AHIP MEDICARE TRAINING 2025-2026
Ms. Jensen has heard about "Original Fee-for-Service Medicare" and "Private Fee-for-Service" plans. Sh
wants to know what the difference is if any. What should you tell her? - ✔✔ANS PFFS plans are a type o
Medicare Advantage plan offered by private companies.
This year you decide to focus your efforts on marketing to employer and union groups. Which of th
following statements best describes what you can and cannot do in order to stay in compliance? - ✔✔AN
You are not required to submit communication and marketing materials specific only to those employe
plans to CMS at the time of use, but CMS may request and review copies if employee complaints occur.
Agent Suma has recently had several clients request his assistance in completing their paper enrollmen
form. What advice would you give him? - ✔✔ANS Agent Suma is only permitted to fill out the applicant'
name and contact information. The applicant must fill in the remaining information in order to protect hi
or her privacy.
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Securit
benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automaticall
enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn
- ✔✔ANS Part B primarily covers physician services. She will be paying a monthly premium and, with th
exception of many preventive and screening tests, generally will have 20% coinsurance for thes
services, in addition to an annual deductible.
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 coul
you tell her? - ✔✔ANS Original Medicare covers ambulance services.
Mr. Diaz continued working with his company and was insured under his employer's group plan until h
reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part
when first eligible and wants to know how much he will have to pay. What should you tell him? - ✔✔AN
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
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 ha
told her about the Medigap Part F plan in which he is enrolled. It not only provides foreign trave
,emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. Wha
should you tell her - ✔✔ANS You are sorry to disappoint Anita but a Medigap Part F plan is no longe
available to those who turn age 65 after January 1,2020. Anita might instead consider other Medigap plan
that offer foreign travel benefits but do not cover the Part B deductible.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicar
Supplemental Insurance provides since his health care needs are different from his wife's needs. Wha
could you tell Mr. Moy? - ✔✔ANS Medicare Supplemental Insurance would help cover his Part A and Pa
B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicar
does not cover.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Securit
Administration and has been receiving disability payments. He is wondering whether he can obtai
coverage under Medicare. What should you tell him? - ✔✔ANS After receiving such disability payment
for 24 months, he will be automatically enrolled in Medicare, regardless of age.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-fo
Service (FFS) Medicare? What could you tell him? - ✔✔ANS Part A, which covers hospital, skilled nursin
facility, hospice, and home health services and Part B, which covers professional services such as thos
provided by a doctor are covered under Original Medicare.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will hav
considerable income when she retires. She is concerned that her income will make it impossible for he
to qualify for Medicare. What could you tell her to address her concern? - ✔✔ANS Medicare is a program
for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, an
Lou Gehrig's disease so she will be eligible for Medicare.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfull
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay sh
will need a month or two of nursing and rehabilitative care. What should you tell them about Origina
Medicare's coverage of care in a skilled nursing facility? - ✔✔ANS Medicare will cover Mrs. Shield's skille
nursing services provided during the first 20 days of her stay, after which she would have a copay unt
she has been in the facility for 100 days.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Origina
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicar
beneficiaries? - ✔✔ANS Beneficiaries under Original Medicare have no cost-sharing for most preventiv
services which include immunizations such as annual flu shots.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicar
enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Pa
D is so she called you to ask what her neighbor was talking about. What could you tell her? - ✔✔ANS Pa
, D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing amon
other factors to see if they have changed.
What impact, if any, will recent regulatory changes have upon Medigap plans? - ✔✔ANS The Part
deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020
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 Mr. Wu may sti
qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
Madeline Martinez was widowed several years ago. Her husband worked for many years and contribute
into the Medicare system. He also left a substantial estate which provides Madeline with an annual incom
of approximately $130,000. Madeline, who has only worked part-time for the last three years, will soo
turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you te
her? - ✔✔ANS You should tell Madeline that she will be able to enroll in Medicare Part A without payin
monthly premiums due to her husband's long work record and participation in the Medicare system. Yo
should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but les
than the highest rate due her substantial income.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicar
Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had fo
several years. However, the plan does not provide drug benefits. How would you advise Agent John Mille
to proceed? - ✔✔ANS Tell prospect Jerry Smith that he should consider adding a standalone Part
prescription drug coverage policy to his present coverage.
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 Medigap plans hel
beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and wi
soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him
- ✔✔ANS He may sign-up for Medicare at any time however coverage usually begins on the fourth mont
after dialysis treatments start.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxe
during that entire period. She is concerned that she will not qualify for coverage under part A becaus
she was not born in the United States. What should you tell her? - ✔✔ANS Most individuals who ar
citizens and age 65 or over are covered under Part A by virtue of having paid Medicare taxes whil
working, though some may be covered as a result of paying monthly premiums.
