AHIP EXAMINATION QUESTIONS STUDY GUIDE
Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is
currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and
did not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period
(AEP) which has just closed. Mr. Wendt has heard that there are certain MA plans that might
provide him with more specialized coverage for his diabetes and wants to know if he must wait
until the next annual open enrollment period (AEP) before enrolling in such a plan. What should
you tell him? - answers✔✔d. If there is a special needs plan (SNP) in Mr. Wendt's area that
specializes in caring for individuals with diabetes, he may enroll in the SNP at any time under a
special enrollment period (SEP). Correct
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? - answers✔✔d. Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his present coverage.
Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare Part A
and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older
neighbor Mel has told her about the Medigap Part F plan 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? - answers✔✔a. You are sorry to disappoint
,Anita but a Medigap Part 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 foreign travel benefits but
do not cover the Part B deductible.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he
enrolls how that will impact his employer-sponsored healthcare coverage. How would you
respond? - answers✔✔d. Juan is likely to be eligible for Medicare once he turns age 65 and if he
enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does
not have to continue to offer him coverage comparable to those under age 65 under its
employer-sponsored group health plan.
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? - answers✔✔b. 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? - answers✔✔b. After
receiving such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
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? - answers✔✔b. He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments start.
,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? - answers✔✔d. Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer's plan.
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? - answers✔✔b. 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? -
answers✔✔a. Most individuals who are citizens and age 65 or over 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? - answers✔✔b. 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. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't
remember what Part D is so she called you to ask what her neighbor was talking about. What
could you tell her? - answers✔✔c. Part D covers prescription drugs and she should look at her
premiums, formulary, and cost-sharing among other factors to see if they have changed.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - answers✔✔d. Mr. Singh can enroll in a stand-alone
, prescription drug plan and continue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare.
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
Medicare. What can you tell her about Medigap as an option to address this concern? -
answers✔✔c. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or
deductibles for medically necessary services.
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has
been automatically enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Quinn? - answers✔✔d. Part B primarily covers physician services. She
will be paying a monthly premium and, with the exception of many preventive and screening
tests, generally will have 20% coinsurance for these services, in addition to an annual
deductible.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -
answers✔✔b. Medicare will cover Mrs. Shield's skilled nursing services provided during the first
20 days of her stay, after which she would have a copay until she has been in the facility for 100
days.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like
to know which of the following services Original Medicare will cover if the appropriate criteria
are met? What could you tell her? - answers✔✔c. Original Medicare covers ambulance services.
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? -
answers✔✔b. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is
currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and
did not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period
(AEP) which has just closed. Mr. Wendt has heard that there are certain MA plans that might
provide him with more specialized coverage for his diabetes and wants to know if he must wait
until the next annual open enrollment period (AEP) before enrolling in such a plan. What should
you tell him? - answers✔✔d. If there is a special needs plan (SNP) in Mr. Wendt's area that
specializes in caring for individuals with diabetes, he may enroll in the SNP at any time under a
special enrollment period (SEP). Correct
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? - answers✔✔d. Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his present coverage.
Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare Part A
and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older
neighbor Mel has told her about the Medigap Part F plan 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? - answers✔✔a. You are sorry to disappoint
,Anita but a Medigap Part 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 foreign travel benefits but
do not cover the Part B deductible.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he
enrolls how that will impact his employer-sponsored healthcare coverage. How would you
respond? - answers✔✔d. Juan is likely to be eligible for Medicare once he turns age 65 and if he
enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does
not have to continue to offer him coverage comparable to those under age 65 under its
employer-sponsored group health plan.
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? - answers✔✔b. 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? - answers✔✔b. After
receiving such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
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? - answers✔✔b. He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments start.
,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? - answers✔✔d. Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer's plan.
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? - answers✔✔b. 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? -
answers✔✔a. Most individuals who are citizens and age 65 or over 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? - answers✔✔b. 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. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't
remember what Part D is so she called you to ask what her neighbor was talking about. What
could you tell her? - answers✔✔c. Part D covers prescription drugs and she should look at her
premiums, formulary, and cost-sharing among other factors to see if they have changed.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - answers✔✔d. Mr. Singh can enroll in a stand-alone
, prescription drug plan and continue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare.
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
Medicare. What can you tell her about Medigap as an option to address this concern? -
answers✔✔c. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or
deductibles for medically necessary services.
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has
been automatically enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Quinn? - answers✔✔d. Part B primarily covers physician services. She
will be paying a monthly premium and, with the exception of many preventive and screening
tests, generally will have 20% coinsurance for these services, in addition to an annual
deductible.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -
answers✔✔b. Medicare will cover Mrs. Shield's skilled nursing services provided during the first
20 days of her stay, after which she would have a copay until she has been in the facility for 100
days.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like
to know which of the following services Original Medicare will cover if the appropriate criteria
are met? What could you tell her? - answers✔✔c. Original Medicare covers ambulance services.
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? -
answers✔✔b. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
