AHIP Final Exam
• What impact, if any, have recent regulatory changes had on Medigap plans?
Answer: The Part B deductible is no longer covered for individuals newly eligible forMedicare
starting January 1, 2020.
• Mrs. Paterson is concerned about the deductibles and co-payments as- sociated with
Original Medicare. What can you tell her about Medigap as an option to address this concern?
Answer: Medigap plans do not cover Original Medicarebenefits, but they coordinate with
Original Medicare coverage.
• Mrs. Turner is comparing her employer's retiree insurance to OriginalMedicare and would
like to know which of the following services OriginalMedicare will cover if the appropriate
criteria are met. What could you tellher?
Answer: Original Medicare covers ambulance services.
• Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tellher?
Answer: Medicare covers hospice services, and they will be available for her.
• 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 coverageunder his
employer's plan.
• Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a MedicareSupplement (Medigap) plan.
Anita's older neighbor Mel has told her about theMedigap Plan F in which he is enrolled. It not
only provides foreign travel emergency benefits but also covers his Medicare Part B
deductible. Anita comes to you for advice. What should you tell her?
Answer: You are sorry to disappointAnita, but a Medigap F plan is no longer available to
those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans
that offer foreigntravel benefits but do not cover the Part B deductible.
• Hank's Fish Store, Inc. is a small company with just 15 employees locatedin Florida.
Hank, the store owner, has provided excellent health benefits to the store's workforce.
William, one of the store's long-time employees, will soon be reaching age 65 and eligible for
Medicare. William is in good health.He intends to remain an active full-time employee,
working several years after becoming eligible for Medicare.What type(s) of retiree health
benefit will
Hank's Fish Store be able to offer William?
Answer: Hank's can continue to offer Williamthe same employee health benefit plan, or, if
,William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is
offered to the public.
• Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolledin Part B because
he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage
plan, what will he have to do?
Answer: He will have toenroll in Part B.
• Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in NorthCarolina. She
is worried that without additional support, her mother will needto go into a nursing home. Mrs.
Velasquez asks you if there is any Medicare plan that might allow her mother to remain in the
community rather than going into a nursing home. How should you advise Mrs.Velasquez?
Answer: There arePrograms of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live safely in the
community at the time of enrolment.
• Which of the following statement(s) is/are correct about a Medicare Savings Account
(MSA) Plans?
I. MSAs may have either a partial network, full network, or no network ofproviders.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drugbenefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimaldeductible of
$500 indexed for inflation.
IV. Non-network providers must accept the same amount that OriginalMedicare would pay
them as payment in full.
Answer: I, II, and IV only
• Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-incomelevel. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to
have prescription drug coverage since her doctorrecently prescribed several expensive
medications. Currently, she is enrolledin Original Medicare and a standalone Part D plan. How
would you advise Mrs.Chi?
Answer: Mrs. Chi may enroll in a MA MSA plan and remain in her current standalonePart D
prescription drug plan.
• Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA) but is not sure if the plan associated with the account will fit her needs. What specific
piece of information about aMedicare MSA plan would it be important for her to know, prior
to enrolling insuch a plan?
Answer: All MSAs cover Part A and Part B benefits, but not Part D prescription
drug benefits, which could be obtained by also enrolling in a separate prescriptiondrug plan.
• Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician because she
was told she would have to wait five weeks to get an appointment when she was feeling ill.
She called you to ask
, what she could do so she would not have to put up with such poor access to care. What could
you tell her?
Answer: She could file a grievance with her plan to complain about the lack of timeliness in
getting an appointment.
• Mrs. Radford asks whether there are any special eligibility requirements forMedicare
Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage.
• Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service
(PFFS) plan. What questions would you need to ask to deter-mine his eligibility?
Answer: You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if
he lives in the PFFS plan's service area.
• Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage withnominal copays. He heard about a
neighbor's MA-PD plan that you representand because he takes numerous prescription drugs, he
is considering signingup for it. What should you tell him?
Answer: He should compare the benefits in his employer-sponsored retiree group health plan
with the benefits in his neighbor's MA-PDplan to determine which one will provide sufficient
coverage for his prescription needs.
• Ms. Gibson recently lost her employer group health and drug coverage andnow she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage?
Answer: She can enroll in the PPO,but she will not be able to purchase a stand-alone Medicare
Part D prescription drugplan.
• Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr.Brennan for treatment. How
muchmay Dr. Brennan charge?
Answer: Dr. Brennan cancharge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing up to 15%of
theMedicare rate.
• Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrollment in a Medicare Advantage plan (Part C). What shouldyou advise her to do before she
can enroll in a Medicare Advantage plan?
Answer: Tojoin a Medicare Advantage plan, she also must enroll in Part B.
• Mr.Wells is trying to understand the difference between Original Medicareand Medicare
Advantage. What would be the correct description?
Answer: Medicare Advantage is a way of covering all the Original Medicare benefits through
private health insurance companies.
