AHIP FWA 2024 Modules 1-5, Nondiscrimination, FWA, Compliance<\/p>\n\n\n\n
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? – ANS Original Medicare covers ambulance services.
Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him? – ANS 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.
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? – ANS
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.<\/p>\n\n\n\n
Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a
substantial estate which provides Madeline with an annual income of
approximately $130,000. Madeline, who has only worked part-time for the
last three years, will soon turn age 65 and hopes to enroll in Original
Medicare. She comes to you for advice. What should you tell her? – ANS
You should tell Madeline that she will be able to enroll in Medicare Part A
without paying monthly premiums due to her husband’s long work record
and participation in the Medicare system. You should also tell Madeline that
she will pay Part B premiums at more than the standard lowest rate but less
than the highest rate due her substantial income.
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? – ANS Medicare does not cover massage therapy, or, in
general, glasses or dentures.
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<\/p>\n\n\n\n
Medicare Part B. She wants to understand what this means. What should
you tell Mrs. Quinn? – ANS 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.
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? – ANS 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.
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? – ANS Mrs. Duarte should file an appeal of
this initial determination within 120 days of the date she received the MSN
in the mail.<\/p>\n\n\n\n
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? – ANS Medicare will cover a total of 190 days of
inpatient psychiatric care during Mr. Rainey’s entire lifetime.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance? – ANS 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.
Anita Magri will turn age 65 in August 2022. 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 Part F plan 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?<\/p>\n\n\n\n