Preview Extract
AHIP MODULE 1 EXAM TEST UPDATED QUESTIONS AND
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
1. 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?
Answer: Medigap helps cover deductibles and co-payments associated with Original
Medicare.
Rationale:
Medigap, also known as Medicare Supplement Insurance, is designed to fill the gaps in
coverage left by Original Medicare. It can help Mrs. Paterson manage her healthcare costs by
paying for deductibles, co-payments, and other out-of-pocket expenses that Medicare doesn't
fully cover. With a Medigap plan, she can have more predictable healthcare expenses and
avoid unexpected financial burdens.
2. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him?
Answer: Mr. Singh can enroll in a standalone Medicare Part D prescription drug plan.
Rationale:
Medicare Part D plans are standalone prescription drug plans offered by private insurance
companies. They provide coverage for prescription medications and are available to
individuals with Original Medicare (Parts A and B) who do not wish to enroll in a Medicare
Advantage plan. Mr. Singh can choose a Part D plan that suits his medication needs and
budget, allowing him to maintain Original Medicare while still accessing prescription drug
coverage.
3. Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make
it impossible for her to qualify for Medicare. What could you tell her to address her concern?
Answer: Ms. Moore's income won't disqualify her from Medicare, but she may face higher
premiums due to income-related monthly adjustment amounts (IRMAA).
Rationale:
Medicare eligibility is primarily based on age and citizenship or permanent residency status,
not income. Ms. Moore, turning 65, can still qualify for Medicare. However, individuals with
higher incomes may be subject to income-related monthly adjustment amounts (IRMAA),
which result in higher premiums for Medicare Part B and Part D. Ms. Moore should be aware
of potential higher premiums but can still enroll in Medicare regardless of her income level.
4. 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?
Answer: Mr. Diaz may have to pay a Part B premium penalty if he didn't sign up when first
eligible, but the amount can vary depending on the length of the delay.
Rationale:
Individuals who delay enrolling in Medicare Part B beyond their initial enrollment period
may face a late enrollment penalty. The penalty increases the Part B premium by 10% for
each full 12-month period of delayed enrollment. Mr. Diaz's penalty would depend on how
many years he delayed enrollment. He should contact Social Security or Medicare for
specific details about his situation and the applicable penalty.
5. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled
in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan
which he has had for several years. However, the plan does not provide drug benefits. How
would you advise Agent John Miller to proceed?
Answer: Agent John Miller should advise Jerry Smith to enroll in a standalone Medicare Part
D prescription drug plan to complement his existing Medicare Parts A and B coverage and
Medigap plan.
Rationale:
Since Jerry's current Medigap plan doesn't include prescription drug coverage, he should
enroll in a standalone Medicare Part D plan to ensure he has access to necessary medications.
This will provide him with comprehensive coverage for both medical services and
prescription drugs, helping to minimize out-of-pocket expenses and ensure comprehensive
healthcare coverage.
6. 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?
Answer: Madeline Martinez is eligible for Original Medicare based on her husband's work
history. She should enroll in Original Medicare when she turns 65.
Rationale:
Madeline is eligible for Medicare based on her husband's work history, even though she has
only worked part-time. Medicare eligibility is primarily based on age and the work history of
the individual or their spouse. Since Madeline's husband worked and contributed to the
Medicare system, she can enroll in Original Medicare when she turns 65, regardless of her
own work history or income from her substantial estate.
7. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social
Security Administration and has been receiving disability payments. He is wondering whether
he can obtain coverage under Medicare. What should you tell him?
Answer: Mr. Bauer may be eligible for Medicare coverage due to his disability status as
determined by the Social Security Administration.
Rationale:
Individuals under 65 who have been receiving Social Security Disability Insurance (SSDI)
benefits for at least 24 months are typically eligible for Medicare coverage, regardless of their
age. Since Mr. Bauer has been receiving disability payments for eighteen months, he should
continue to receive SSDI benefits until he becomes eligible for Medicare coverage after 24
months. He should contact the Social Security Administration for further guidance on his
eligibility and enrollment process.
8. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full
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?
Answer: Mrs. Chen is eligible for Medicare Part A coverage regardless of her citizenship
status, as long as she meets the other eligibility criteria.
