirement board for 24 months
Us citizens or aliens legally residing in the US for _____ yrs. are eligible
5 continuous years
Individuals already receiving ss benefits or railroad benefits automatically
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Medicare- Ahip Training

Eligibility for Medicare

  • Over 65
  • Be disabled
  • Have permanent kidney failure What is not taken into consideration for eligibility? individual income individuals with higher income pay higher premiums individuals with lower income may qualify for additional benefits What are the ways for individuals to receive Medicare coverage Direct from federal government and through private health plans most outpatient Medicare drug benefits are through private company Part A of Medicare helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice Part B Medicare supplemental includes a broad range of coverage ( Physician care, drugs administered by physician, vaccines and IV Meds) Part C (Medicare Advantage) regulates and authorizes Medicare advantage plans, which must cover (A & B) Benefits Part D Medicare Prescription drug coverage ( Must be covered by A&B) also must live in covered area Part E Medicare Miscellaneous Programs Including: Medicare cost plans (Cover A & B Benefits) Are Medicare cost plans offered in all states? no, they are only offered in a limited number of states, mostly rural areas Medicare supplement plans are also called Medigap Original medicare ( A&B) can be combined with Medicare supplement plan and/or Medicare Prescription drug plan Eligibility for A&B -Must be 65 yrs. old or be under 65 with certain disabilities including all who get benefits from ss or railroad retirement board for 24 months Us citizens or aliens legally residing in the US for _____ yrs. are eligible 5 continuous years Individuals already receiving ss benefits or railroad benefits automatically

enroll on the month they turn 65 Individuals with disabilities under age 65 automatically enroll the _______ after receiving ss or railroad. Month Disabled individuals in puerto rico automatically get part A after ____ 24 months but need to sign up for part b if they want it Individuals with ALS get A&B automatically the month after their ss begins When does the initial enrollment period start 3 months before their 65th birthday and ends 3 months later people with ESRO may sign up any time. however coverage doesnt typically start until 4 months after dialysis treatment When is the general enrollment period? January 1st- March 31st When does coverage start for individuals enrolled during general enrollment? July 1st of the year enrolled Agents are encouraged to tell low income individuals to apply for help through the phone 1-800-Medicare under original medicare = what deductible for each period $ Benefit period begins the day individual is admitted to a hospital or skilled nursing facility Benefits end when individual hasn't received those benefits for 60 days in a row Day 1- $0 coinsurance for each period day 61- $371 coinsurance per day for each period day 91 and beyond $742 coinsurance per each inpatient physician care 190 lifetime days Benefit amounts for day 1- $0 for each benefit period Benefit amount for day 21- $185.50 coinsurance per day Benefit amount for day 101 + Beyond all cost individuals with group health coverage based on their current employment or spouses employment may enroll In part A ( May have to buy it) and/or part B anytime while covered by group plan group health coverage members can also enroll during the 8 month period immediately following last month of group coverage

  1. colorectal cancer screening
  2. pap and pelvic exam every 24 months
  3. diabetes
  4. prostate cancer
  5. smoking and Tabaco counseling
  6. glaucoma test When is the automatic enrollment period for part D October 1st - December 7th with part D , typically pay a monthly premium, annual deductible, per- script cost sharing Beneficiaries must file an appeal within _________ days of the date they get the MSN ( Medical Summary Notice) in the mail. 120 days Appeals should be sent to MAC ( Medicare administrative contractor) that processed their claim If beneficiaries disagree with claim they have _______ days to request a reconsideration 180 days providers send written notice before services end Medigap only works with original medicare medigap is sold by many (private) companies to fill in gaps in original medicare benefits but cordinates with original medicare coverage Medigap is not a medicare advantage plan or original medicare medigap cant be used with a medicare advantage plan it is illegal to sell a medigap plan to someone who already has a medicare advantage plan Turning 65 and signing up for part B triggers a 6 month medigap open enrollment period during the open enrollment period , medigap insurers must issue a policy regardless of pre-exsisting conditions , guaranteed issue right