AHIP QUESTIONS AND ANSWERS
1. 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?: She could file a grievance with
her plan to complain about the lack of timeliness in getting an appointment.
2. Edward IP suffered from serious kidney disease. As a result. Edward became eligible
for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12 months ago.
Edward is now age 50 and asks you if his Medicare coverage will continue, what should
you say?: Individuals eligible for Medicare based on ESRD generally lose eligibility 36
months after the month in which the individual receives a kidney transplant unless they
are eligible for Medicare on another basis such as age or disability. Edward may, however,
remain enrolled in Part B but solely for coverage of immunosuppressive drugs if he has no
other health care coverage that would cover the drugs.
3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a few
months to live. She would like to spend these final months in hospice care. Mildred's
family asks you whether hospice benefits will be paid for under the Allcare Medicare
Advantage plan. What should you say?: Mildred may remain enrolled in Allcare and make
a hospice election. Hospice benefits will be paid for by Original Medicare under Part A and
Allcare will continue to pay for any non-hospice services.
4. 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.
5. Mr. Moy'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. Moy?: Medicare Supplemental
Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee-
for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
6. 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 age 65 or over are covered
,AHIP QUESTIONS AND ANSWERS
under Part A by virtue of having paid Medicare taxes while working, though some may be
covered as a result of paying monthly premiums.
7. 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.
8. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?: Beneficiaries under Original
Medicare have no cost-sharing for most preventive services which include immunizations
such as annual flu shots.
9. Mrs. Pea is 66 years old, has coverage under an employer plan, and will retire H 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 after the last
month on her employer plan that differs from the standard general enrollment period,
during which she may enroll in Medicare Part B.
10. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal
disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage
under Medicare. What should you tell him?: He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
11. Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her?: You
should tell Madeline that she will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband's long work record and participation in the
Medicare system. You should also tell Madeline that she will pay Part B premiums at more
than the standard lowest rate but less than the highest rate due her substantial income.
12. 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?: To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
,AHIP QUESTIONS AND ANSWERS
13. To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.: Mrs. Gonzalez cannot purchase a Medigap
plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D
prescription drug plan.
14. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not provide
drug benefits. How would you advise Agent John Miller to proceed?: Tell prospect Jerry
Smith that he should consider adding a standalone Part D prescription drug coverage policy
to his present coverage.
15. 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, and Lou Gehrig's disease so she
will be eligible for Medicare.
16. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?: It is
illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
besides, Medigap only works with Original Medicare.
17. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park 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.
18. 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.
19. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs?: Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
20. Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE).
This coverage has recently been terminated due to the end of the PHE. While Shirley was
enrolled in Medicaid, she missed an opportunity to enroll in Medicare and now wants
, AHIP QUESTIONS AND ANSWERS
Part B. Which of the following statements best describes Shirley's ability to now enroll in
Medicare Part B?: Shirley is eligible for a Special Enrollment Period (SEP) for up to six
months after the termination of her Medicaid coverage. Under this SEP, Shirley can choose
retroactive coverage back to the date of termination from Medicaid or coverage beginning
the month after the month of enrollment.
21. Anthony Boniface turned 65 in 2023. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll in
Medicare, his entire area was impacted by a hurricane causing massive flooding and
severe wind damage. The Federal government declared this to be a natural disaster which
has recently ended. During this period Anthony's initial enrollment period expired.
Anthony asks you how he can now obtain Medicare coverage. What should you say?:
Anthony is eligible for a special enrollment period (SEP) because he missed an enrollment
period due to the impact of the Federally declared disaster. This SEP will allow Anthony to
enroll in Part B up to six months after the end of the emergency declaration. Anthony may
enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up
to 6 months.
22. 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 a Medicare MSA plan would it be important for
her to know, prior to enrolling in such a plan?: 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 prescription drug plan.
23. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she can go to for her health care. What should you tell her?: Mrs. Ramos
can obtain care from any provider who participates in Original Medicare, but generally will
have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO
network.
24. 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?: He should compare the benefits in his employer-sponsored retiree group health plan
with the benefits in his neighbor's MA-PD plan to determine which one will provide
sufficient coverage for his prescription needs.
