2024/2025AHIPFINALEXAMTEST
Mr.Davisis52yearsoldandhasrecentlybeendiagnosedwithend-
stagerenalgdisease(ESRD)andwillsoonbegindialysis.Heiswonderin
gifhecanobtaingcoverageunderMedicare.Whatshouldyoutellhim?
✓Hemaysign-
upforgMedicareatanytimehowevercoverageusuallybeginsonthefourt
hmonthaftergdialysisgtreatmentsgstart.
JuanPerez,whoisturningage65nextmonth,intendstoworkforseveral
moregyearsatSmallcap,Incorporated.Smallcaphasaworkforceof1
5employeesandgoffersemployer-
sponsoredhealthcarecoverage.Juanisanaturalizedcitizenandghasc
ontributedtotheMedicaresystemforover20years.Juanasksyouifhe
willgbeentitledtoMedicareandifheenrollshowthatwillimpacthisemp
loyer-gsponsoredhealthcarecoverage.Howwouldyourespond?
✓JuanislikelytobegeligibleforMedicareonceheturnsage65andifhee
nrollsMedicarewouldgbecometheprimarypayorofhishealthcareclai
msandSmallcapdoesnothavetogcontinuetoofferhimcoveragecomp
arabletothoseunderage65underitsgemployer-
sponsoredgrouphealthplan.
Mr.Moy'swifehasaMedicareAdvantageplan,buthewantstounderstandwhat
,coverageMedicareSupplementalInsuranceprovidessincehishealthcarene
eds
aredifferentfromhiswife'sneeds.WhatcouldyoutellMr.Moy?
✓MedicaregSupplementalInsurancewouldhelpcoverhisPartAandPar
tBdeductiblesorgcoinsuranceinOriginalFee-for-
Service(FFS)MedicareaswellaspossiblysomegservicesthatMedicare
doesnotcover.
Mrs.Peňais66yearsold,hascoverageunderanemployerplan,andwillre
tirenextgyear.SheheardshemustenrollinPartBatthebeginningoftheyea
rtoensurenogapgincoverage.Whatcanyoutellher?
✓Shemayenrollatanytimewhilesheiscoveredgunderheremployerplan,
butshewillhaveaspecialeight-
monthenrollmentperiodgafterthelastmonthonheremployerplanthatd
iffersfromthestandardgeneralgenrollmentperiod,duringwhichshema
yenrollinMedicarePartB.
Mrs.Chenwillbe65soon,hasbeenacitizenfortwelveyears,hasbeenem
ployedgfulltime,andpaidtaxesduringthatentireperiod.Sheisconcerne
dthatshewillnotgqualifyforcoverageunderpartAbecauseshewasnotb
ornintheUnitedStates.
Whatshouldyoutellher?✓Mostindividualswhoarecitizensandage65
,oroverarecoveredunderPartAbyvirtueofhavingpaidMedicaretaxeswhile
working,thoughsomemaybecoveredasaresultofpayingmonthlypremiums.
Mrs.GonzalezisenrolledinOriginalMedicareandhasaMedigappolicyas
well,butgitprovidesnodrugcoverage.Shewouldliketokeepthecoverag
eshehasbutgreplaceherexistingMedigapplanwithonethatprovidesdr
ugcoverage.Whatgshouldyoutellher?
✓✓Mrs.GonzalezcannotpurchaseaMedigapplanthatcoversgdrugs,but
shecouldkeepherMedigappolicyandenrollinaPartDprescriptiongdrug
plan.
Mrs.Westwearsglassesanddenturesandhasenjoyedconsiderable
painreliefgfromarthritisthroughmassagetherapy.Sheisconcerneda
boutwhetherornotgMedicarewillcovertheseitemsandservices.W
hatshouldyoutellher?
✓✓Medicaredoesnotcovermassagetherapy,or,ingeneral,glassesordentur
es.
Mr.Patelisingoodhealthandispreparingabudgetinanticipationofhisreti
rementgwhenheturns66.Hewantstounderstandthehealthcarecosts
hemightbegexposedtounderMedicareifheweretorequirehospitalizat
ionasaresultofangillness.Ingeneralterms,whatcouldyoutellhimabo
uthiscostsforinpatientghospitalservices
underOriginalMedicare?✓✓UnderOriginalMedicare,thereisasingledeductible
, amountdueforthefirst60daysofanyinpatienthospitalstay,afterwhichit
convertsintoaper-
daycoinsuranceamountthroughday90.Afterday90,hewouldgpayadail
yamountupto60daysoverhislifetime,afterwhichhewouldbegrespons
iblegforgallgcosts.
Ms.HendersonbelievesthatshewillqualifyforMedicareCoveragewhen
sheturnsg65,withoutpayinganypremiums,becauseshehasbeenworki
ngfor40yearsandgpayingMedicaretaxes.Whatshouldyoutellher?
✓✓ToobtainPartBcoverage,shegmustpayastandardmonthlypremium,t
houghitishigherforindividualswithhighergincomes.
Mr.Alonsoreceivessomehelppayingforhistwogenericprescriptiondrug
sfromhisgemployer'sretireecoverage,buthewantstocompareittoaPart
Dprescriptiondruggplan.Heasksyouwhatcostshewouldgenerallyexpe
cttoencounterwhengenrollingintoastandardMedicarePartDprescripti
ondrugplan.Whatshouldyougtellhim?
✓✓Hegenerallywouldpayamonthlypremium,annualdeductible,andg
per-prescriptioncost-sharing.
