AHIP FINAL EXAM QUESTIONS AND
CORRECT ANSWERS
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
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for the Part D low-
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income subsidy. Where might he turn for help with his prescription drug costs? -
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ANSWERS-
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Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceut
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ical Assistance Program.
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Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
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Social Security Administration and has been receiving disability payments. He is won
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dering whether he can obtain coverage under Medicare. What should you tell him? -
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ANSWERS-
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After receiving such disability payments for 24 months, he will be automatically enroll
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ed in Medicare, regardless of age.
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Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mild
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red recently learned that she is suffering from inoperable cancer and has just a few
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months to live. She would like to spend these final months in hospice care. Mildred's
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family asks you whether hospice benefits will be paid for under the Allcare Medicare
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Advantage plan. What should you say? - ANSWERS- gf gf gf gf gf gf gf
Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefit
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s will be paid for by Original Medicare under Part A and Allcare will continue to pay f
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or any non-hospice services.
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Mr. Schmidt would like to plan for retirement and has asked you what is covered und
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er Original Fee-for-Service (FFS) Medicare. What could you tell him? - ANSWERS-
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Part A, which covers hospital, skilled nursing facility, hospice, and home health servi
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ces and Part B, which covers professional services such as those provided by a doct
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or are covered under Original Medicare.
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Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enro
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lled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (M
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edigap) plan which he has had for several years. However, the plan does not provide
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drug benefits. How would you advise Agent John Miller to proceed? - ANSWERS-
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Tell prospect Jerry Smith that he should consider adding a standalone Part D prescri
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ption drug coverage policy to his present coverage.
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Mr. Davis is 52 years old and has recently been diagnosed with end-
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stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can o
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btain coverage under Medicare. What should you tell him? - ANSWERS-
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He may sign- gf gf
up for Medicare at any time however coverage usually begins on the fourth month aft
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er dialysis treatments start.
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,Mr. Diaz continued working with his company and was insured under his employer's
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group plan until he reached age 68. He has heard that there is a premium penalty for
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those who did not sign up for Part B when first eligible and wants to know how much
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he will have to pay. What should you tell him? - ANSWERS-
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Mr. Diaz will not pay any penalty because he had continuous coverage under his em
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ployer's plan. gf
Madeline Martinez was widowed several years ago. Her husband worked for many y
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ears and contributed into the Medicare system. He also left a substantial estate whic
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h provides Madeline with an annual income of approximately $130,000. Madeline, w
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ho has only worked part-
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time for the last three years, will soon turn age 65 and hopes to enroll in Original Me
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dicare. She comes to you for advice. What should you tell her? - ANSWERS-
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You should tell Madeline that she will be able to enroll in Medicare Part A without pa
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ying monthly premiums due to her husband's long work record and participation in th
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e Medicare system. You should also tell Madeline that she will pay Part B premiums
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at more than the standard lowest rate but less than the highest rate due her substant
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ial income. gf
Edward IP suffered from serious kidney disease. As a result. Edward became eligibl
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e for Medicare coverage due to end-
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stage renal disease (ESRD). A close relative donated their kidney and Edward succe
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ssfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks
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you if his Medicare coverage will continue, what should you say? - ANSWERS-
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Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months
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after the month in which the individual receives a kidney transplant unless they are el
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igible for Medicare on another basis such as age or disability. Edward may, however,
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remain enrolled in Part B but solely for coverage of immunosuppressive drugs if he
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has no other health care coverage that would cover the drugs.
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Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next
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year. She heard she must enroll in Part B at the beginning of the year to ensure no g
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ap in coverage. What can you tell her? - ANSWERS-
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She may enroll at any time while she is covered under her employer plan, but she wil
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l have a special eight-
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month enrollment period after the last month on her employer plan that differs from t
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he standard general enrollment period, during which she may enroll in Medicare Part
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B.
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Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medig
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ap plan to pick up costs not covered by that plan. What should you tell him? -
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ANSWERS-
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It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA pla
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n, and besides, Medigap only works with Original Medicare.
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Ms. Henderson believes that she will qualify for Medicare Coverage when she turns
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65, without paying any premiums, because she has been working for 40 years and p
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aying Medicare taxes. What should you tell her? - ANSWERS-
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To obtain Part B coverage, she must pay a standard monthly premium, though it is hi
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gher for individuals with higher incomes.