1. 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?: She could file a grievance with
her plan to complain about the lack of timeliness in getting an appointment.
2. Edward IP suffered from serious kidney disease. As a result. Edward became eligible
for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12 months ago.
Edward is now age 50 and asks you if his Medicare coverage will continue, what should
you say?: Individuals eligible for Medicare based on ESRD generally lose eligibility 36
months after the month in which the individual receives a kidney transplant unless they
are eligible for Medicare on another basis such as age or disability. Edward may, however,
remain enrolled in Part B but solely for coverage of immunosuppressive drugs if he has no
other health care coverage that would cover the drugs.
3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a few
months to live. She would like to spend these final months in hospice care. Mildred's
family asks you whether hospice benefits will be paid for under the Allcare Medicare
Advantage plan. What should you say?: Mildred may remain enrolled in Allcare and make
a hospice election. Hospice benefits will be paid for by Original Medicare under Part A and
Allcare will continue to pay for any non-hospice services.
4. 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.
5. Mr. Moy'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. Moy?: Medicare Supplemental
Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee-
for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
6. 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 age 65 or over are covered
,AHIP QUESTIONS AND ANSWERS
under Part A by virtue of having paid Medicare taxes while working, though some may be
covered as a result of paying monthly premiums.
7. 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.
8. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?: Beneficiaries under Original
Medicare have no cost-sharing for most preventive services which include immunizations
such as annual flu shots.
9. Mrs. Pea is 66 years old, has coverage under an employer plan, and will retire H 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 after the last
month on her employer plan that differs from the standard general enrollment period,
during which she may enroll in Medicare Part B.
10. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal
disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage
under Medicare. What should you tell him?: He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
11. Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her?: You
should tell Madeline that she will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband's long work record and participation in the
Medicare system. You should also tell Madeline that she will pay Part B premiums at more
than the standard lowest rate but less than the highest rate due her substantial income.
12. 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?: To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
,AHIP QUESTIONS AND ANSWERS
13. To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.: Mrs. Gonzalez cannot purchase a Medigap
plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D
prescription drug plan.
14. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not provide
drug benefits. How would you advise Agent John Miller to proceed?: Tell prospect Jerry
Smith that he should consider adding a standalone Part D prescription drug coverage policy
to his present coverage.
15. 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, and Lou Gehrig's disease so she
will be eligible for Medicare.
16. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?: It is
illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
besides, Medigap only works with Original Medicare.
17. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park 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.
18. 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.
19. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs?: Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
20. Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE).
This coverage has recently been terminated due to the end of the PHE. While Shirley was
enrolled in Medicaid, she missed an opportunity to enroll in Medicare and now wants
, AHIP QUESTIONS AND ANSWERS
Part B. Which of the following statements best describes Shirley's ability to now enroll in
Medicare Part B?: Shirley is eligible for a Special Enrollment Period (SEP) for up to six
months after the termination of her Medicaid coverage. Under this SEP, Shirley can choose
retroactive coverage back to the date of termination from Medicaid or coverage beginning
the month after the month of enrollment.
21. Anthony Boniface turned 65 in 2023. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll in
Medicare, his entire area was impacted by a hurricane causing massive flooding and
severe wind damage. The Federal government declared this to be a natural disaster which
has recently ended. During this period Anthony's initial enrollment period expired.
Anthony asks you how he can now obtain Medicare coverage. What should you say?:
Anthony is eligible for a special enrollment period (SEP) because he missed an enrollment
period due to the impact of the Federally declared disaster. This SEP will allow Anthony to
enroll in Part B up to six months after the end of the emergency declaration. Anthony may
enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up
to 6 months.
22. 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 a Medicare MSA plan would it be important for
her to know, prior to enrolling in such a plan?: 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 prescription drug plan.
23. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she can go to for her health care. What should you tell her?: Mrs. Ramos
can obtain care from any provider who participates in Original Medicare, but generally will
have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO
network.
24. 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?: He should compare the benefits in his employer-sponsored retiree group health plan
with the benefits in his neighbor's MA-PD plan to determine which one will provide
sufficient coverage for his prescription needs.
