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AHIP Medicare Training Module 1 Final
Reviewed Multiple Choice Questions With
Correct Answers Latest 2025/
- Whatgimpact,gifgany,ghavegrecentgregulatorygchangesghadgupongMedigap plans? A. ThegPartgAgdeductiblegisgnoglongergcoveredgundergMedigapgplansgforgallg en rolleesgstartinggJanuaryg1,g2020. B. ThegPartgAgdeductiblegisgnoglongergcoveredgforgindividualsgnewlygeligiblegforg M edicaregstartinggJanuaryg1,g2020. C. ThegPartgBgdeductiblegisgnoglongergcoveredgforgindividualsgnewlygeligiblegforg M edicaregstartinggJanuaryg1,g2020. D. ThegPartgBgdeductiblegisgnowgcoveredgforgsomegnewlygeligiblegindividualsg dep endinggongtheirgfinancialgstatus.:gC.gThegPartgBgdeductiblegisgnoglongergcoveredg forgindi vidualsgnewlygeligiblegforgMedicaregstartinggJanuaryg1,g2020. Explanation:gStartinggJanuaryg1,g2020,gMedigapgplansgsoldgtogindividualsgwhogareg newl ygeligiblegtogMedicaregaregnoglongergallowedgtogcovergthegPartgBgdeductible.gIfgang individual galreadyghadgonegofgthegplansgbeforegJanuaryg1,g2020,gtheygcangkeepgtheirg plan.gIfgangindiv idualgwasgeligiblegforgMedicaregbeforegJanuaryg1,g2020,gbutgaregnotg yetgenrolled,ghegorgsh egmaygbegablegtogpurchasegonegofgthesegplans.
- Mrs.gGeisler'sgneighborgtoldghergshegshouldglookgatghergPartgDgoptionsgduringg the
gannualgMedicaregenrollmentgperiodgbecausegfeaturesgofgPartgDgmightghaveg chan ged.gMrs.gGeislergcan'tgremembergwhatgPartgDgisgsogshegcalledgyougtogaskg whatghe rgneighborgwasgtalkinggabout.gWhatgcouldgyougtellgher? A. PartgDgcoversghospitalgandghomeghealthgservicesgandgthegcost- sharingghasg changedgthisgyear. B. PartgDgcoversgphysiciangandgnon- physiciangpractitionergservicesgandgtheg deductibleghasgnotgchangedgthisgyear,g butgthegphysiciangchargesgmayggogup. C. PartgDgcoversgprescriptiongdrugsgandgshegshouldglookgatghergpremiums,g form ulary,gandgcost-sharinggamonggothergfactorsgtogseegifgtheyghavegchanged. D. PartgDgcoversglong- termgcaregservicesgandgshegshouldn'tgworrygbecauseg thereghasgbeengnogchangeg ingcoverage.:gC.gPartgDgcoversgprescriptiongdrugsgandg shegshouldglookgatghergpremium s,gformulary,gandgcost-sharinggamonggothergfactorsgtogseegifgtheyghavegchanged. Explanation:gPartgDgprovidesgprescriptiongdruggcoverage.gPremiums,gplangformu- g laries,gandgcost- sharing,gamonggothergfactors,gmaygchangegfromgonegplangyeargtog another.
- Mrs.gShieldsgisgcoveredgbygOriginalgMedicare.gShegsustainedgaghipgfractureg an dgisgbeinggsuccessfullygtreatedgforgthatgcondition.gHowever,gshegandgherg physici ansgfeelgthatgaftergherglengthyghospitalgstaygshegwillgneedgagmonthgorgtwog ofgnursingg andgrehabilitativegcare.gWhatgshouldgyougtellgthemgaboutgOriginal
D. Medicaregwillgcover,gatgitsgallowablegamount,gasgmanygstaysgasgaregneededg th roughoutgMr.gRainey'sglife,gasglonggasgnogsinglegstaygexceedsg 190 gdays.:gC.g Medi caregwillgcovergagtotalgofg 190 gdaysgofginpatientgpsychiatricgcaregduringgMr.g Rainey'sgenti reglifetime. Explanation:gMedicaregPartgAgprovidesgcoveragegforginpatientgpsychiatricgcaregforgupg tog 190 glifetimegdays.
