AHIP questions and answers A+ Grade
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?
- correct answer Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, end stage renal disease and Lou Gehrig's disease, so she will be eligible for Medicare.
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?
- correct answer 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.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at
some time in the future, reduce his benefits below what is available in Original Medicare. What should
you tell him about his concern?
- correct answer Medicare health plans must cover all benefits available under Medicare Part A and Part
B. Many also cover Part D prescription drugs.
Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that it is a
forgery since it does not have her Social Security number on it. What should you tell her?
- correct answer The card she received is valid, the change has been made to protect Medicare
beneficiaries from identity theft, and she should now destroy her old card.
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the
benefit package of a Medicare Health Plan before she starts looking at specific plans. What could you
tell her?
- correct answer Medicare Health Plans may offer extra benefits that Original Medicare does not offer
such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A
and Part B services.
,Mr. Meoni'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.Meoni?
- correct answer Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing
in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not
cover.
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?
- correct 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.
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?
- correct answer After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
Mr. Denton 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?
- correct answer He may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start.
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?
- correct answer In order to obtain Part B coverage, she must pay a standard monthly premium, though
it is higher for individuals with higher incomes.
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?
- correct answer Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
,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?
- correct answer She may enroll at any time while she is covered under her employer plan, but she will
have a special eight-month enrollment period that differs from the standard general enrollment period,
during which she may enroll in Medicare Part B.
Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. She is considering enrollment
in a Medicare health plan (Part C). What should you advise her to do before she will be able to enroll
into a Medicare health plan?
- correct answer In order to join a Medicare health plan, she also must enroll in Part B.
Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that might be
of assistance?
- correct answer 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 is responsible.
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?
- correct answer Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
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?
- correct answer Under Original Medicare, there is a single deductible amount due for the first 60 days
of any inpatient hospital stay, after which it converts into 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 for all costs
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?
- correct answer Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20
days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days
, 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?
- correct answer Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mrs. Quinn has 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?
- correct answer Part B primarily covers physician services. She will be paying a monthly premium and,
with the exception of many preventive and screening tests, generally will have 20% co-payments for
these services, in addition to an annual deductible.
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?
- correct answer Medicare covers periodic performance of a range of screening tests that are meant to
provide early detection of disease. Mr. Buck will need to check specific tests before obtaining them to
see if they will be covered
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?
- correct answer Original Medicare covers ambulance services.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
acupuncture. She is concerned about whether or not Medicare will cover these items and services. What
should you tell her?
- correct answer Medicare does not cover acupuncture, or, in general, glasses or dentures.
Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should
you tell him?
- correct answer Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered
for Part A and Part B services through Original Fee-for-Service Medicare.
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
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?
- correct answer Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, end stage renal disease and Lou Gehrig's disease, so she will be eligible for Medicare.
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?
- correct answer 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.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at
some time in the future, reduce his benefits below what is available in Original Medicare. What should
you tell him about his concern?
- correct answer Medicare health plans must cover all benefits available under Medicare Part A and Part
B. Many also cover Part D prescription drugs.
Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that it is a
forgery since it does not have her Social Security number on it. What should you tell her?
- correct answer The card she received is valid, the change has been made to protect Medicare
beneficiaries from identity theft, and she should now destroy her old card.
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the
benefit package of a Medicare Health Plan before she starts looking at specific plans. What could you
tell her?
- correct answer Medicare Health Plans may offer extra benefits that Original Medicare does not offer
such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A
and Part B services.
,Mr. Meoni'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.Meoni?
- correct answer Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing
in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not
cover.
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?
- correct 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.
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?
- correct answer After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
Mr. Denton 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?
- correct answer He may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start.
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?
- correct answer In order to obtain Part B coverage, she must pay a standard monthly premium, though
it is higher for individuals with higher incomes.
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?
- correct answer Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
,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?
- correct answer She may enroll at any time while she is covered under her employer plan, but she will
have a special eight-month enrollment period that differs from the standard general enrollment period,
during which she may enroll in Medicare Part B.
Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. She is considering enrollment
in a Medicare health plan (Part C). What should you advise her to do before she will be able to enroll
into a Medicare health plan?
- correct answer In order to join a Medicare health plan, she also must enroll in Part B.
Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that might be
of assistance?
- correct answer 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 is responsible.
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?
- correct answer Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
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?
- correct answer Under Original Medicare, there is a single deductible amount due for the first 60 days
of any inpatient hospital stay, after which it converts into 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 for all costs
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?
- correct answer Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20
days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days
, 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?
- correct answer Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mrs. Quinn has 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?
- correct answer Part B primarily covers physician services. She will be paying a monthly premium and,
with the exception of many preventive and screening tests, generally will have 20% co-payments for
these services, in addition to an annual deductible.
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?
- correct answer Medicare covers periodic performance of a range of screening tests that are meant to
provide early detection of disease. Mr. Buck will need to check specific tests before obtaining them to
see if they will be covered
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?
- correct answer Original Medicare covers ambulance services.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
acupuncture. She is concerned about whether or not Medicare will cover these items and services. What
should you tell her?
- correct answer Medicare does not cover acupuncture, or, in general, glasses or dentures.
Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should
you tell him?
- correct answer Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered
for Part A and Part B services through Original Fee-for-Service Medicare.
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