Rationale:
Medicare Part A eligibility is primarily based on age, citizenship or permanent residency
status, and work history. Mrs. Chen's concerns about not qualifying due to her non-native
status are unfounded, as being born in the United States is not a requirement for Medicare
eligibility. As a citizen who has been employed full-time and paid taxes for the required
duration, Mrs. Chen meets the eligibility criteria for Medicare Part A coverage when she turns
65.
9. What impact, if any, will recent regulatory changes have upon Medigap plans?
Answer: Recent regulatory changes may impact Medigap plans by altering coverage options,
premium costs, and enrollment eligibility.
Rationale:
Regulatory changes can affect various aspects of Medigap plans, including coverage options,
premium costs, and enrollment eligibility. For instance, changes in regulations might
introduce new coverage benefits or restrict certain benefits previously offered. Premium costs
could fluctuate due to changes in regulations regarding pricing structures or factors affecting
plan pricing. Additionally, regulatory changes may impact who is eligible to enroll in
Medigap plans and under what conditions, potentially affecting the demographics of plan
participants. Overall, staying informed about regulatory changes is crucial for understanding
their potential impact on Medigap plans.
10. Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employersponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare coverage. How would you
respond?
Answer: Juan Perez will likely be entitled to Medicare at age 65, and enrolling may impact
his employer-sponsored healthcare coverage.
Rationale:
As a naturalized citizen who has contributed to the Medicare system for over 20 years, Juan
Perez is likely eligible for Medicare benefits at age 65. However, since Smallcap,
Incorporated has employer-sponsored healthcare coverage, Juan should consider how
enrolling in Medicare may impact his current coverage. Typically, when an individual
becomes eligible for Medicare and enrolls in Parts A and B, Medicare becomes the primary
payer for healthcare services, and employer-sponsored coverage becomes secondary. Juan
should review his options carefully and consider factors such as coverage benefits, costs, and
network providers before making a decision. Additionally, Juan should consult with his
employer's HR department or a Medicare advisor to fully understand how enrolling in
Medicare will impact his employer-sponsored healthcare coverage.
11. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the health
coverage provided to Medicare beneficiaries?
Answer: Original Medicare provides health coverage to Medicare beneficiaries, including
Part A for hospital services and Part B for medical services.
Rationale:
Original Medicare consists of two main parts: Part A (hospital insurance) and Part B (medical
insurance). Part A covers inpatient hospital stays, skilled nursing facility care, hospice care,
and some home health care services. Part B covers medically necessary services like doctor's
visits, outpatient care, preventive services, and some medical equipment. It's important for
Mr. Xi to understand these basic components of Original Medicare as he approaches age 65
and considers his healthcare options.
12. Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him?
Answer: Original Fee-for-Service (FFS) Medicare covers hospital services (Part A) and
medical services (Part B).
Rationale:
Original Fee-for-Service (FFS) Medicare, also known as Traditional Medicare, provides
coverage for hospital services (Part A) such as inpatient hospital stays, skilled nursing facility
care, hospice care, and some home health care services. Additionally, it covers medical
services (Part B) including doctor's visits, outpatient care, preventive services, and some
medical equipment. Mr. Schmidt should be aware that while Original Medicare covers a wide
range of services, it may not cover all healthcare costs, and he may need to consider
additional coverage options such as Medicare Supplement (Medigap) plans or Medicare
Advantage plans to fill in any gaps in coverage.
13. 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?
Answer: Medicare Part D is the prescription drug coverage component of Medicare.
Rationale:
Medicare Part D is a prescription drug coverage program offered by private insurance
companies approved by Medicare. It helps Medicare beneficiaries pay for prescription drugs
they need. Mrs. Geisler's neighbor likely advised her to review her Part D options during the
annual Medicare enrollment period because Part D plans can change their covered
medications, premiums, deductibles, and copayments each year. It's essential for Mrs. Geisler
to review her Part D plan annually to ensure it continues to meet her prescription drug needs
and budget.
14. 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?
Answer: Yes, individuals with end-stage renal disease (ESRD) are eligible for Medicare
coverage.
Rationale:
Medicare provides coverage for individuals with end-stage renal disease (ESRD), regardless
of age. Mr. Davis, being diagnosed with ESRD and soon beginning dialysis, qualifies for
Medicare benefits. However, there are certain conditions and requirements that he needs to
meet, such as being a U.S. citizen or permanent resident and either having worked the
required amount of time under Social Security, Railroad Retirement Board, or being the
spouse or dependent child of someone who meets these criteria. It's important for Mr. Davis
to apply for Medicare benefits and understand his coverage options as he begins his treatment
for ESRD.