- Mr.gBuckghasgseveralgfamilygmembersgwhogdiedgfromgdifferentgcancers.gHeg wa ntsgtogknowgifgMedicaregcoversgcancergscreening.gWhatgshouldgyougtellghim? A. Medicaregcoversgtreatmentsgforgexistinggdisease,ginjury,gandgmalformedglimb sgorgbodygparts.gAsgsuch,gitgdoesgnotgcoverganygscreeninggtestsgandgtheseg mustgb egpaidgforgbygthegbeneficiarygout-of-pocket. B. MedicaregcoversgallgscreeninggtestsgthatghavegbeengapprovedgbygthegFDAgong agf requencygdeterminedgbygthegtreatinggphysician. C. Medicaregcoversgthegperiodicgperformancegofgagrangegofgscreeninggtestsgthat
aregmeantgtogprovidegearlygdetectiongofgdisease.gMr.gBuckgwillgneedgtogcheck specificgtestsgbeforegobtaininggthemgtogseegifgtheygwillgbegcovered. D. Medicaregcoversgsomegscreeninggtestsgthatgmustgbegperformedgwithingtheg fir stgyeargaftergenrollment.gBeyondgthatgpointgexpensesgforgscreeninggtestsg aregtheg responsibilitygofgthegbeneficiary.:gC.gMedicaregcoversgthegperiodicgper- gformancegofgagrangegofgscreeninggtestsgthatgaregmeantgtogprovidegearlygdetectiongofg dis ease.gMr.gBuckgwillgneedgtogcheckgspecificgtestsgbeforegobtaininggthemgtogseegifg theygwillg begcovered. Explanation:gOriginalgMedicaregandgMedicaregAdvantagegplansgcovergmostgpreven- g tivegservices,gsuchgasgscreeninggtests,gbutgbeneficiariesgmustgconfirmgcoveragegofg spe cificgtestsgwithgtheirgplans.
- MadelinegMartinezgwasgwidowedgseveralgyearsgago.gHerghusbandgworkedgforg m anygyearsgandgcontributedgintogthegMedicaregsystem.gHegalsogleftgagsubstan- g tialgestategwhichgprovidesgMadelinegwithgangannualgincomegofgapproximately $130,000.gMadeline,gwhoghasgonlygworkedgpart- timegforgtheglastgthreegyears,gwillg soongturngageg 65 gandghopesgtogenrollgingOriginalg Medicare.gShegcomesgtogyoug forgadvice.gWhatgshouldgyougtellgher? A.YougshouldgtellgMadelinegthatgshegwillgbegablegtogenrollgingbothgMedicaregPartgAga ndgPartgBgwithoutgpayinggmonthlygpremiumsgduegtogherghusband'sglongg workgrec ordgandgparticipationgingthegMedicaregsystem. B.gYougshouldgtellgMadelinegthatgshegwillgneedgtogpaygpremiumsgforgPartgAgbecaus egofghergshortgworkghistory.gYougshouldgalsogtellgMadelinegthatgshegwillgpaygpartgBg premiumsgatgtheghighestgrategbecauseghergincomegovergtheglastg severalgyearsgha sgexceededg$100,000.
Explanation:gMadelinegwillgbegablegtogenrollgingpremium- freegPartgAgduegtogherg husband'sgworkgrecord.gShegwillgpaygagpremiumgforgPartgBgcoverag egbasedgongherg incomeglevelg(hergincome- relatedgmonthlygadjustmentgamountg[IRMMA]).gAngincomeg levelgofg$100,000gwouldgmea ngMrs.gMartinezgwouldgpaygagpremiumgmoregthangtheg standardg(lowest)gamountgbutgnotgt heghighestglevelgwhichglooksgatgincomesgabove $500,000gforgthosegfilinggindividualgincomegtaxgreturns.
