AHIP MODULE 1-5 EXAM 2025
WITH VERIFIED ANSWERS
Mrs. Ellis recently turned 66 and decided after many years of work to
retire and begin receiving Social Security benefits. Shortly thereafter
Mrs. Ellis received a letter informing her that she had been automatically
enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis? - ANSWER Part B primarily covers
physician services. She will be paying a monthly premium and, except
for many preventive and screening tests, generally will have 20% co-
payments for these services, in addition to an annual deductible.
Mr. Singh would like drug coverage but does not want to be enrolled in
a Medicare Advantage plan. What should you tell him? - ANSWER 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. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What
could you tell Mrs. Cook that might be of assistance? - ANSWER 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.
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? - ANSWER To obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher
incomes.
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? - ANSWER After receiving
such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
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? - ANSWER 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.
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? - ANSWER Tell prospect
Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
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? - ANSWER Mr. Wu may still
qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
Mr. Vasquez is in good health and is preparing a budget in anticipation
of his retirement when he turns 66. He wants to understand the health
care costs he might be exposed to under Medicare if he were to require
hospitalization because of an illness. In general terms, what could you
tell him about his costs for inpatient hospital services under Original
Medicare? - ANSWER Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient hospital stay,
after which it converts into a per-day coinsurance amount through day
90. After day 90, he would pay a daily amount up to 60 days over his
lifetime, after which he would be responsible for all costs.
Mr. Moy will soon turn age 65. He is slightly younger than his wife. 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? - ANSWER Medicare Supplemental Insurance would help
cover his Part A deductible and Part B coinsurance or copayments in
Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
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? - ANSWER 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. 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 but
Smallcap must continue to offer him coverage under its employer-
sponsored group health plan and would become a secondary payor.
Ms. Kumar 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? -
ANSWER 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.
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? - ANSWER 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.
Anthony Boniface turned 65 in 2024. 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
WITH VERIFIED ANSWERS
Mrs. Ellis recently turned 66 and decided after many years of work to
retire and begin receiving Social Security benefits. Shortly thereafter
Mrs. Ellis received a letter informing her that she had been automatically
enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis? - ANSWER Part B primarily covers
physician services. She will be paying a monthly premium and, except
for many preventive and screening tests, generally will have 20% co-
payments for these services, in addition to an annual deductible.
Mr. Singh would like drug coverage but does not want to be enrolled in
a Medicare Advantage plan. What should you tell him? - ANSWER 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. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What
could you tell Mrs. Cook that might be of assistance? - ANSWER 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.
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? - ANSWER To obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher
incomes.
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? - ANSWER After receiving
such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
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? - ANSWER 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.
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? - ANSWER Tell prospect
Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
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? - ANSWER Mr. Wu may still
qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
Mr. Vasquez is in good health and is preparing a budget in anticipation
of his retirement when he turns 66. He wants to understand the health
care costs he might be exposed to under Medicare if he were to require
hospitalization because of an illness. In general terms, what could you
tell him about his costs for inpatient hospital services under Original
Medicare? - ANSWER Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient hospital stay,
after which it converts into a per-day coinsurance amount through day
90. After day 90, he would pay a daily amount up to 60 days over his
lifetime, after which he would be responsible for all costs.
Mr. Moy will soon turn age 65. He is slightly younger than his wife. 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? - ANSWER Medicare Supplemental Insurance would help
cover his Part A deductible and Part B coinsurance or copayments in
Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
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? - ANSWER 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. 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 but
Smallcap must continue to offer him coverage under its employer-
sponsored group health plan and would become a secondary payor.
Ms. Kumar 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? -
ANSWER 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.
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? - ANSWER 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.
Anthony Boniface turned 65 in 2024. 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