Ms. Jensen has heard about "Original Fee-for-Service Medicare" and "Private Fee-for-Service" plans. Sh
wants to know what the difference is if any. What should you tell her? - ✔✔ANS PFFS plans are a type o
Medicare Advantage plan offered by private companies.
This year you decide to focus your efforts on marketing to employer and union groups. Which of th
following statements best describes what you can and cannot do in order to stay in compliance? - ✔✔AN
You are not required to submit communication and marketing materials specific only to those employe
plans to CMS at the time of use, but CMS may request and review copies if employee complaints occur.
Agent Suma has recently had several clients request his assistance in completing their paper enrollmen
form. What advice would you give him? - ✔✔ANS Agent Suma is only permitted to fill out the applicant'
name and contact information. The applicant must fill in the remaining information in order to protect hi
or her privacy.
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Securit
benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automaticall
enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn
- ✔✔ANS Part B primarily covers physician services. She will be paying a monthly premium and, with th
exception of many preventive and screening tests, generally will have 20% coinsurance for thes
services, in addition to an annual deductible.
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 coul
you tell her? - ✔✔ANS Original Medicare covers ambulance services.
Mr. Diaz continued working with his company and was insured under his employer's group plan until h
reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part
when first eligible and wants to know how much he will have to pay. What should you tell him? - ✔✔AN
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
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 ha
told her about the Medigap Part F plan in which he is enrolled. It not only provides foreign trave
,emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. Wha
should you tell her - ✔✔ANS You are sorry to disappoint Anita but a Medigap Part F plan is no longe
available to those who turn age 65 after January 1,2020. Anita might instead consider other Medigap plan
that offer foreign travel benefits but do not cover the Part B deductible.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicar
Supplemental Insurance provides since his health care needs are different from his wife's needs. Wha
could you tell Mr. Moy? - ✔✔ANS Medicare Supplemental Insurance would help cover his Part A and Pa
B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicar
does not cover.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Securit
Administration and has been receiving disability payments. He is wondering whether he can obtai
coverage under Medicare. What should you tell him? - ✔✔ANS After receiving such disability payment
for 24 months, he will be automatically enrolled in Medicare, regardless of age.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-fo
Service (FFS) Medicare? What could you tell him? - ✔✔ANS Part A, which covers hospital, skilled nursin
facility, hospice, and home health services and Part B, which covers professional services such as thos
provided by a doctor are covered under Original Medicare.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will hav
considerable income when she retires. She is concerned that her income will make it impossible for he
to qualify for Medicare. What could you tell her to address her concern? - ✔✔ANS Medicare is a program
for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, an
Lou Gehrig's disease so she will be eligible for Medicare.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfull
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay sh
will need a month or two of nursing and rehabilitative care. What should you tell them about Origina
Medicare's coverage of care in a skilled nursing facility? - ✔✔ANS Medicare will cover Mrs. Shield's skille
nursing services provided during the first 20 days of her stay, after which she would have a copay unt
she has been in the facility for 100 days.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Origina
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicar
beneficiaries? - ✔✔ANS Beneficiaries under Original Medicare have no cost-sharing for most preventiv
services which include immunizations such as annual flu shots.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicar
enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Pa
D is so she called you to ask what her neighbor was talking about. What could you tell her? - ✔✔ANS Pa
, D covers prescription drugs and she should look at her premiums, formulary, and cost-sharing amon
other factors to see if they have changed.
What impact, if any, will recent regulatory changes have upon Medigap plans? - ✔✔ANS The Part
deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020
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 Mr. Wu may sti
qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
Madeline Martinez was widowed several years ago. Her husband worked for many years and contribute
into the Medicare system. He also left a substantial estate which provides Madeline with an annual incom
of approximately $130,000. Madeline, who has only worked part-time for the last three years, will soo
turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you te
her? - ✔✔ANS You should tell Madeline that she will be able to enroll in Medicare Part A without payin
monthly premiums due to her husband's long work record and participation in the Medicare system. Yo
should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but les
than the highest rate due her substantial income.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicar
Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had fo
several years. However, the plan does not provide drug benefits. How would you advise Agent John Mille
to proceed? - ✔✔ANS Tell prospect Jerry Smith that he should consider adding a standalone Part
prescription drug coverage policy to his present coverage.
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 Medigap plans hel
beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and wi
soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him
- ✔✔ANS He may sign-up for Medicare at any time however coverage usually begins on the fourth mont
after dialysis treatments start.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxe
during that entire period. She is concerned that she will not qualify for coverage under part A becaus
she was not born in the United States. What should you tell her? - ✔✔ANS Most individuals who ar
citizens and age 65 or over are covered under Part A by virtue of having paid Medicare taxes whil
working, though some may be covered as a result of paying monthly premiums.
