AHIP EXAM WITH ACCURATE
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 enrollment
period (AEP) before enrolling in such a plan. What should you tell him? - ANS-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? - ANS-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? -
ANS-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? - ANS-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? -
ANS-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? -
ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-b. Mr. Wu may still qualify for help in paying Part D costs through his
State Pharmaceutical Assistance Program.
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 enrollment
period (AEP) before enrolling in such a plan. What should you tell him? - ANS-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? - ANS-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? -
ANS-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? - ANS-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? -
ANS-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? -
ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-b. Mr. Wu may still qualify for help in paying Part D costs through his
State Pharmaceutical Assistance Program.