Mr.Davisis52yearsoldandhasrecentlybeendiagnosedwithend-
stagerenalgdisease(ESRD)andwillsoonbegindialysis.Heiswonderin
gifhecanobtaingcoverageunderMedicare.Whatshouldyoutellhim?
✓Hemaysign-
upforgMedicareatanytimehowevercoverageusuallybeginsonthefourt
hmonthaftergdialysisgtreatmentsgstart.
JuanPerez,whoisturningage65nextmonth,intendstoworkforseveral
moregyearsatSmallcap,Incorporated.Smallcaphasaworkforceof1
5employeesandgoffersemployer-
sponsoredhealthcarecoverage.Juanisanaturalizedcitizenandghasc
ontributedtotheMedicaresystemforover20years.Juanasksyouifhe
willgbeentitledtoMedicareandifheenrollshowthatwillimpacthisemp
loyer-gsponsoredhealthcarecoverage.Howwouldyourespond?
✓JuanislikelytobegeligibleforMedicareonceheturnsage65andifhee
nrollsMedicarewouldgbecometheprimarypayorofhishealthcareclai
msandSmallcapdoesnothavetogcontinuetoofferhimcoveragecomp
arabletothoseunderage65underitsgemployer-
sponsoredgrouphealthplan.
Mr.Moy'swifehasaMedicareAdvantageplan,buthewantstounderstandwhat
,coverageMedicareSupplementalInsuranceprovidessincehishealthcarene
eds
aredifferentfromhiswife'sneeds.WhatcouldyoutellMr.Moy?
✓MedicaregSupplementalInsurancewouldhelpcoverhisPartAandPar
tBdeductiblesorgcoinsuranceinOriginalFee-for-
Service(FFS)MedicareaswellaspossiblysomegservicesthatMedicare
doesnotcover.
Mrs.Peňais66yearsold,hascoverageunderanemployerplan,andwillre
tirenextgyear.SheheardshemustenrollinPartBatthebeginningoftheyea
rtoensurenogapgincoverage.Whatcanyoutellher?
✓Shemayenrollatanytimewhilesheiscoveredgunderheremployerplan,
butshewillhaveaspecialeight-
monthenrollmentperiodgafterthelastmonthonheremployerplanthatd
iffersfromthestandardgeneralgenrollmentperiod,duringwhichshema
yenrollinMedicarePartB.
Mrs.Chenwillbe65soon,hasbeenacitizenfortwelveyears,hasbeenem
ployedgfulltime,andpaidtaxesduringthatentireperiod.Sheisconcerne
dthatshewillnotgqualifyforcoverageunderpartAbecauseshewasnotb
ornintheUnitedStates.
Whatshouldyoutellher?✓Mostindividualswhoarecitizensandage65
,oroverarecoveredunderPartAbyvirtueofhavingpaidMedicaretaxeswhile
working,thoughsomemaybecoveredasaresultofpayingmonthlypremiums.
Mrs.GonzalezisenrolledinOriginalMedicareandhasaMedigappolicyas
well,butgitprovidesnodrugcoverage.Shewouldliketokeepthecoverag
eshehasbutgreplaceherexistingMedigapplanwithonethatprovidesdr
ugcoverage.Whatgshouldyoutellher?
✓✓Mrs.GonzalezcannotpurchaseaMedigapplanthatcoversgdrugs,but
shecouldkeepherMedigappolicyandenrollinaPartDprescriptiongdrug
plan.
Mrs.Westwearsglassesanddenturesandhasenjoyedconsiderable
painreliefgfromarthritisthroughmassagetherapy.Sheisconcerneda
boutwhetherornotgMedicarewillcovertheseitemsandservices.W
hatshouldyoutellher?
✓✓Medicaredoesnotcovermassagetherapy,or,ingeneral,glassesordentur
es.
Mr.Patelisingoodhealthandispreparingabudgetinanticipationofhisreti
rementgwhenheturns66.Hewantstounderstandthehealthcarecosts
hemightbegexposedtounderMedicareifheweretorequirehospitalizat
ionasaresultofangillness.Ingeneralterms,whatcouldyoutellhimabo
uthiscostsforinpatientghospitalservices
underOriginalMedicare?✓✓UnderOriginalMedicare,thereisasingledeductible
, amountdueforthefirst60daysofanyinpatienthospitalstay,afterwhichit
convertsintoaper-
daycoinsuranceamountthroughday90.Afterday90,hewouldgpayadail
yamountupto60daysoverhislifetime,afterwhichhewouldbegrespons
iblegforgallgcosts.
Ms.HendersonbelievesthatshewillqualifyforMedicareCoveragewhen
sheturnsg65,withoutpayinganypremiums,becauseshehasbeenworki
ngfor40yearsandgpayingMedicaretaxes.Whatshouldyoutellher?
✓✓ToobtainPartBcoverage,shegmustpayastandardmonthlypremium,t
houghitishigherforindividualswithhighergincomes.
Mr.Alonsoreceivessomehelppayingforhistwogenericprescriptiondrug
sfromhisgemployer'sretireecoverage,buthewantstocompareittoaPart
Dprescriptiondruggplan.Heasksyouwhatcostshewouldgenerallyexpe
cttoencounterwhengenrollingintoastandardMedicarePartDprescripti
ondrugplan.Whatshouldyougtellhim?
✓✓Hegenerallywouldpayamonthlypremium,annualdeductible,andg
per-prescriptioncost-sharing.
