AHIP COMPREHENSIVE CERTIFICATION
EVALUATION VERIFIED QUESTIONS AND
FULL SOLUTIONS
●● (W) Mr. Wells is trying to understand the difference between
Original Medicare and Medicare Advantage. What would be a correct
description?
Answer: Medicare Advantage is a way of covering all of the Original
Medicare benefits through private health insurance companies.
●● During a sales presentation in Ms. Sullivan's home, she tells you that
she has heard about a type of Medicare health plan known as Private
Fee-for-Service (PFFS). She wants to know if this would be available to
her. What should you tell her about PFFS plans?
Answer: A PFFS plan is one of various types of Medicare Advantage
plans offered by private entities and she may enroll in one if it is
available in her area.
●● (W) Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B
to enroll in Medicare Advantage
,●● Mr. Castillo, a naturalized citizen, previously enrolled in Medicare
Part B but has recently stopped paying his Part B premium. He would
like to enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him?
Answer: He is not eligible to enroll in a Medicare Advantage plan until
he re-enrolls in Medicare Part B
●● (W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA)
plan several years ago. Her doctor recently confirmed a diagnosis of
end-stage renal disease (ESRD). What options does Mrs. Billings have
in regard to her MA plan during the next open enrollment season?
Answer: She may remain in her ABC MA plan or enroll in a Special
Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area
●● Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him?
Answer: In most Medicare Advantage HMOs, Mr. Kumar must obtain
his services only from providers who have a contractual relationship
with the plan (except in an emergency).
●● Mrs. Ramos is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care. What
should you tell her?
,Answer: Mrs. Ramos can obtain care from any provider who participates
in Original Medicare, but generally will be charged a lower co-payment
if she goes to one of the plan's preferred providers.
●● Mr. Sinclair has diabetes and heart trouble and is generally satisfied
with the care he has received under Original Medicare, but he would like
to know more about Medicare Advantage Special Needs Plans (SNPs).
What could you tell him?
Answer: SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug
coverage that could be very helpful as well
●● (W) Mr. Greco is in excellent health, lives in his own home, and has
a sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and Mr.
Greco would like to join that plan. What should you tell him?
Answer: SNPs limit enrollment to certain sub-populations of
beneficiaries. Given his current situation, he is unlikely to qualify and
would not be able to enroll in the SNP.
●● (W) 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: Most individuals who are citizens and over age 65 are covered
under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
●● (W) 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: After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
●● (W) Mr. Davis is 49 years old and has been receiving disability
benefits from the Social Security Administration for 12 months. Can you
sell him a Medicare Advantage or Part D Prescription Drug policy?
Answer: No, he cannot purchase a Medicare Advantage or Part D policy
because he has not received Social Security or Railroad Retirement
disability benefits for 24 months.
●● (W) 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: In order to obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher
incomes
EVALUATION VERIFIED QUESTIONS AND
FULL SOLUTIONS
●● (W) Mr. Wells is trying to understand the difference between
Original Medicare and Medicare Advantage. What would be a correct
description?
Answer: Medicare Advantage is a way of covering all of the Original
Medicare benefits through private health insurance companies.
●● During a sales presentation in Ms. Sullivan's home, she tells you that
she has heard about a type of Medicare health plan known as Private
Fee-for-Service (PFFS). She wants to know if this would be available to
her. What should you tell her about PFFS plans?
Answer: A PFFS plan is one of various types of Medicare Advantage
plans offered by private entities and she may enroll in one if it is
available in her area.
●● (W) Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B
to enroll in Medicare Advantage
,●● Mr. Castillo, a naturalized citizen, previously enrolled in Medicare
Part B but has recently stopped paying his Part B premium. He would
like to enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him?
Answer: He is not eligible to enroll in a Medicare Advantage plan until
he re-enrolls in Medicare Part B
●● (W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA)
plan several years ago. Her doctor recently confirmed a diagnosis of
end-stage renal disease (ESRD). What options does Mrs. Billings have
in regard to her MA plan during the next open enrollment season?
Answer: She may remain in her ABC MA plan or enroll in a Special
Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area
●● Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him?
Answer: In most Medicare Advantage HMOs, Mr. Kumar must obtain
his services only from providers who have a contractual relationship
with the plan (except in an emergency).
●● Mrs. Ramos is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care. What
should you tell her?
,Answer: Mrs. Ramos can obtain care from any provider who participates
in Original Medicare, but generally will be charged a lower co-payment
if she goes to one of the plan's preferred providers.
●● Mr. Sinclair has diabetes and heart trouble and is generally satisfied
with the care he has received under Original Medicare, but he would like
to know more about Medicare Advantage Special Needs Plans (SNPs).
What could you tell him?
Answer: SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug
coverage that could be very helpful as well
●● (W) Mr. Greco is in excellent health, lives in his own home, and has
a sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and Mr.
Greco would like to join that plan. What should you tell him?
Answer: SNPs limit enrollment to certain sub-populations of
beneficiaries. Given his current situation, he is unlikely to qualify and
would not be able to enroll in the SNP.
●● (W) 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: Most individuals who are citizens and over age 65 are covered
under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
●● (W) 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: After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
●● (W) Mr. Davis is 49 years old and has been receiving disability
benefits from the Social Security Administration for 12 months. Can you
sell him a Medicare Advantage or Part D Prescription Drug policy?
Answer: No, he cannot purchase a Medicare Advantage or Part D policy
because he has not received Social Security or Railroad Retirement
disability benefits for 24 months.
●● (W) 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: In order to obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher
incomes