15. 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?
Answer: Original Medicare covers skilled nursing facility (SNF) care for up to 100 days
following a qualifying hospital stay.
Rationale:
After a qualifying hospital stay of at least three consecutive days, Original Medicare covers
up to 100 days of skilled nursing facility (SNF) care per benefit period. This coverage
includes necessary nursing and rehabilitative care to aid in Mrs. Shields' recovery from her
hip fracture. However, it's essential to note that while Medicare covers the full cost for the
first 20 days, there may be a daily coinsurance for days 21 to 100. Mrs. Shields and her
physicians should ensure that her care needs are well-documented and that she meets all
Medicare requirements for coverage to avoid any unexpected costs.
16. 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?
Answer: Original Medicare covers a wide range of services, including hospital stays, doctor
visits, lab tests, preventive care, and some home health services, if the appropriate criteria are
met.
Rationale:
Original Medicare provides coverage for various medical services, including hospital stays
(Part A), doctor visits, outpatient care, lab tests, preventive services (Part B), and some home
health services. Mrs. Turner should understand that while Original Medicare covers many
services, there may be limitations and out-of-pocket costs associated with certain treatments
or procedures. It's essential for her to compare the coverage and costs of her employer's
retiree insurance with those of Original Medicare to make an informed decision about her
healthcare coverage in retirement.
17. 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?
Answer: Mr. Wu can explore pharmaceutical assistance programs offered by pharmaceutical
companies, state governments, or charitable organizations for help with his prescription drug
costs.
Rationale:
While Mr. Wu may not qualify for the Part D low-income subsidy, he still has options for
assistance with prescription drug costs. Pharmaceutical companies often offer patient
assistance programs (PAPs) that provide free or discounted medications to individuals who
meet specific eligibility criteria, such as income limitations. Additionally, many states have
prescription drug assistance programs that help eligible residents with the cost of
medications. Charitable organizations may also provide assistance with prescription drug
costs for individuals in need. Mr. Wu should research and inquire about these programs to
find one that best suits his needs and financial situation.
18. 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?
Answer: Being automatically enrolled in Medicare Part B means that Mrs. Quinn will
receive medical insurance coverage through Medicare.
Rationale:
When individuals start receiving Social Security benefits at age 65 or older, they are typically
automatically enrolled in Medicare Part A and Part B. Medicare Part A covers hospital
services, while Part B covers medical services such as doctor's visits, outpatient care, and
preventive services. Mrs. Quinn should understand that she will now have medical insurance
coverage through Medicare Part B, and she may need to pay a monthly premium for this
coverage, depending on her income. It's important for her to review the coverage provided by
Medicare Part B and consider any additional coverage options, such as Medicare Supplement
plans or Medicare Advantage plans, to ensure her healthcare needs are adequately met.
19. 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?
Answer: Medicare Supplemental Insurance, also known as Medigap, helps cover certain outof-pocket costs that Original Medicare doesn't, such as deductibles, coinsurance, and
copayments.
Rationale:
Medicare Supplemental Insurance, or Medigap, is designed to complement Original Medicare
by covering some of the out-of-pocket costs that beneficiaries would otherwise have to pay,
such as deductibles, coinsurance, and copayments. Unlike Medicare Advantage plans, which
often have networks of doctors and hospitals, Medigap plans typically allow beneficiaries to
see any healthcare provider who accepts Medicare. Mr. Moy should understand that the
coverage provided by Medigap plans is standardized by the government, with different plans
offering different levels of coverage. He should carefully compare the benefits and costs of
different Medigap plans to find one that best meets his individual healthcare needs and
budget.
20. Anita Magri will turn age 65 in August 2020. 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?
Answer: Anita should be aware that Medicare Supplement Plan F is no longer available to
new Medicare enrollees as of January 1, 2020.