- Mrs.gWestgwearsgglassesgandgdenturesgandghasgenjoyedgconsiderablegpaing rel iefgfromgarthritisgthroughgacupuncture.gShegisgconcernedgaboutgwhethergorg notg Medicaregwillgcovergthesegitemsgandgservices.gWhatgshouldgyougtellgher? A. Medicaregdoesgnotgcovergmassagegtherapy,gor,ginggeneral,gglassesgorgden- gtures. B. Medicaregcoversg80%gofgthegcostgofgthesegthreegservices. C. Medicaregcoversgglasses,gbutgnotgdenturesgorgmassagegtherapy. D. Medicaregcoversg50%gofgthegcostgofgthesegthreegservices.:gA.gMedicaregdoesg no tgcovergmassagegtherapy,gor,ginggeneral,gglassesgorgdentures. Explanation:gNeithergMedicaregPartgAgnorgPartgBgcoversgmassagegtherapy,gdentures,gorgr outinegeyegexaminationsgtogprescribegeyeglasses.
- Ms.gHendersongbelievesgthatgshegwillgqualifygforgMedicaregcoveragegwheng sh egturnsg65,gwithoutgpayingganygpremiums,gbecausegsheghasgbeengworkingg forg 4 0 gyearsgandgpayinggMedicaregtaxes.gWhatgshouldgyougtellgher? A. ShegisgcorrectgthatgshegwillgnotghavegtogpaygagpremiumgbecausegStateg pr ogramsgcovergthegcostgofgPartgBgpremiumsgforgall Medicaregbeneficiaries.
B. MedicaregbeneficiariesgonlygpaygagPartgBgpremiumgifgtheygaregenrolledgingag Me dicaregAdvantagegplan. C. TogobtaingPartgBgcoverage,gshegmustgpaygagstandardgmonthlygpremium,g th oughgitgisghighergforgindividualsgwithghighergincomes. D. ShegisgcorrectgbecausegshegwillgbegcoveredgundergPartgA,gwithoutgpayingg pr emiumsgandgsheghasgworkedgforg 40 gyearsgsogshegwill notghavegtogpaygPartgBgpremiums.:gC.gTogobtaingPartgBgcoverage,gshegmustgpaygagstan dardgmonthlygpremium,gthoughgitgisghighergforgindividualsgwithghighergincomes. Explanation:gTypically,gpeoplegeligiblegforgMedicaregpaygthegstandardgmonthlygpremi- gumgrategforgPartgB.gHowever,gthisgamountgmaygvarygbasedgongangindividual'sgincome.
- Mrs.gPatersongisgconcernedgaboutgthegdeductiblesgandgco-paymentsgassoci- g atedgwithgOriginalgMedicare.gWhatgcangyougtellghergaboutgMedigapgasgangoptiong tog addressgthisgconcern?
10 D. Mr.gDiazgwillgpaygagpenalty,gwhichgwillgbegagflatgamountgeachgyear,gpaidgduringgtheg firstgmonthgofgcoverage.:gA.gMr.gDiazgwillgnotgpayganygpenaltygbecausegheghadg continu ousgcoveragegunderghisgemployer'sgplan. Explanation:gIndividualsgwithgcoveragegbasedgongtheirgowngcurrentgemploymentgareg no tgsubjectgtogtheglategenrollmentgpenalty.
- Mr.gWugisgeligiblegforgMedicare.gHeghasglimitedgfinancialgresourcesgbutgfailedg tog qualifygforgthegPartgDglow- incomegsubsidy.gWheregmightghegturngforghelpgwithghisgprescriptiongdruggcosts? A. Mr.gWugmaygstillgqualifygforghelpgingpayinggPartgDgcostsgthroughghisgStateg Ph armaceuticalgAssistancegProgram. B. Mr.gWugmaygstillgqualifygforghelpgingpayinggforgPartgDgcostsgthroughgtheg Fe deralgPharmaceuticalgAssistancegProgram. C. Mr.gWughasgnogalternativegbutgtogliquidateghisgremaininggassetsgandgapply
11 forgcoveragegthroughghisgstate'sgMedicaidgprogram. D. Mr.gWugmaygstillgqualifygforghelpgingpayinggforgPartgDgcostsgthroughgtheglocalg Off icegofgthegAging.:gA.gMr.gWugmaygstillgqualifygforghelpgingpayinggPartgDgcostsg throughghisg StategPharmaceuticalgAssistancegProgram. Explanation:gAgStategPharmaceuticalgAssistancegProgramgmaygbegablegtogprovideg as sistancegwithgprescriptiongdruggcostsgforgthosegwhogaregofglimitedgmeansgbutgdog notgqu alifygforgthegPartgDglow-incomegsubsidy.
