AHIP Final Exam Test Questions and Answers
1. 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 canobtain 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 month afterdialysis treatments start.
2. Juan Perez, who is turning age 65 next month, intends to work for several more years
at Smallcap, Incorporated. Smallcap has a workforce of15 employ-ees and offers employer-
sponsored healthcare coverage. Juan is a naturalizedcitizen 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 impacthis employer-sponsored healthcare coverage. How would you
respond ANS Juanis likely to be eligible for Medicare once he turns age 65 and if he enrolls
Medicarewould 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 itsemployer-
sponsored group health plan.
3. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand 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 Medicare
,Supplemental Insurance would help cover his Part A and Part B deductibles or coinsurance in
Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does
not cover.
4. Mrs. PeHa is 66 years old, has coverage under an employer plan, and will retirenext year.
She heard she must enroll in Part B at the beginning of the year to ensure no gap in
coverage. What can you tell her ANS She may enroll at any time while she is covered under her
employer plan, but she will have a special eight-month enrollment period after the last month on
her employer plan that differs from the standard general enrollment period, during which she
may enroll in Medicare Part B.
5. 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 concernedthat she will not qualify for
coverage under part A because she was not born inthe United States. What should you tell
her ANS 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.
6. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy aswell, 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
ANS Mrs. Gonzalez cannot purchase a Medigap
,plan that covers drugs, but she could keep her Medigap policy and enroll in a PartD
prescription drug plan.
7. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whetheror not Medicare will
cover these items and services. What should you tell her ANS Medicare does not cover
massage therapy, or, in general, glasses or dentures.
8. Mr. Patel 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 hemight be exposed to
under Medicare if he were to require hospitalization as aresult of an illness. In general
terms, what could you tell him about his costsfor inpatient hospital services
under Original Medicare ANS Under Original Medicare, there is a single deductible amount
due for the first 60 days of any inpatient hospital stay, after which it convertsinto 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 forall costs.
9. 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 ANS To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher forindividuals with higher incomes.
10. Mr. Alonso receives some help paying for his two generic prescription drugs from his
, employer's retiree coverage, but he wants to compare it to a Part D prescription drug
plan. He asks you what costs he would generally ex-pect to encounter when enrolling into
a standard MedicarePart D prescriptiondrug plan. What should you tell him ANS He
generally would pay a monthly premium,annual deductible, and per-prescription cost-sharing.
11. 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 ANS 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.
12. 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 thatbest describes the health
coverage provided to Medicare beneficiaries ANS Ben-eficiaries under Original Medicare have
no cost-sharing for most preventive serviceswhich include immunizations such as annual flu
shots.
1. 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 canobtain 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 month afterdialysis treatments start.
2. Juan Perez, who is turning age 65 next month, intends to work for several more years
at Smallcap, Incorporated. Smallcap has a workforce of15 employ-ees and offers employer-
sponsored healthcare coverage. Juan is a naturalizedcitizen 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 impacthis employer-sponsored healthcare coverage. How would you
respond ANS Juanis likely to be eligible for Medicare once he turns age 65 and if he enrolls
Medicarewould 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 itsemployer-
sponsored group health plan.
3. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand 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 Medicare
,Supplemental Insurance would help cover his Part A and Part B deductibles or coinsurance in
Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does
not cover.
4. Mrs. PeHa is 66 years old, has coverage under an employer plan, and will retirenext year.
She heard she must enroll in Part B at the beginning of the year to ensure no gap in
coverage. What can you tell her ANS She may enroll at any time while she is covered under her
employer plan, but she will have a special eight-month enrollment period after the last month on
her employer plan that differs from the standard general enrollment period, during which she
may enroll in Medicare Part B.
5. 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 concernedthat she will not qualify for
coverage under part A because she was not born inthe United States. What should you tell
her ANS 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.
6. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy aswell, 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
ANS Mrs. Gonzalez cannot purchase a Medigap
,plan that covers drugs, but she could keep her Medigap policy and enroll in a PartD
prescription drug plan.
7. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whetheror not Medicare will
cover these items and services. What should you tell her ANS Medicare does not cover
massage therapy, or, in general, glasses or dentures.
8. Mr. Patel 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 hemight be exposed to
under Medicare if he were to require hospitalization as aresult of an illness. In general
terms, what could you tell him about his costsfor inpatient hospital services
under Original Medicare ANS Under Original Medicare, there is a single deductible amount
due for the first 60 days of any inpatient hospital stay, after which it convertsinto 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 forall costs.
9. 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 ANS To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher forindividuals with higher incomes.
10. Mr. Alonso receives some help paying for his two generic prescription drugs from his
, employer's retiree coverage, but he wants to compare it to a Part D prescription drug
plan. He asks you what costs he would generally ex-pect to encounter when enrolling into
a standard MedicarePart D prescriptiondrug plan. What should you tell him ANS He
generally would pay a monthly premium,annual deductible, and per-prescription cost-sharing.
11. 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 ANS 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.
12. 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 thatbest describes the health
coverage provided to Medicare beneficiaries ANS Ben-eficiaries under Original Medicare have
no cost-sharing for most preventive serviceswhich include immunizations such as annual flu
shots.
