©EMILLECT2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
AHIP Exam Study Guide Solutions
Medicare Advantage - ANSWER✔✔--Cover all Part A and Part B benefits;
-Provide plan cost-sharing actuarially equivalent to cost sharing under Medicare Parts A and B, but may
be different for specific services; and
-Include an annual maximum out-of-pocket (MOOP) limit on total enrollee cost sharing (deductibles,
coinsurance, and copayments) for Part A and Part B services.
-Cover the following services even when provided by non-network providers:
emergency services:
out-of-area urgently needed services; and
out-of-area renal dialysis
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? - ANSWER✔✔-Medicare is a
program for people age 65 or older and those under age 65 with certain disabilities, end stage renal
disease or Lou Gehrig's disease, so she will be eligible for Medicare.
Page 1/45
, ©EMILLECT2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
Mr. Styles 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? - 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. Hudson is concerned that if he signs up for a Medicare health 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? - ANSWER✔✔-Medicare health plans must cover all benefits available under
Medicare Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what
Part D is so she called you to ask what her neighbor was talking about. What could you tell her? -
ANSWER✔✔-Part D covers prescription drugs and she should look at her premiums, formulary, and cost
sharing to see if they have changed.
Mrs. Weems 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? - 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.
Page 2/45
, ©EMILLECT2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
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? - 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.
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? - 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? - ANSWER✔✔-After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug policy?
- ANSWER✔✔-No, he cannot purchase a Medicare Advantage or Part D policy because he has not
received Social Security or Railroad Retirement disability benefits for 24 months.
Page 3/45
, ©EMILLECT2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
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? - 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? -
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? -
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 is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in a
Medicare health plan. What should you advise her to do before she will be able to enroll into a Medicare
health plan? - ANSWER✔✔-In order to join a Medicare health plan, she must be enrolled in Parts A, B
and D
Page 4/45
FIRST PUBLISH OCTOBER 2024
AHIP Exam Study Guide Solutions
Medicare Advantage - ANSWER✔✔--Cover all Part A and Part B benefits;
-Provide plan cost-sharing actuarially equivalent to cost sharing under Medicare Parts A and B, but may
be different for specific services; and
-Include an annual maximum out-of-pocket (MOOP) limit on total enrollee cost sharing (deductibles,
coinsurance, and copayments) for Part A and Part B services.
-Cover the following services even when provided by non-network providers:
emergency services:
out-of-area urgently needed services; and
out-of-area renal dialysis
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? - ANSWER✔✔-Medicare is a
program for people age 65 or older and those under age 65 with certain disabilities, end stage renal
disease or Lou Gehrig's disease, so she will be eligible for Medicare.
Page 1/45
, ©EMILLECT2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
Mr. Styles 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? - 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. Hudson is concerned that if he signs up for a Medicare health 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? - ANSWER✔✔-Medicare health plans must cover all benefits available under
Medicare Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what
Part D is so she called you to ask what her neighbor was talking about. What could you tell her? -
ANSWER✔✔-Part D covers prescription drugs and she should look at her premiums, formulary, and cost
sharing to see if they have changed.
Mrs. Weems 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? - 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.
Page 2/45
, ©EMILLECT2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
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? - 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.
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? - 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? - ANSWER✔✔-After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug policy?
- ANSWER✔✔-No, he cannot purchase a Medicare Advantage or Part D policy because he has not
received Social Security or Railroad Retirement disability benefits for 24 months.
Page 3/45
, ©EMILLECT2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
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? - 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? -
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? -
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 is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in a
Medicare health plan. What should you advise her to do before she will be able to enroll into a Medicare
health plan? - ANSWER✔✔-In order to join a Medicare health plan, she must be enrolled in Parts A, B
and D
Page 4/45