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, Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
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Mrs. Park that might be of assistance? - ANSWERS-
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She should contact her state Medicaid agency to see if she qualifies for one of sever
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al programs that can help with Medicare costs for which she is responsible.
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Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE).
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This coverage has recently been terminated due to the end of the PHE. While Shirle
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y was enrolled in Medicaid, she missed an opportunity to enroll in Medicare and now
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wants Part B. Which of the following statements best describes Shirley's ability to no
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w enroll in Medicare Part B? - ANSWERS-
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Shirley is eligible for a Special Enrollment Period (SEP) for up to six months after the
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termination of her Medicaid coverage. Under this SEP, Shirley can choose retroactiv
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e coverage back to the date of termination from Medicaid or coverage beginning the
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month after the month of enrollment. gf gf gf gf gf
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent heal
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th and will have considerable income when she retires. She is concerned that her inc
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ome will make it impossible for her to qualify for Medicare. What could you tell her to
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address her concern? - ANSWERS- gf gf gf gf
Medicare is a program for people age 65 or older and those under age 65 with certai
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n disabilities, end-
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stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
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Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but
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it provides no drug coverage. She would like to keep the coverage she has but repla
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ce her existing Medigap plan with one that provides drug coverage. What should you
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tell her? - ANSWERS-
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Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could kee
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p her Medigap policy and enroll in a Part D prescription drug plan.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed f
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ull time, and paid taxes during that entire period. She is concerned that she will not q
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ualify for coverage under part A because she was not born in the United States. Wha
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t should you tell her? - ANSWERS-
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Most individuals who are citizens and age 65 or over are covered under Part A by vir
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tue of having paid Medicare taxes while working, though some may be covered as a
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result of paying monthly premiums. gf gf gf gf
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are p
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rovided under Original Medicare. What should you tell Mr. Xi that best describes the
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health coverage provided to Medicare beneficiaries? - ANSWERS-
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Beneficiaries under Original Medicare have no cost- gf gf gf gf gf gf
sharing for most preventive services which include immunizations such as annual flu
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shots.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what cov
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erage Medicare Supplemental Insurance provides since his health care needs are dif
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ferent from his wife's needs. What could you tell Mr. Moy? - ANSWERS-
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Medicare Supplemental Insurance would help cover his Part A and Part B deductible
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CORRECT ANSWERS
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
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for the Part D low-
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income subsidy. Where might he turn for help with his prescription drug costs? -
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ANSWERS-
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Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceut
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ical Assistance Program.
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Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
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Social Security Administration and has been receiving disability payments. He is won
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dering whether he can obtain coverage under Medicare. What should you tell him? -
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ANSWERS-
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After receiving such disability payments for 24 months, he will be automatically enroll
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ed in Medicare, regardless of age.
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Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mild
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red recently learned that she is suffering from inoperable cancer and has just a few
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months to live. She would like to spend these final months in hospice care. Mildred's
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family asks you whether hospice benefits will be paid for under the Allcare Medicare
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Advantage plan. What should you say? - ANSWERS- gf gf gf gf gf gf gf
Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefit
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s will be paid for by Original Medicare under Part A and Allcare will continue to pay f
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or any non-hospice services.
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Mr. Schmidt would like to plan for retirement and has asked you what is covered und
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er Original Fee-for-Service (FFS) Medicare. What could you tell him? - ANSWERS-
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Part A, which covers hospital, skilled nursing facility, hospice, and home health servi
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ces and Part B, which covers professional services such as those provided by a doct
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or are covered under Original Medicare.
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Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enro
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lled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (M
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edigap) plan which he has had for several years. However, the plan does not provide
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drug benefits. How would you advise Agent John Miller to proceed? - ANSWERS-
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Tell prospect Jerry Smith that he should consider adding a standalone Part D prescri
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ption drug coverage policy to his present coverage.
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Mr. Davis is 52 years old and has recently been diagnosed with end-
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stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can o
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btain coverage under Medicare. What should you tell him? - ANSWERS-
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He may sign- gf gf
up for Medicare at any time however coverage usually begins on the fourth month aft
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er dialysis treatments start.
