AHIP EXAM QUESTIONS WITH COMPLETE
SOLUTIONS.
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.
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 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. 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?
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.
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.
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.
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.
, 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.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,
but it provides no drug coverage. She would like to keep the coverage she has,
but replace her existing Medigap plan with one that provides drug coverage. What
should you tell her?
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.
Which of the following statement(s) is/are correct about a Medicare Savings
Account (MSA) Plans? I. MSAs may have either a partial network, full network, or
no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug
benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal
deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare
would pay them as payment in full.
MSAs may have either a partial network, full network, or no network of providers. MSA
plans cover Part A and Part B benefits but not Part D prescription drug benefits. Non-
network providers must accept the same amount that Original Medicare would pay them
as payment in full.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge?
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care
he has received under Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What could you tell him?
SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and
they provide prescription drug coverage that could be very helpful as well.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis,
putting him at severe risk for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most appropriate for him?
C-SNP
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special
Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-
sharing amounts and Mr. Greco would like to join that plan. What should you tell
him?
SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
SOLUTIONS.
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.
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 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. 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?
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.
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.
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.
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.
, 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.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,
but it provides no drug coverage. She would like to keep the coverage she has,
but replace her existing Medigap plan with one that provides drug coverage. What
should you tell her?
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.
Which of the following statement(s) is/are correct about a Medicare Savings
Account (MSA) Plans? I. MSAs may have either a partial network, full network, or
no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug
benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal
deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare
would pay them as payment in full.
MSAs may have either a partial network, full network, or no network of providers. MSA
plans cover Part A and Part B benefits but not Part D prescription drug benefits. Non-
network providers must accept the same amount that Original Medicare would pay them
as payment in full.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge?
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care
he has received under Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What could you tell him?
SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and
they provide prescription drug coverage that could be very helpful as well.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis,
putting him at severe risk for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most appropriate for him?
C-SNP
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special
Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-
sharing amounts and Mr. Greco would like to join that plan. What should you tell
him?
SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
