AHIP EXAM
Mr. Schmidt would like to plan for retirement and has Part A, which covers hospital, skilled nursing facility, hospice, and home health
asked you what is covered under Original Fee-for-Service services and Part B, which covers professional services such as those provided by
(FFS) Medicare. What could you tell him? a doctor are covered under Original Medicare.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed She should contact her state Medicaid agency to see if she qualifies for one of the
income. What could you tell Mrs. Cook that might be of several programs that can help with Medicare costs for which she is responsible.
assistance?
Mr. Moy will soon turn age 65. He is slightly younger than Medicare supplemental insurance would help cover his Part A deductible and Part B
his wife. Mr. Moy's wife has a Medicare Advantage plan, coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as well as
but he wants to understand what coverage Medicare possibly some services that Medicare does not cover
Supplemental insurance provides since his health care
needs are different from his wife's needs. What could you
tell Mr. Moy?
Mr. Vasquez is in good health and is preparing a budget in Under Original Medicare, there is a single deductible amount due for the first 60
anticipation of his retirement when he turns 66. He wants days of any inpatient hospital stay, after which it converts into a per-day
to understand the health care costs he might be exposed coinsurance amount through day 90. After day 90, he would pay a daily amount up
to under Medicare is he were to require hospitalization to 60 days over his lifetime, after which he would be responsible for all costs
because of an illness. In general terms, what could you tell
him about his costs for inpatient hospital services under
Original Medicare?
Mr. Wu is eligible for Medicare. He has limited financial Mr. Wu may still qualify for help in paying Part D costs through his State
resources but failed to qualify for the Part D low-income Pharmaceutical Assistance program (SPAP)
subsidy. Where might he turn for help with his prescription
drug costs?
Ms. Henderson believes that she will qualify for Medicare To obtain Part B coverage, she must pay a standard monthly premium, though it is
Coverage when she turns 65, without paying any higher for individuals with higher income
premiums, because she has been working for 40 years
and paying Medicare taxes. What should you tell her?
Agent John Miller is meeting with Jerry Smith, a new Tell prospect Jerry Smith that he should consider adding a standalone Part D
prospect. Jerry is currently enrolled in Medicare Parts A prescription drug coverage policy to his present coverage
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?
Madeline Martinez was widowed several years ago. Her You should tell Madeline that she will be able to enroll in Medicare Part A without
husband worked for many years and contributed into the paying monthly premiums due to her husband's long work record and participation
Medicare system. He also left a substantial estate which in the Medicare system. You should also tell Madeline that she will pay Part B
provides Madeline with an annual income of approximately premiums at more than the standard lowest rate but less than the highest rate due
$130,000. Madeline, who has only worked part-time for the her substantial income
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?
Ms. Kumar plans to retire when she turns 65 in a few Medicare is a program for people age 65 or older and those under age 65 with
months. She is in excellent health and will have certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will
considerable income when she retires. She is concerned be eligible for Medicare
that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern?
Edward suffered from serious kidney disease. As a result. Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months
Edward became eligible for Medicare coverage due to after the month in which the individual receives a kidney transplant unless they are
end-stage renal disease (ESRD). A close relative donated eligible for Medicare on another basis such as age or disability. Edward may,
their kidney and Edward successfully underwent transplant however, remain enrolled in Part B but solely for coverage of immunosuppressive
surgery 12 months ago. Edward is now age 50 and asks drugs if he has no other health care coverage that would cover the drugs.
you if his Medicare coverage will continue, what should
you say?
Mrs. Thomas is 66 years old, has coverage under an She may enroll at any time while she is covered under her employer plan, but she
employer plan, and will retire next year. She heard she will have a special eight-month enrollment period after the last month on her
must enroll in Part B at the beginning of the year to ensure employer plan that differs from the standard general enrollment period, during which
no gap in coverage. What can you tell her? she may enroll in Medicare Part B.
Stuvia 2026-2027
, AHIP EXAM
Ms. Lewis has aggressive cancer and would like to know if Medicare covers hospice services, and they will be available for her
Medicare will cover hospice services in case she needs
them. What should you tell her?
Mr. Bauer is 49 years old, but eighteen months ago he was After receiving such disability payments for 24 months, he will be automatically
declared disabled by the Social Security Administration enrolled in Medicare, regardless of age
and has been receiving disability payments. He is
wondering whether he can obtain coverage under
Medicare. What should you tell him?
Mr. Singh would like drug coverage but does not want to Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
be enrolled in a Medicare Advantage plan. What should covered for Part A and Part B services through Original Fee-for-Service Medicare.
you tell him?
