AHIP 2024 final exam
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance? - ANS She should contact her state Medicaid
agency to see if she qualifies forprograms that can help with Medicare costs for which
she is responsible.
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? -
ANS 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.
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 -
ANS After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
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? - ANS 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.
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? - ANS 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.
, 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? - ANS Tell prospect
Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage.
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? - ANS The penalty will be a permanent 10%
increase in his Part B premium for every 12-month period that passed during which he
could have enrolled and did not.
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? - ANS 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.
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? - ANS 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.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has
an attractive premium. He wants to know if he must use doctors in a network as his
current HMO plan requires him to do. What should you tell him? - ANS He may receive
health care services from any doctor allowed to bill Medicare, as long as he shows the
doctor the plan's identification card and the doctor agrees to accept the PFFS plan's
payment terms and conditions, which could include balance billing.
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 determine his eligibility? - ANS
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in
the PFFS plan's service area.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance? - ANS She should contact her state Medicaid
agency to see if she qualifies forprograms that can help with Medicare costs for which
she is responsible.
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? -
ANS 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.
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 -
ANS After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
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? - ANS 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.
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? - ANS 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.
, 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? - ANS Tell prospect
Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage.
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? - ANS The penalty will be a permanent 10%
increase in his Part B premium for every 12-month period that passed during which he
could have enrolled and did not.
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? - ANS 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.
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? - ANS 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.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has
an attractive premium. He wants to know if he must use doctors in a network as his
current HMO plan requires him to do. What should you tell him? - ANS He may receive
health care services from any doctor allowed to bill Medicare, as long as he shows the
doctor the plan's identification card and the doctor agrees to accept the PFFS plan's
payment terms and conditions, which could include balance billing.
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 determine his eligibility? - ANS
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in
the PFFS plan's service area.
