AHIP Final & Module 1–5 Test Bank | Accurate UPDATED
ACTUAL Exam Questions and CORRECT Answers with Solutions
Graded A+
Question 1.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 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?
Correct Answer: 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.
Question 2.
Mr. Moy'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. Moy?
Correct Answer: 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.
‣ 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? -✓✓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.
Question 3.
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 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.
,Question 4.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it
provides no drug coverage. She would like to keep the coverage she has but replace her
existing Medigap plan with one that provides drug coverage. What should you tell her?
Correct Answer: Mrs. Gonzalez cannot purchase a Medigap plan that covers
drugs, but she could keep her Medigap policy and enroll in a Part D
prescription drug plan.
Question 5.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. 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 massage therapy, or, in general,
glasses or dentures.
‣ 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? -✓✓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.
Question 6.
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: To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
Question 7.
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 MedicarePart D prescription drug plan. What should you tell him?
Correct Answer: He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
Question 8.
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.
Question 9.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?
Correct Answer: Beneficiaries under Original Medicare have no cost- sharing
for most preventive services which include immunizations such as annual flu
shots.
Question 10.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
Medicare Summary Notice (MSN) and disagrees with a determination that partially
denied one of her claims for services. What advice would you give her?
Correct Answer: Mrs. Duarte should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
Question 11.
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?
Correct Answer: 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.
Question 12.
Mrs. Park is an elderly retiree. Mrs. Park 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.
Question 13.
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.
Question 14.
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.
Question 15.
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?
Correct Answer: Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present coverage.
Question 16.
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.
Question 17.
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 the 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.
Question 18.
Which of the following statement is/are correct about a Medicare Savings Account (MSA)
Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
ACTUAL Exam Questions and CORRECT Answers with Solutions
Graded A+
Question 1.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 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?
Correct Answer: 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.
Question 2.
Mr. Moy'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. Moy?
Correct Answer: 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.
‣ 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? -✓✓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.
Question 3.
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 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.
,Question 4.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it
provides no drug coverage. She would like to keep the coverage she has but replace her
existing Medigap plan with one that provides drug coverage. What should you tell her?
Correct Answer: Mrs. Gonzalez cannot purchase a Medigap plan that covers
drugs, but she could keep her Medigap policy and enroll in a Part D
prescription drug plan.
Question 5.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. 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 massage therapy, or, in general,
glasses or dentures.
‣ 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? -✓✓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.
Question 6.
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: To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
Question 7.
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 MedicarePart D prescription drug plan. What should you tell him?
Correct Answer: He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
Question 8.
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.
Question 9.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?
Correct Answer: Beneficiaries under Original Medicare have no cost- sharing
for most preventive services which include immunizations such as annual flu
shots.
Question 10.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
Medicare Summary Notice (MSN) and disagrees with a determination that partially
denied one of her claims for services. What advice would you give her?
Correct Answer: Mrs. Duarte should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
Question 11.
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?
Correct Answer: 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.
Question 12.
Mrs. Park is an elderly retiree. Mrs. Park 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.
Question 13.
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.
Question 14.
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.
Question 15.
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?
Correct Answer: Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present coverage.
Question 16.
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.
Question 17.
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 the 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.
Question 18.
Which of the following statement is/are correct about a Medicare Savings Account (MSA)
Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
