AHIP NUR COMMUNITY EXAM LATEST UPDATED 2024 QUESTIONS WITH
DETAILED ANSWERS
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
Mrs. Willard 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
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 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. 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?
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. Lopez has heard that he can sign up for a product called “Medicare Advantage” but is
not sure about what type of plan designs are available through this program. What should
you tell him about the types of health plans that are available through the Medicare
Advantage program?
They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description?
Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies
During a sales presentation in Ms. Sullivan’s home, she tells you that she has heard about
a type of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to
know if this would be available to her. What should you tell her about PFFS plans?
A PFFS plan is one of various types of Medicare Advantage plans offered by private
entities and she may enroll in one if it is available in her area.
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?
After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age
Mr. Roberts is concerned that if he signs up for a Medicare Advantage 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?
Medicare health plans must cover all benefits available under Medicare Part A and
,Part B. Many also cover Part D prescription drugs
Mrs. Carol enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her
doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options
does she have in regard to her MA plan during the next open enrollment season?
She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for
individuals suffering from ESRD if one is available in her area
Mrs. Prudence is a widow who will attain age 65 and enroll in Medicare in just a few
weeks. She concerned about having prescription drug coverage. Which of the following
statements provides the best advice?
Prescription drug coverage can be obtained by enrolling in a Medicare Advantage
plan that includes Part D coverage
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him?
In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from
providers who have a contractual relationship with the plan (except in an
emergency)
, Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard
about a neighbor’s MA-PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should you tell him?
Beneficiaries should check with their employer or union group benefits administrator
before changing plans to avoid losing coverage they want to keep
Mrs. Walters is enrolled in her state’s Medicaid program in addition to Medicare. What
should she be aware of when considering enrollment in a Medicare Health Plan?
Medicaid will coordinate benefits only with Medicaid participating providers.
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to
services since she receives some assistance for her health care costs from the State.
What should you tell her?
Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with
Medicaid participating providers.
Mr. Rivera has QMB-Plus eligibility and is thus covered by both Medicare and Medicaid. He
decides to enroll in a Medicare Advantage (MA) plan. Later in the year, Mr. Rivera needs
dentures, a service only covered under Medicaid. What action would you recommend he
take in order to have this cost covered?
He should go to a Medicaid provider or obtain the services through a Medicaid manage
care plan if he is enrolled in one
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.
DETAILED ANSWERS
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
Mrs. Willard 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
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 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. 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?
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. Lopez has heard that he can sign up for a product called “Medicare Advantage” but is
not sure about what type of plan designs are available through this program. What should
you tell him about the types of health plans that are available through the Medicare
Advantage program?
They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description?
Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies
During a sales presentation in Ms. Sullivan’s home, she tells you that she has heard about
a type of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to
know if this would be available to her. What should you tell her about PFFS plans?
A PFFS plan is one of various types of Medicare Advantage plans offered by private
entities and she may enroll in one if it is available in her area.
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?
After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age
Mr. Roberts is concerned that if he signs up for a Medicare Advantage 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?
Medicare health plans must cover all benefits available under Medicare Part A and
,Part B. Many also cover Part D prescription drugs
Mrs. Carol enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her
doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options
does she have in regard to her MA plan during the next open enrollment season?
She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for
individuals suffering from ESRD if one is available in her area
Mrs. Prudence is a widow who will attain age 65 and enroll in Medicare in just a few
weeks. She concerned about having prescription drug coverage. Which of the following
statements provides the best advice?
Prescription drug coverage can be obtained by enrolling in a Medicare Advantage
plan that includes Part D coverage
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him?
In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from
providers who have a contractual relationship with the plan (except in an
emergency)
, Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard
about a neighbor’s MA-PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should you tell him?
Beneficiaries should check with their employer or union group benefits administrator
before changing plans to avoid losing coverage they want to keep
Mrs. Walters is enrolled in her state’s Medicaid program in addition to Medicare. What
should she be aware of when considering enrollment in a Medicare Health Plan?
Medicaid will coordinate benefits only with Medicaid participating providers.
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to
services since she receives some assistance for her health care costs from the State.
What should you tell her?
Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with
Medicaid participating providers.
Mr. Rivera has QMB-Plus eligibility and is thus covered by both Medicare and Medicaid. He
decides to enroll in a Medicare Advantage (MA) plan. Later in the year, Mr. Rivera needs
dentures, a service only covered under Medicaid. What action would you recommend he
take in order to have this cost covered?
He should go to a Medicaid provider or obtain the services through a Medicaid manage
care plan if he is enrolled in one
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.
