AHIP Exam Questions and Answers 100% Pass
Medicare Advantage - ✔✔-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? - ✔✔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.
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? - ✔✔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
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,about his concern? - ✔✔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? - ✔✔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? - ✔✔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.
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? - ✔✔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? - ✔✔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
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Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
,coverage under Medicare. What should you tell him? - ✔✔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? - ✔✔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.
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? - ✔✔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? - ✔✔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? -
✔✔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? - ✔✔In order to join a Medicare health plan, she must be enrolled in Parts A, B and D
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Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
, Mrs. Toma has a low, fixed income. What could you tell her that might be of assistance? - ✔✔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.
Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for some type
of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to know what the
assistance could do for him if he qualifies. What could you tell him? - ✔✔He might qualify for help with
Part D prescription drug costs and help paying Part A and/or Part B premiums, deductibles, and/or cost
sharing.
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 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
Mrs. Kanof is covered by Original Medicare. She sustained a hip fracture and is being successfully treated
for that condition. However, she and her physicians feel 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? - ✔✔Medicare will cover Mrs. Kanof's skilled nursing
services provided during the first 20 days of her stay, after which she would have a copay until she has
been in the facility for 100 days.
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
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Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
Medicare Advantage - ✔✔-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? - ✔✔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.
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? - ✔✔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
Page 1/35
Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
,about his concern? - ✔✔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? - ✔✔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? - ✔✔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.
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? - ✔✔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? - ✔✔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
Page 2/35
Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
,coverage under Medicare. What should you tell him? - ✔✔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? - ✔✔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.
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? - ✔✔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? - ✔✔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? -
✔✔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? - ✔✔In order to join a Medicare health plan, she must be enrolled in Parts A, B and D
Page 3/35
Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
, Mrs. Toma has a low, fixed income. What could you tell her that might be of assistance? - ✔✔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.
Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for some type
of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to know what the
assistance could do for him if he qualifies. What could you tell him? - ✔✔He might qualify for help with
Part D prescription drug costs and help paying Part A and/or Part B premiums, deductibles, and/or cost
sharing.
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 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
Mrs. Kanof is covered by Original Medicare. She sustained a hip fracture and is being successfully treated
for that condition. However, she and her physicians feel 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? - ✔✔Medicare will cover Mrs. Kanof's skilled nursing
services provided during the first 20 days of her stay, after which she would have a copay until she has
been in the facility for 100 days.
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
Page 4/35
Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
