AHIP MEDICARE
Premium Study Guide
Practice Questions & Answers for Exam Preparation
100% PASS STUDY MATERIAL
1. 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 canobtain coverage
under Medicare. What should you tell him ANS He may sign-up for Medicare at any time
however coverage usually begins on the fourth month afterdialysis treatments start.
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2. Juan Perez, who is turning age 65 next month, intends to work for several more years
at Smallcap, Incorporated. Smallcap has a workforce of15 employ-ees and offers
employer-sponsored healthcare coverage. Juan is a naturalizedcitizen 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 impacthis employer-sponsored
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healthcare coverage. How would you respond ANS Juanis likely to be eligible for
Medicare once he turns age 65 and if he enrolls Medicarewould become the primary
payor of his healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under itsemployer-sponsored group health
plan.
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,3. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his health care
needs are different from his wife's needs. What could you tell Mr.Moy ANS Medicare
Supplemental Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services
that Medicare does not cover.
4. Mrs. PeHa is 66 years old, has coverage under an employer plan, and will retirenext 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 ANS She may enroll at any time while she is covered under
her employer plan, but she will have a special eight-month enrollment period after the last
month on her employer plan that differs from the standard general enrollment period,
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during which she may enroll in Medicare Part B.
5. 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 concernedthat she will not
qualify for coverage under part A because she was not born inthe United States. What
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should you tell her ANS Most individuals who are citizens and age 65 or over 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.
6. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy aswell, but it
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provides no drug coverage. She would like to keep the coverage she has but replace her
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,existing Medigap plan with one that provides drug coverage. What should you tell her
ANS Mrs. Gonzalez cannot purchase a Medigap
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, plan that covers drugs, but she could keep her Medigap policy and enroll in a PartD
prescription drug plan.
7. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whetheror 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.
8. 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 hemight be exposed to
under Medicare if he were to require hospitalization as aresult of an illness. In general
terms, what could you tell him about his costsfor inpatient hospital services
wis
under Original Medicare ANS Under Original Medicare, there is a single deductible
amount due for the first 60 days of any inpatient hospital stay, after which it convertsinto a
per-day coinsurance amount through day 90. After day 90, he would pay a daily amount
up to 60 days over his lifetime, after which he would be responsible forall costs.
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9. 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 ANS To obtain Part B coverage, she
must pay a standard monthly premium, though it is higher forindividuals with higher
incomes.
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10. Mr. Alonso receives some help paying for his two generic prescription drugs from
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Premium Study Guide
Practice Questions & Answers for Exam Preparation
100% PASS STUDY MATERIAL
1. 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 canobtain coverage
under Medicare. What should you tell him ANS He may sign-up for Medicare at any time
however coverage usually begins on the fourth month afterdialysis treatments start.
wis
2. Juan Perez, who is turning age 65 next month, intends to work for several more years
at Smallcap, Incorporated. Smallcap has a workforce of15 employ-ees and offers
employer-sponsored healthcare coverage. Juan is a naturalizedcitizen 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 impacthis employer-sponsored
epr
healthcare coverage. How would you respond ANS Juanis likely to be eligible for
Medicare once he turns age 65 and if he enrolls Medicarewould become the primary
payor of his healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under itsemployer-sponsored group health
plan.
of
wiserof
,3. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his health care
needs are different from his wife's needs. What could you tell Mr.Moy ANS Medicare
Supplemental Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services
that Medicare does not cover.
4. Mrs. PeHa is 66 years old, has coverage under an employer plan, and will retirenext 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 ANS She may enroll at any time while she is covered under
her employer plan, but she will have a special eight-month enrollment period after the last
month on her employer plan that differs from the standard general enrollment period,
wis
during which she may enroll in Medicare Part B.
5. 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 concernedthat she will not
qualify for coverage under part A because she was not born inthe United States. What
epr
should you tell her ANS Most individuals who are citizens and age 65 or over 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.
6. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy aswell, but it
of
provides no drug coverage. She would like to keep the coverage she has but replace her
wiserof
,existing Medigap plan with one that provides drug coverage. What should you tell her
ANS Mrs. Gonzalez cannot purchase a Medigap
wis
epr
of
wiserof
, plan that covers drugs, but she could keep her Medigap policy and enroll in a PartD
prescription drug plan.
7. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whetheror 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.
8. 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 hemight be exposed to
under Medicare if he were to require hospitalization as aresult of an illness. In general
terms, what could you tell him about his costsfor inpatient hospital services
wis
under Original Medicare ANS Under Original Medicare, there is a single deductible
amount due for the first 60 days of any inpatient hospital stay, after which it convertsinto a
per-day coinsurance amount through day 90. After day 90, he would pay a daily amount
up to 60 days over his lifetime, after which he would be responsible forall costs.
epr
9. 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 ANS To obtain Part B coverage, she
must pay a standard monthly premium, though it is higher forindividuals with higher
incomes.
of
10. Mr. Alonso receives some help paying for his two generic prescription drugs from
wiserof
