AHIP EXAM QUESTIONS WITH COMPLETE
SOLUTIONS.
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
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
, 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?
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?
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?
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?
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?
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?
b. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
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?
c. Beneficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
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?
SOLUTIONS.
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
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
, 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?
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?
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?
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?
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?
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?
b. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
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?
c. Beneficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
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?