- Mrs.gTurnergisgcomparingghergemployer'sgretireeginsurancegtogOriginalgMe dicaregandgwouldglikegtogknowgwhichgofgthegfollowinggservicesgOriginalg Medic aregwillgcovergifgthegappropriategcriteriagaregmet?gWhatgcouldgyougtellg her? A. OriginalgMedicaregcoversgroutinegdentalgcare. B. OriginalgMedicaregcoversgcosmeticgsurgery. C. OriginalgMedicaregcoversgambulancegservices. D. OriginalgMedicaregcoversgroutineglong- termgcustodialgcare.:gC.gOriginalg Medicaregcoversgambulancegservices. Explanation:gOriginalgMedicaregdoesgcovergambulancegservices.
- Mrs.gDuartegisgenrolledgingOriginalgMedicaregPartsgAgandgB.gSheghasgrecentlyg re viewedghergMedicaregSummarygNoticeg(MSN)gandgdisagreesgwithgagdetermi- g nationgthatgpartiallygdeniedgonegofghergclaimsgforgservices.gWhatgadvicegwouldg y ouggivegher? A. Mrs.gDuartegshouldgrequestgagreconsiderationgofgthegdecisiongbygagqualifiedg in dependentgpartygwithing 60 gdaysgofgthegdategshegreceived thegMSNgingthegmail.
13 Explanation:gBeneficiariesgmustgfilegangappealgrelatedgtogPartgAgorgPartgBgservices withing 120 gdaysgofgthegdategtheyggetgthegMSNgingthegmail.
- AnitagMagrigwillgturngageg 65 gingAugustg2020.gAnitagintendsgtogenrollging Original gMedicaregPartgAgandgPartgB.gShegwouldgalsoglikegtogenrollgingagMedicareg Supplemen tg(Medigap)gplan.gAnita'sgoldergneighborgMelghasgtoldghergaboutgthegMedigapgPartg Fgplangingwhichghegisgenrolled.gItgnotgonlygprovidesgforeigngtravelg emergencygbene fitsgbutgalsogcoversghisgMedicaregPartgBgdeductible.gAnitag comesgtogyougforgadvic e.gWhatgshouldgyougtellgher? A.gYougwouldgbeghappygtoghelpgAnitagenrollgingagMedigapgPartgFgplangthatgwillgprovi degforeigngtravelgbenefitsgasgwellgasgcoverghergPartgBgdeductible. B.gYougaregsorrygtogdisappointgAnitagbutgagMedigapgPartgFgplangisgnoglongergavaila blegtogthosegwhogturngageg 65 gaftergJanuaryg1,g2020.gAnitagmightginsteadg considerg othergMedigapgplansgthatgoffergforeigngtravelgbenefitsgbutgdognotgcoverg thegPartgBgd eductible. C.YougaregsorrygtogdisappointgAnitagbutgMedigapgplansgaregnoglongergavailableg tog thosegwhogturngageg 65 gaftergJanuaryg1,g2020. AnitagshouldginsteadgconsidergagMedicaregAdvantagegplan. D.gYougwouldgbeghappygtoghelpgAnitagenrollgingagMedigapgplangbutgbeforegshegcang dogso,gshegmustgalsogenrollgingagMedicaregPartgD prescriptiongdruggplan.:gB.gYougaregsorrygtogdisappointgAnitagbutgagMedigapgPartgFgplang isgnoglongergavailablegtogthosegwhogturngageg 65 gaftergJanuaryg1,g2020.gAnitag mightginstea dgconsidergothergMedigapgplansgthatgoffergforeigngtravelgbenefitsgbutgdog notgcovergthegPar tgBgdeductible. Explanation:gIndividualsgwhogattaingageg 65 gongorgaftergJanuaryg1,g 2020 gcannotg purchas
14 egagMedigapgplangthatgpaysgthegPartgBgdeductible.gGenerally,gthesegaregplansgC,gF,gorghighgd eductiblegF.gAnitagcangstillgpurchasegagMedigapgplangthatgprovidesgforeigngtravelgemerge ncygbenefitsgsuchgasgplangG.
