AHIP MODULES 1 5 MEDICARE CERTIFICATION
PRACTICE QUESTIONS AND DETAILED
SOLUTIONS
◉ MOD 1 - Review -Juan Perez, who is turning age 65 next month,
intends to work for several more years at Smallcap, Incorporated.
Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen 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
impact his employer- sponsored healthcare coverage. How would
you respond?
a.Juan is likely to be ineligible for Medicare since he was born
outside the United States and has only contributed to the Medicare
system for 20 years.
b.Juan is likely to be eligible for Medicare once he turns age 65 and if
he enrolls his employer-sponsored coverage would continue to be
the primary payor while Medicare would be considered a secondary
payor of his healthcare claims.
c.Juan is likely to be eligible for Medicare once he turns age 65 and if
h.
Answer: d.Juan is likely to be eligible for Medicare once he turns age
65 and if he enrolls, Medicare would 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 its
employer-sponsored group health plan and would become a
secondary payor.
◉ MOD 1 - Review - 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?
a.Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present
coverage.
b.Tell prospect Jerry Smith that he should drop his Medigap
coverage and put those premium dollars toward the purchase of a
standalone Part D prescription drug plan because he can always
reactivate his Medigap policy on a guaranteed issue basis.
Furthermore, because he has had Medigap Jerry will not incur a Part
D late enrollment penalty.
c.Tell prospect Jerry Smith that Medigap is simply a variation of a
Medicare Advantage plan and the companies John r.
Answer: a.Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present
coverage.
,◉ MOD 1 - Review - Mildred Savage enrolled in Allcare Medicare
Advantage plan several years ago. Mildred recently learned that she
is suffering 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?
a.Hospice benefits will be available to Mildred but they will be paid
for by Original Medicare under Part B.
b.Hospice benefits will be paid for under Mildred's Allcare Medicare
Advantage plan which must cover all Medicare Part A and Part B
benefits.
c.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
.d.Hospice benefits are not covered under Medicare and must be
paid for using private f.
Answer: c.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
◉ MOD 1 - Review - Mr. Vasquez 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 because of an illness.
, In general terms, what could you tell him about his costs for
inpatient hospital services under Original Medicare?
a.Under Original Medicare, if the inpatient hospital service is
provided by a participating Medicare provider, the co-payment is
waived. Co-payments are only charged when a beneficiary opts to
receive care from a non-participating provider.
b.Under Original Medicare, the inpatient hospital co-payment is a
percentage of allowed charges. The percentage increases after 60
days and again after 90 days.
c.Under Original Medicare, there is a single deductible amount due
for the first 60 days of any inpatient hospital stay, after which it
converts.
Answer: c.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.
◉ MOD 1. - Review - Edward 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?
a.Individuals eligible for Medicare based on ESRD generally lose
eligibility 36 months after the month in which the individual
PRACTICE QUESTIONS AND DETAILED
SOLUTIONS
◉ MOD 1 - Review -Juan Perez, who is turning age 65 next month,
intends to work for several more years at Smallcap, Incorporated.
Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen 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
impact his employer- sponsored healthcare coverage. How would
you respond?
a.Juan is likely to be ineligible for Medicare since he was born
outside the United States and has only contributed to the Medicare
system for 20 years.
b.Juan is likely to be eligible for Medicare once he turns age 65 and if
he enrolls his employer-sponsored coverage would continue to be
the primary payor while Medicare would be considered a secondary
payor of his healthcare claims.
c.Juan is likely to be eligible for Medicare once he turns age 65 and if
h.
Answer: d.Juan is likely to be eligible for Medicare once he turns age
65 and if he enrolls, Medicare would 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 its
employer-sponsored group health plan and would become a
secondary payor.
◉ MOD 1 - Review - 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?
a.Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present
coverage.
b.Tell prospect Jerry Smith that he should drop his Medigap
coverage and put those premium dollars toward the purchase of a
standalone Part D prescription drug plan because he can always
reactivate his Medigap policy on a guaranteed issue basis.
Furthermore, because he has had Medigap Jerry will not incur a Part
D late enrollment penalty.
c.Tell prospect Jerry Smith that Medigap is simply a variation of a
Medicare Advantage plan and the companies John r.
Answer: a.Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present
coverage.
,◉ MOD 1 - Review - Mildred Savage enrolled in Allcare Medicare
Advantage plan several years ago. Mildred recently learned that she
is suffering 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?
a.Hospice benefits will be available to Mildred but they will be paid
for by Original Medicare under Part B.
b.Hospice benefits will be paid for under Mildred's Allcare Medicare
Advantage plan which must cover all Medicare Part A and Part B
benefits.
c.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
.d.Hospice benefits are not covered under Medicare and must be
paid for using private f.
Answer: c.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
◉ MOD 1 - Review - Mr. Vasquez 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 because of an illness.
, In general terms, what could you tell him about his costs for
inpatient hospital services under Original Medicare?
a.Under Original Medicare, if the inpatient hospital service is
provided by a participating Medicare provider, the co-payment is
waived. Co-payments are only charged when a beneficiary opts to
receive care from a non-participating provider.
b.Under Original Medicare, the inpatient hospital co-payment is a
percentage of allowed charges. The percentage increases after 60
days and again after 90 days.
c.Under Original Medicare, there is a single deductible amount due
for the first 60 days of any inpatient hospital stay, after which it
converts.
Answer: c.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.
◉ MOD 1. - Review - Edward 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?
a.Individuals eligible for Medicare based on ESRD generally lose
eligibility 36 months after the month in which the individual