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,Mr. Diaz continued working with his company and was insured under his employer's
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group plan until he reached age 68. He has heard that there is a premium penalty for
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those who did not sign up for Part B when first eligible and wants to know how much
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he will have to pay. What should you tell him? - ANSWERS-
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Mr. Diaz will not pay any penalty because he had continuous coverage under his em
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ployer's plan. gf
Madeline Martinez was widowed several years ago. Her husband worked for many y
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ears and contributed into the Medicare system. He also left a substantial estate whic
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h provides Madeline with an annual income of approximately $130,000. Madeline, w
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ho has only worked part-
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time for the last three years, will soon turn age 65 and hopes to enroll in Original Me
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dicare. She comes to you for advice. What should you tell her? - ANSWERS-
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You should tell Madeline that she will be able to enroll in Medicare Part A without pa
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ying monthly premiums due to her husband's long work record and participation in th
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e Medicare system. You should also tell Madeline that she will pay Part B premiums
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at more than the standard lowest rate but less than the highest rate due her substant
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ial income. gf
Edward IP suffered from serious kidney disease. As a result. Edward became eligibl
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e for Medicare coverage due to end-
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stage renal disease (ESRD). A close relative donated their kidney and Edward succe
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ssfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks
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you if his Medicare coverage will continue, what should you say? - ANSWERS-
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Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months
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after the month in which the individual receives a kidney transplant unless they are el
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igible for Medicare on another basis such as age or disability. Edward may, however,
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remain enrolled in Part B but solely for coverage of immunosuppressive drugs if he
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has no other health care coverage that would cover the drugs.
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Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next
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year. She heard she must enroll in Part B at the beginning of the year to ensure no g
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ap in coverage. What can you tell her? - ANSWERS-
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She may enroll at any time while she is covered under her employer plan, but she wil
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l have a special eight-
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month enrollment period after the last month on her employer plan that differs from t
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he standard general enrollment period, during which she may enroll in Medicare Part
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B.
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Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medig
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ap plan to pick up costs not covered by that plan. What should you tell him? -
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ANSWERS-
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It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA pla
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n, and besides, Medigap only works with Original Medicare.
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Ms. Henderson believes that she will qualify for Medicare Coverage when she turns
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65, without paying any premiums, because she has been working for 40 years and p
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aying Medicare taxes. What should you tell her? - ANSWERS-
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To obtain Part B coverage, she must pay a standard monthly premium, though it is hi
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gher for individuals with higher incomes.
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, Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
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Mrs. Park that might be of assistance? - ANSWERS-
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She should contact her state Medicaid agency to see if she qualifies for one of sever
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al programs that can help with Medicare costs for which she is responsible.
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Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE).
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This coverage has recently been terminated due to the end of the PHE. While Shirle
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y was enrolled in Medicaid, she missed an opportunity to enroll in Medicare and now
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wants Part B. Which of the following statements best describes Shirley's ability to no
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w enroll in Medicare Part B? - ANSWERS-
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Shirley is eligible for a Special Enrollment Period (SEP) for up to six months after the
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termination of her Medicaid coverage. Under this SEP, Shirley can choose retroactiv
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e coverage back to the date of termination from Medicaid or coverage beginning the
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month after the month of enrollment. gf gf gf gf gf
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent heal
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th and will have considerable income when she retires. She is concerned that her inc
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ome will make it impossible for her to qualify for Medicare. What could you tell her to
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address her concern? - ANSWERS- gf gf gf gf
Medicare is a program for people age 65 or older and those under age 65 with certai
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n disabilities, end-
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stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
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Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but
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it provides no drug coverage. She would like to keep the coverage she has but repla
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ce her existing Medigap plan with one that provides drug coverage. What should you
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tell her? - ANSWERS-
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Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could kee
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p her Medigap policy and enroll in a Part D prescription drug plan.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed f
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ull time, and paid taxes during that entire period. She is concerned that she will not q
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ualify for coverage under part A because she was not born in the United States. Wha
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t should you tell her? - ANSWERS-
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Most individuals who are citizens and age 65 or over are covered under Part A by vir
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tue of having paid Medicare taxes while working, though some may be covered as a
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result of paying monthly premiums. gf gf gf gf
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are p
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rovided under Original Medicare. What should you tell Mr. Xi that best describes the
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health coverage provided to Medicare beneficiaries? - ANSWERS-
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Beneficiaries under Original Medicare have no cost- gf gf gf gf gf gf
sharing for most preventive services which include immunizations such as annual flu
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shots.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what cov
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erage Medicare Supplemental Insurance provides since his health care needs are dif
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ferent from his wife's needs. What could you tell Mr. Moy? - ANSWERS-
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Medicare Supplemental Insurance would help cover his Part A and Part B deductible
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