AHIP FINAL EXAM NEW EST VERSION
QUESTIONS AND ANSW ERS
1. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
Answer 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?
2. After receiving such disability payments for 24 months, he will be automati-
cally enrolled in Medicare, regardless of age.
Answer 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?
3. Mildred may remain enrolled in Allcare and make a hospice election.
Hospice benefits will be paid for by Original Medicare under Part A and Allcare
will continue to pay for any non-hospice services.
Answer Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suttering from inoperable cancer and has just a few months to live. She would like to
spend these final months in hospice care. Mildred's family asks you whether hospice benefits will be paid for under
the Allcare Medicare Advantage plan. What should you say?
,4. Part A, which covers hospital, skilled nursing facility, hospice, and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
Answer 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?
5. Tell prospect Jerry Smith that he should consider adding a standalone Part
D prescription drug coverage policy to his present coverage.
Answer 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?
6. He may sign-up for Medicare at any time however coverage usually begins on
the fourth month after dialysis treatments start.
Answer 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?
7. Mr. Diaz will not pay any penalty because he had continuous coverage under
his employer's plan.
Answer 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?
8. 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.
Answer 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?
9. Individuals eligible for Medicare based on ESRD generally lose eligibility 36
months after the month in which the individual receives a kidney transplant
unless they are eligible for Medicare on another basis such as age or disability.
Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would
cover the drugs.
Answer Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully
underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will
continue, what should you say?
, 10. 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, during which she may enroll in Medicare Part B.
Answer 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?
11. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled
in an MA plan, and besides, Medigap only works with Original Medicare.
Answer 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?
12. To obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
Answer 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?
13. 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
QUESTIONS AND ANSW ERS
1. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
Answer 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?
2. After receiving such disability payments for 24 months, he will be automati-
cally enrolled in Medicare, regardless of age.
Answer 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?
3. Mildred may remain enrolled in Allcare and make a hospice election.
Hospice benefits will be paid for by Original Medicare under Part A and Allcare
will continue to pay for any non-hospice services.
Answer Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suttering from inoperable cancer and has just a few months to live. She would like to
spend these final months in hospice care. Mildred's family asks you whether hospice benefits will be paid for under
the Allcare Medicare Advantage plan. What should you say?
,4. Part A, which covers hospital, skilled nursing facility, hospice, and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
Answer 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?
5. Tell prospect Jerry Smith that he should consider adding a standalone Part
D prescription drug coverage policy to his present coverage.
Answer 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?
6. He may sign-up for Medicare at any time however coverage usually begins on
the fourth month after dialysis treatments start.
Answer 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?
7. Mr. Diaz will not pay any penalty because he had continuous coverage under
his employer's plan.
Answer 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?
8. 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.
Answer 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?
9. Individuals eligible for Medicare based on ESRD generally lose eligibility 36
months after the month in which the individual receives a kidney transplant
unless they are eligible for Medicare on another basis such as age or disability.
Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would
cover the drugs.
Answer Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully
underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will
continue, what should you say?
, 10. 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, during which she may enroll in Medicare Part B.
Answer 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?
11. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled
in an MA plan, and besides, Medigap only works with Original Medicare.
Answer 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?
12. To obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
Answer 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?
13. 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
