(Answered) 2022 AHIP Exam Version
1
(Answers below every question)
Mr. Davis 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? He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
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? 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.
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? 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.
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? 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.
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?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.
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? 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.
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? To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
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? He
generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
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?
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. 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? Beneficiaries under Original Medicare have no cost-
sharing for most preventive services which include immunizations such
as annual flu shots.
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?Mrs. Duarte should file an appeal of
this initial determination within 120 days of the date she received the
MSN in the mail.
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? 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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance? She should
1
(Answers below every question)
Mr. Davis 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? He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
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? 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.
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? 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.
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? 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.
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?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.
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? 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.
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? To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
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? He
generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
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?
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. 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? Beneficiaries under Original Medicare have no cost-
sharing for most preventive services which include immunizations such
as annual flu shots.
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?Mrs. Duarte should file an appeal of
this initial determination within 120 days of the date she received the
MSN in the mail.
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? 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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance? She should