Mrs. Ellis recently turned 66 and decided after many years Part B primarily covers physician services. She will be paying a monthly premium
of work to retire and begin receiving Social Security and, except for many preventive screening and tests, generally will have 20% co-
benefits. Shortly thereafter Mrs. Ellis received a letter payments for these services in addition to an annual deductible
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?
Anthony Boniface turned 65 in 2024. He was not receiving Anthony is eligible for a special enrollment period (SEP) because he missed an
Social Security or Railroad Retirement Benefits on his 65th enrollment period due to the impact of the Federally declared disaster. This SEP will
birthday. He was interested in obtaining Medicare allow Anthony to enroll in Part B up to six months after the end of the emergency
coverage and is eligible for premium-free Part A. Before he declaration. Anthony may enroll in premium-free Part A at any time and his Part A
could enroll in Medicare, his entire area was impacted by a coverage will be retroactive for up to 6 months.
hurricane causing massive flooding and severe wind
damage. The Federal government declared this to be a
natural disaster which has recently ended. During this
period Anthony's initial enrollment period expired. Anthony
asks you how he can now obtain Medicare coverage. What
should you say?
Juan Perez, who is turning age 65 next month, intends to Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
work for several more years at Smallcap, Incorporated. Medicare would become the primary payor of his healthcare claims and Smallcap
Smallcap has a workforce of 15 employees and offers does not have to continue to offer him coverage comparable to those under age 65
employer-sponsored healthcare coverage. Juan is a under its employer-sponsored group health plan and would become a secondary
naturalized citizen and has contributed to the Medicare payor
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?
Mr. Capadona would like to purchase a Medicare It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
Advantage (MA) plan and a Medigap plan to pick up costs plan, and besides, Medigap only works with Original Medicare.
not covered by that plan. What should you tell him?
Mrs. Foster is covered by Original Medicare. She Medicare will cover Mrs. Foster's skilled nursing services provided during the first
sustained a hip fracture and is being successfully treated 20 days of her stay, after which she would have a copay until she has been in the
for that condition. However, she and her physicians feel facility for 100 days.
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?
Mildred Savage enrolled in Allcare Medicare Advantage Mildred may remain enrolled in Allcare and make a hospice election. Hospice
plan several years ago. Mildred recently learned that she is benefits will be paid for by Original Medicare under Part A and Allcare will continue
suffering from inoperable cancer and has just a few to pay for any non-hospice services.
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?
Stuvia 2026-2027
Mr. Schmidt would like to plan for retirement and has Part A, which covers hospital, skilled nursing facility, hospice, and home health
asked you what is covered under Original Fee-for-Service services and Part B, which covers professional services such as those provided by
(FFS) Medicare. What could you tell him? a doctor are covered under Original Medicare.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed She should contact her state Medicaid agency to see if she qualifies for one of the
income. What could you tell Mrs. Cook that might be of several programs that can help with Medicare costs for which she is responsible.
assistance?
Mr. Moy will soon turn age 65. He is slightly younger than Medicare supplemental insurance would help cover his Part A deductible and Part B
his wife. Mr. Moy's wife has a Medicare Advantage plan, coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as well as
but he wants to understand what coverage Medicare possibly some services that Medicare does not cover
Supplemental insurance provides since his health care
needs are different from his wife's needs. What could you
tell Mr. Moy?
Mr. Vasquez is in good health and is preparing a budget in Under Original Medicare, there is a single deductible amount due for the first 60
anticipation of his retirement when he turns 66. He wants days of any inpatient hospital stay, after which it converts into a per-day
to understand the health care costs he might be exposed coinsurance amount through day 90. After day 90, he would pay a daily amount up
to under Medicare is he were to require hospitalization to 60 days over his lifetime, after which he would be responsible for all costs
because of an illness. In general terms, what could you tell
him about his costs for inpatient hospital services under
Original Medicare?
Mr. Wu is eligible for Medicare. He has limited financial Mr. Wu may still qualify for help in paying Part D costs through his State
resources but failed to qualify for the Part D low-income Pharmaceutical Assistance program (SPAP)
subsidy. Where might he turn for help with his prescription
drug costs?
Ms. Henderson believes that she will qualify for Medicare To obtain Part B coverage, she must pay a standard monthly premium, though it is
Coverage when she turns 65, without paying any higher for individuals with higher income
premiums, because she has been working for 40 years
and paying Medicare taxes. What should you tell her?
Agent John Miller is meeting with Jerry Smith, a new Tell prospect Jerry Smith that he should consider adding a standalone Part D
prospect. Jerry is currently enrolled in Medicare Parts A prescription drug coverage policy to his present coverage
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?