Rationale:
Medicare Supplement Plan F, which covered the Medicare Part B deductible among other
benefits, was discontinued for new Medicare enrollees beginning January 1, 2020. Therefore,
Anita will not be able to enroll in Plan F when she becomes eligible for Medicare in August
2020. Instead, she should consider other available Medigap plans, such as Plan G or Plan N,
which may offer similar coverage options to meet her healthcare needs. It's essential for Anita
to review the benefits and costs of different Medigap plans and choose one that best fits her
individual circumstances and preferences.
21. Mrs. Peňa 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 ensure no gap in coverage.
What can you tell her?
Answer: Mrs. Peňa should enroll in Medicare Part B during her Initial Enrollment Period
(IEP) to avoid a gap in coverage once her employer plan ends.
Rationale:
Medicare requires individuals who are covered by an employer's group health plan to enroll
in Medicare Part B during their Initial Enrollment Period (IEP), which begins three months
before their 65th birthday month and ends three months after. If Mrs. Peňa delays enrolling in
Part B and her employer plan ends, she may face a gap in coverage and potentially incur
penalties for late enrollment. Therefore, it's crucial for her to understand her Medicare
enrollment options and take appropriate action before her employer coverage ends to ensure
continuous healthcare coverage.
22. 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 but replace her
existing Medigap plan with one that provides drug coverage. What should you tell her?
Answer: Mrs. Gonzalez should be aware that she can't replace her existing Medigap plan
with one that provides drug coverage. Instead, she should consider enrolling in a standalone
Medicare Part D prescription drug plan to add drug coverage to her Original Medicare and
Medigap coverage.
Rationale:
Medicare Supplement (Medigap) plans are designed to work alongside Original Medicare
and do not typically include prescription drug coverage. While Mrs. Gonzalez can't replace
her existing Medigap plan with one that provides drug coverage, she can enroll in a
standalone Medicare Part D prescription drug plan to add drug coverage to her existing
coverage. Mrs. Gonzalez should carefully review her current coverage, including her
Medigap plan, and compare it with available Part D plans to find one that best meets her
prescription drug needs and budget. It's essential for her to consider factors such as
premiums, deductibles, copayments, and formulary coverage when selecting a Part D plan.
23. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap
plan to pick up costs not covered by that plan. What should you tell him?
Answer: Mr. Capadona cannot enroll in both a Medicare Advantage (MA) plan and a
Medigap plan simultaneously.
Rationale:
Medicare Advantage (MA) plans and Medigap plans serve as alternatives to each other, and
individuals cannot be enrolled in both simultaneously. Medicare Advantage plans provide
comprehensive coverage through private insurance companies, often including prescription
drug coverage and additional benefits like dental and vision. On the other hand, Medigap
plans work alongside Original Medicare to help cover out-of-pocket costs such as
copayments, coinsurance, and deductibles. Mr. Capadona should carefully consider his
healthcare needs and preferences to choose the option that best suits him.
24. 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?
Answer: Mrs. Duarte should follow the appeals process outlined on her Medicare Summary
Notice (MSN) to dispute the partially denied claim for services.
Rationale:
The Medicare Summary Notice (MSN) provides detailed information about services billed to
Medicare and any decisions regarding coverage or payment. If Mrs. Duarte disagrees with a
determination, she has the right to appeal. The MSN typically includes instructions on how to
initiate the appeals process, including deadlines and the necessary steps to take. Mrs. Duarte
should carefully follow these instructions and provide any supporting documentation or
information to support her appeal. It's essential for her to address any discrepancies or errors
promptly to ensure that she receives the appropriate coverage and benefits under Medicare.
25. 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?
Answer: Mr. Alonso can generally expect to encounter costs such as monthly premiums, an
annual deductible (if applicable), copayments or coinsurance for each prescription, and
potential coverage gaps known as the "donut hole" in a standard Medicare Part D prescription
drug plan.
Rationale:
Medicare Part D prescription drug plans typically involve several costs for enrollees. These
include monthly premiums, an annual deductible (if applicable), copayments or coinsurance
for each prescription, and costs during the coverage gap, also known as the "donut hole." Mr.
Alonso should carefully review the details of various Part D plans, including their premiums,
formularies, copayments, and coverage gaps, to determine which plan best meets his
prescription drug needs and budget. Additionally, he should consider factors such as preferred
pharmacies and mail-order options when comparing plans.
26. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance?
Answer: Mrs. Park may be eligible for Extra Help, a program that helps lower-income
Medicare beneficiaries with prescription drug costs.