- Mrs.gParkgisgangelderlygretiree.gSheghasgaglow,gfixedgincome.gWhatgcouldgyoug tell gMrs.gParkgthatgmightgbegofgassistance? A. ShegshouldgcontactghergstategMedicaidgagencygtogseegifgshegqualifiesgforg one gorgseveralgprogramsgthatgcanghelpgwithgMedicaregcostsgforgwhichgshegisg respo nsible. B. ShegshouldgonlygseekghelpgfromgprivategorganizationsgtogcoverghergMedicareg co sts. C. ShegshouldgnotgsigngupgforgagMedicaregAdvantagegplan. D. ShegcangapplygtogthegMedicaregagencygforglowergpremiumsgandgcost-shar- g ing.:gA.gShegshouldgcontactghergstategMedicaidgagencygtogseegifgshegqualifiesgforgoneg orgs everalgprogramsgthatgcanghelpgwithgMedicaregcostsgforgwhichgshegisgresponsible.
16
- Mr.gSinghgwouldglikegdruggcoveragegbutgdoesgnotgwantgtogbegenrolledgingag Me dicaregAdvantagegplan.gWhatgshouldgyougtellghim? A. Mr.gSinghgcangenrollgingagstand- alonegprescriptiongdruggplangandgcontinueg togbegcoveredgforgPartgAgandgPartgBgse rvicesgthroughgOriginalgFee-For-Serviceg Medicare. B. Mr.gSinghgmustgleavegOriginalgMedicaregtogreceivegdruggcoverage. C. PartgDgprescriptiongdruggcoveragegcangonlygbegobtainedgbygenrollmentgintog ag MedicaregAdvantagegplangthatgalsogcoversgPartgA andgPartgBgservices. D. Mr.gSinghgwillghavegtogenrollgingMedicaidgifghegwishesgtogobtaingprescriptiong dr uggcoveragegthroughgsomegmeansgothergthanga MedicaregAdvantagegplan.:gA.gMr.gSinghgcangenrollgingagstand-alonegprescription
17 druggplangandgcontinuegtogbegcoveredgforgPartgAgandgPartgBgservicesgthroughgOriginal Fee-For-ServicegMedicare. Explanation:gPrescriptiongdruggcoveragegisgavailablegtogthosegwhogenrollgingag stand- alonegPartgDgprescriptiongdruggplangandgcontinuegcoveragegundergOriginalg Medicar egPartgAgandgPartgB.