• What impact, if any, have recent regulatory changes had on Medigap plans?
Answer: The Part B deductible is no longer covered for individuals newly eligible forMedicare
starting January 1, 2020.
• Mrs. Paterson is concerned about the deductibles and co-payments as- sociated with
Original Medicare. What can you tell her about Medigap as an option to address this concern?
Answer: Medigap plans do not cover Original Medicarebenefits, but they coordinate with
Original Medicare coverage.
• Mrs. Turner is comparing her employer's retiree insurance to OriginalMedicare and would
like to know which of the following services OriginalMedicare will cover if the appropriate
criteria are met. What could you tellher?
Answer: Original Medicare covers ambulance services.
• Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tellher?
Answer: Medicare covers hospice services, and they will be available for her.
• 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 coverageunder his
employer's plan.
• Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a MedicareSupplement (Medigap) plan.
Anita's older neighbor Mel has told her about theMedigap Plan F in which he is enrolled. It not
only provides foreign travel emergency benefits but also covers his Medicare Part B
deductible. Anita comes to you for advice. What should you tell her?
Answer: You are sorry to disappointAnita, but a Medigap F plan is no longer available to
those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans
that offer foreigntravel benefits but do not cover the Part B deductible.
• Hank's Fish Store, Inc. is a small company with just 15 employees locatedin Florida.
Hank, the store owner, has provided excellent health benefits to the store's workforce.
William, one of the store's long-time employees, will soon be reaching age 65 and eligible for
Medicare. William is in good health.He intends to remain an active full-time employee,
working several years after becoming eligible for Medicare.What type(s) of retiree health
benefit will
Hank's Fish Store be able to offer William?
Answer: Hank's can continue to offer Williamthe same employee health benefit plan, or, if
,William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is
offered to the public.
• Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolledin Part B because
he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage
plan, what will he have to do?
Answer: He will have toenroll in Part B.
• Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in NorthCarolina. She
is worried that without additional support, her mother will needto go into a nursing home. Mrs.
Velasquez asks you if there is any Medicare plan that might allow her mother to remain in the
community rather than going into a nursing home. How should you advise Mrs.Velasquez?
Answer: There arePrograms of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live safely in the
community at the time of enrolment.
• Which of the following statement(s) is/are correct about a Medicare Savings Account
(MSA) Plans?
I. MSAs may have either a partial network, full network, or no network ofproviders.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drugbenefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimaldeductible of
$500 indexed for inflation.
IV. Non-network providers must accept the same amount that OriginalMedicare would pay
them as payment in full.
Answer: I, II, and IV only
• Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-incomelevel. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to
have prescription drug coverage since her doctorrecently prescribed several expensive
medications. Currently, she is enrolledin Original Medicare and a standalone Part D plan. How
would you advise Mrs.Chi?
Answer: Mrs. Chi may enroll in a MA MSA plan and remain in her current standalonePart D
prescription drug plan.
• Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA) but is not sure if the plan associated with the account will fit her needs. What specific
piece of information about aMedicare MSA plan would it be important for her to know, prior
to enrolling insuch a plan?
Answer: All MSAs cover Part A and Part B benefits, but not Part D prescription
drug benefits, which could be obtained by also enrolling in a separate prescriptiondrug plan.
• Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician because she
was told she would have to wait five weeks to get an appointment when she was feeling ill.
She called you to ask
, what she could do so she would not have to put up with such poor access to care. What could
you tell her?
Answer: She could file a grievance with her plan to complain about the lack of timeliness in
getting an appointment.
• Mrs. Radford asks whether there are any special eligibility requirements forMedicare
Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage.
• Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service
(PFFS) plan. What questions would you need to ask to deter-mine his eligibility?
Answer: You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if
he lives in the PFFS plan's service area.
• Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage withnominal copays. He heard about a
neighbor's MA-PD plan that you representand because he takes numerous prescription drugs, he
is considering signingup for it. What should you tell him?
Answer: He should compare the benefits in his employer-sponsored retiree group health plan
with the benefits in his neighbor's MA-PDplan to determine which one will provide sufficient
coverage for his prescription needs.
• Ms. Gibson recently lost her employer group health and drug coverage andnow she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage?
Answer: She can enroll in the PPO,but she will not be able to purchase a stand-alone Medicare
Part D prescription drugplan.
• Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr.Brennan for treatment. How
muchmay Dr. Brennan charge?
Answer: Dr. Brennan cancharge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing up to 15%of
theMedicare rate.
• Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrollment in a Medicare Advantage plan (Part C). What shouldyou advise her to do before she
can enroll in a Medicare Advantage plan?
Answer: Tojoin a Medicare Advantage plan, she also must enroll in Part B.
• Mr.Wells is trying to understand the difference between Original Medicareand Medicare
Advantage. What would be the correct description?
Answer: Medicare Advantage is a way of covering all the Original Medicare benefits through
private health insurance companies.