Rationale:
Extra Help, also known as the Low-Income Subsidy (LIS) program, assists Medicare
beneficiaries with limited income and resources in paying for their prescription drug costs,
including premiums, deductibles, and copayments or coinsurance. This program can
significantly reduce Mrs. Park's out-of-pocket expenses for medications. To qualify for Extra
Help, Mrs. Park needs to meet certain income and asset criteria. She should contact her local
Social Security office or visit the Social Security website to apply for Extra Help and
determine her eligibility. Additionally, Mrs. Park may also explore other assistance programs
for low-income individuals, such as Medicaid, which can provide further support with
healthcare costs beyond prescription drugs.
27. 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?
Answer: Medicare typically does not cover routine dental care, eyeglasses, or massage
therapy.
Rationale:
Medicare generally does not cover routine dental care, such as dentures, routine eye exams,
eyeglasses, or massage therapy for pain relief. However, there may be exceptions in certain
circumstances, such as dental services required due to an accident or medical condition, or
vision care related to certain eye diseases. Mrs. West should carefully review her Medicare
coverage and consider alternative options, such as supplemental insurance or discount plans,
to help cover the costs of these items and services if they are not covered by Medicare.
28. 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?
Answer: Under Original Medicare, Mr. Patel would be responsible for paying the Part A
deductible for inpatient hospital services, which is $1,556 per benefit period in 2021.
Rationale:
Original Medicare Part A covers inpatient hospital services, but beneficiaries are responsible
for certain costs. The main cost Mr. Patel would face is the Part A deductible, which is the
amount he must pay out of pocket before Medicare starts paying its share. As of 2021, the
Part A deductible for inpatient hospital services is $1,556 per benefit period. It's important for
Mr. Patel to consider this deductible when budgeting for potential healthcare costs in
retirement.
29. 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 years and paying
Medicare taxes. What should you tell her?
Answer: Ms. Henderson will qualify for Medicare coverage at age 65, but she may still have
to pay premiums depending on her work history and specific circumstances.
Rationale:
While it's true that most people become eligible for premium-free Medicare Part A at age 65
if they or their spouse have worked and paid Medicare taxes for at least 10 years (40
quarters), Medicare Part B typically requires a monthly premium. The amount of the
premium depends on factors such as income and when Ms. Henderson enrolls. So, while she
will qualify for Medicare coverage, she may still have to pay premiums for certain parts of it.
30. 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?
Answer: Medicare covers inpatient psychiatric hospital stays for up to 190 days over a
lifetime.
Rationale:
Medicare Part A covers mental health care provided in a psychiatric hospital or general
hospital. For inpatient psychiatric hospital stays, Medicare covers up to 190 days in a
lifetime. However, coverage beyond this limit may be possible under certain circumstances,
such as if the patient meets specific criteria and has days remaining in their lifetime reserve
days. It's essential for Mr. Rainey or his representative to understand these coverage
limitations and potential exceptions.
31. 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?
Answer: Medicare Supplemental Insurance (Medigap) helps cover costs not covered by
Original Medicare, such as copayments, coinsurance, and deductibles.
Rationale:
Medigap plans are designed to complement Original Medicare coverage by filling in the
gaps, such as out-of-pocket costs that Medicare doesn't cover. These can include copayments,
coinsurance, and deductibles, which can vary depending on the specific Medigap plan
chosen. Unlike Medicare Advantage plans, which may offer different coverage options and
networks, Medigap plans work alongside Original Medicare and can provide more flexibility
in choosing healthcare providers. It's important for Mr. Moy to consider his specific
healthcare needs and compare different Medigap plans to find the best coverage for him.
32. 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?
Answer: Yes, Medicare covers certain cancer screenings, including mammograms, Pap tests,
colonoscopies, and prostate cancer screenings.
Rationale:
Medicare covers various cancer screenings as part of its preventive services. These screenings
can help detect cancer early, when treatment is often more effective. Examples of covered
screenings include mammograms for breast cancer, Pap tests for cervical cancer,
colonoscopies for colorectal cancer, and prostate-specific antigen (PSA) tests for prostate
cancer. However, coverage details may vary based on factors such as age, risk factors, and
frequency of screening. It's important for Mr. Buck to discuss with his healthcare provider
which screenings are appropriate for him based on his family history and individual risk
factors.