- Mrs.gQuinngrecentlygturnedg 66 gandgdecidedgaftergmanygyearsgofgworkgtogbe- g gingreceivinggSocialgSecuritygbenefits.gShortlygthereaftergMrs.gQuinngreceivedg a gletterginformingghergthatgsheghasgbeengautomaticallygenrolledgingMedicareg PartgB .gShegwantsgtogunderstandgwhatgthisgmeans.gWhatgshouldgyougtellgMrs.g Quinn? A. ShegwillgneedgtogpaygnogpremiumsgforgPartgBgasgshegqualifiesgforgpremi- g um-freegcoveragegduegtogthegnumbergofgquartersgshe hasgworked. B. PartgBgprimarilygcoversgphysiciangservices.gShegwillgbegpayinggagmonthlyg pr emiumgand,gwithgthegexceptiongofgmanygpreventivegandgscreeninggtests,g gener allygwillghaveg20%gcoinsurancegforgthesegservices,gingadditiongtogang annualgde ductible. C. PartgBgwillgcoverghergdentalgandgvisiongneeds. D. Shegshouldgdisenrollgifgshegdoesgnotgwantgtogpaygthegmonthlygpremiums.g Th eregisgnogdisadvantagegingdoinggso.:gB.gPartgBgprimarilygcoversgphysiciang services .gShegwillgbegpayinggagmonthlygpremiumgand,gwithgthegexceptiongofgmanyg preventivega ndgscreeninggtests,ggenerallygwillghaveg20%gcoinsurancegforgtheseg services,gingadditi ongtogangannualgdeductible. Explanation:gMedicaregPartgBgprimarilygcoversgphysiciangservices.gEnrolleesgpaygag mo
19 coinsurancegamountgthroughgdayg90.gAftergdayg90,ghegwouldgpaygagdailygamount upgtog 60 gdaysgoverghisglifetime,gaftergwhichghegwouldgbegresponsiblegforgallg costs. C. UndergOriginalgMedicare,gtheginpatientghospitalgco-paymentgisgagflatgper- dayg amountgthatgremainsgthegsamegthroughoutgthegfirstg 60 gdaysgofgagbeneficiary' sg stay.gAftergdayg 60 gthegamountggraduallygincreasesguntilgdayg90.gAfterg 90 gdaysg he gwouldgpaygthegfullgamountgofgallgcosts. D. UndergOriginalgMedicare,gtheginpatientghospitalgco- paymentgisgagpercentageg ofgallowedgcharges.gThegpercentagegincreasesgafterg 60 g daysgandgagaingafterg 90 gdays.:gB.gUndergOriginalgMedicare,gtheregisgagsinglegdeductibl egamountgduegforg thegfirstg 60 gdaysgofganyginpatientghospitalgstay,gaftergwhichgitgconvertsgi ntogagper- daygcoinsurancegamountgthroughgdayg90.gAftergdayg90,ghegwouldgpaygagdailygamountgupg tog 60 gdaysgoverghisglifetime,gaftergwhichghegwouldgbegresponsiblegforgallgcosts. Explanation:gBeneficiariesgaregresponsiblegforgagsinglegdeductiblegamountgforgeachg be nefitgperiod,gfollowedgbygagper- daygcoinsurancegamountgthroughgdayg90.gForgdayg 91 gandgbeyond,gtheregisgagchargegforg eachg"lifetimegreservegday"gupgtog 60 gdaysgoverg agbeneficiary'sglifetime.gAftergthis,ghegwou ldgbegresponsiblegforgallgcosts.
- Mr.gAlonsogreceivesgsomeghelpgpayinggforghisgtwoggenericgprescriptiong drug sgfromghisgemployer'sgretireegcoverage,gbutghegwantsgtogcomparegitgtogag PartgDgpr escriptiongdruggplan.gHegasksgyougwhatgcostsghegwouldggenerallygex- g pectgtogencountergwhengenrollinggintogagstandardgMedicaregPartgDgprescriptiong d ruggplan.gWhatgshouldgyougtellghim? A. Heggenerallygwouldgpaygonlygagmonthlygpremium.gMedicaregcoversgallgotherg co
20 sts. B. Heggenerallygwouldgpaygonlygagmonthlygpremiumgandgdeductible.gMedicareg c oversgallgothergcosts. C. Heggenerallygwouldgpaygagmonthlygpremium,gannualgdeductible,gandgper-pre- g scriptiongcost-sharing. D. Heggenerallygwouldgpaygonlygagper-prescriptiongco- payment.gMedicareg coversgallgothergcosts.:gC.gHeggenerallygwouldgpaygagmonthl ygpremium,gannualg deductible,gandgper-prescriptiongcost-sharing. Explanation:gCostsgforgPartgDgbeneficiariesgtypicallygincludegagmonthlygpremium,g annu algdeductible,gandgper-prescriptiongcost-sharing.