Madeline Martinez was widowed several years ago. Her You should tell Madeline that she will be able to enroll in Medicare Part A without
husband worked for many years and contributed into the paying monthly premiums due to her husband's long work record and participation
Medicare system. He also left a substantial estate which in the Medicare system. You should also tell Madeline that she will pay Part B
provides Madeline with an annual income of approximately premiums at more than the standard lowest rate but less than the highest rate due
$130,000. Madeline, who has only worked part-time for the her substantial income
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?
Ms. Kumar plans to retire when she turns 65 in a few Medicare is a program for people age 65 or older and those under age 65 with
months. She is in excellent health and will have certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will
considerable income when she retires. She is concerned be eligible for Medicare
that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern?
Edward suffered from serious kidney disease. As a result. Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months
Edward became eligible for Medicare coverage due to after the month in which the individual receives a kidney transplant unless they are
end-stage renal disease (ESRD). A close relative donated eligible for Medicare on another basis such as age or disability. Edward may,
their kidney and Edward successfully underwent transplant however, remain enrolled in Part B but solely for coverage of immunosuppressive
surgery 12 months ago. Edward is now age 50 and asks drugs if he has no other health care coverage that would cover the drugs.
you if his Medicare coverage will continue, what should
you say?
Mrs. Thomas is 66 years old, has coverage under an She may enroll at any time while she is covered under her employer plan, but she
employer plan, and will retire next year. She heard she will have a special eight-month enrollment period after the last month on her
must enroll in Part B at the beginning of the year to ensure employer plan that differs from the standard general enrollment period, during which
no gap in coverage. What can you tell her? she may enroll in Medicare Part B.
Stuvia 2026-2027
, AHIP EXAM
Ms. Lewis has aggressive cancer and would like to know if Medicare covers hospice services, and they will be available for her
Medicare will cover hospice services in case she needs
them. What should you tell her?
Mr. Bauer is 49 years old, but eighteen months ago he was After receiving such disability payments for 24 months, he will be automatically
declared disabled by the Social Security Administration enrolled in Medicare, regardless of age
and has been receiving disability payments. He is
wondering whether he can obtain coverage under
Medicare. What should you tell him?
Mr. Singh would like drug coverage but does not want to Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
be enrolled in a Medicare Advantage plan. What should covered for Part A and Part B services through Original Fee-for-Service Medicare.
you tell him?
Mrs. Ellis recently turned 66 and decided after many years Part B primarily covers physician services. She will be paying a monthly premium
of work to retire and begin receiving Social Security and, except for many preventive screening and tests, generally will have 20% co-
benefits. Shortly thereafter Mrs. Ellis received a letter payments for these services in addition to an annual deductible
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?
Anthony Boniface turned 65 in 2024. He was not receiving Anthony is eligible for a special enrollment period (SEP) because he missed an
Social Security or Railroad Retirement Benefits on his 65th enrollment period due to the impact of the Federally declared disaster. This SEP will
birthday. He was interested in obtaining Medicare allow Anthony to enroll in Part B up to six months after the end of the emergency
coverage and is eligible for premium-free Part A. Before he declaration. Anthony may enroll in premium-free Part A at any time and his Part A
could enroll in Medicare, his entire area was impacted by a coverage will be retroactive for up to 6 months.
hurricane causing massive flooding and severe wind
damage. The Federal government declared this to be a
natural disaster which has recently ended. During this
period Anthony's initial enrollment period expired. Anthony
asks you how he can now obtain Medicare coverage. What
should you say?
Juan Perez, who is turning age 65 next month, intends to Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
work for several more years at Smallcap, Incorporated. Medicare would become the primary payor of his healthcare claims and Smallcap
Smallcap has a workforce of 15 employees and offers does not have to continue to offer him coverage comparable to those under age 65
employer-sponsored healthcare coverage. Juan is a under its employer-sponsored group health plan and would become a secondary
naturalized citizen and has contributed to the Medicare payor
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?
Mr. Capadona would like to purchase a Medicare It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
Advantage (MA) plan and a Medigap plan to pick up costs plan, and besides, Medigap only works with Original Medicare.
not covered by that plan. What should you tell him?
Mrs. Foster is covered by Original Medicare. She Medicare will cover Mrs. Foster's skilled nursing services provided during the first
sustained a hip fracture and is being successfully treated 20 days of her stay, after which she would have a copay until she has been in the
for that condition. However, she and her physicians feel facility for 100 days.
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?
Mildred Savage enrolled in Allcare Medicare Advantage Mildred may remain enrolled in Allcare and make a hospice election. Hospice
plan several years ago. Mildred recently learned that she is benefits will be paid for by Original Medicare under Part A and Allcare will continue
suffering from inoperable cancer and has just a few to pay for any non-hospice services.
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?
Stuvia 2026-2027
