AHIP FINAL EXAM TEST
QUESTIONS AND
ANSWERS
1.Mr. gCapadona gwould glike gto gpurchase ga gMedicare gAdvantage g(MA) gplan
gand ga gMedigap gplan gto gpick gup gcosts gnot gcovered gby gthat gplan. gWhat
gshould gyou gtell ghim?:
g g g g gANS>> gIt gis gillegal gfor gyou gto gsell gMr. gCapadona ga gMedigap gplan
gif ghe gis genrolled gin gan gMA gplan, gand gbesides, gMedigap gonly gworks
gwith gOriginal gMedicare.
2.Agent gJohn gMiller gis gmeeting gwith gJerry gSmith, ga gnew gprospect. gJerry gis
gcur- grently genrolled gin gMedicare gParts gA gand gB. gJerry ghas galso gpurchased
ga gMedicare gSupplement g(Medigap) gplan gwhich ghe ghas ghad gfor gseveral
gyears. gHowever, gthe gplan gdoes gnot gprovide gdrug gbenefits. gHow gwould gyou
gadvise gAgent gJohn gMiller gto gproceed?: g
g g g g g g gANS>> gTell gprospect gJerry gSmith gthat ghe gshould gconsider gadding
ga gstandalone gPart gD gprescription gdrug gcoverage gpolicy gto ghis gpresent
gcoverage
3.Mr. gWu gis geligible gfor gMedicare. gHe ghas glimited gfinancial gresources gbut
gfailed gto gqualify gfor gthe gPart gD glow-income gsubsidy. gWhere gmight ghe gturn
gfor ghelp gwith ghis gprescription gdrug gcosts?:
g g g g g g g g gANS>> g gMr. gWu gmay gstill gqualify gfor ghelp gin gpaying gPart gD
gcosts gthrough ghis gState gPharmaceutical gAssistance gProgram g(SPAP).
4.Mr. gVasquez gis gin ggood ghealth gand gis gpreparing ga gbudget gin
ganticipation gof ghis gretirement gwhen ghe gturns g66. gHe gwants gto gunderstand
gthe ghealth gcare gcosts ghe gmight gbe gexposed gto gunder gMedicare gif ghe gwere
gto grequire ghospitalization gbecause gof gan gillness. gIn ggeneral gterms, gwhat
gcould gyou gtell ghim gabout ghis gcosts gfor ginpatient ghospital gservices gunder
gOriginal gMedicare?:
g g g g g g g gANS>> g gUnder gOriginal gMedicare, gthere gis ga gsingle gdeductible
gamount gdue gfor gthe gfirst g60 gdays gof gany ginpatient ghospital gstay, gafter
gwhich git gconverts ginto ga gper-day gcoinsurance gamount gthrough gday
90. gAfter gday g90, ghe gwould gpay ga gdaily gamount gup gto g60 gdays gover
ghis glifetime, gafter gwhich ghe gwould gbe gresponsible gfor gall gcosts.
5.Mr. gMoy gwill gsoon gturn gage g65. gHe gis gslightly gyounger gthan ghis gwife.
gMr. gMoy's gwife ghas ga gMedicare gAdvantage gplan, gbut ghe gwants gto
gunderstand gwhat gcoverage gMedicare gSupplemental gInsurance gprovides
gsince ghis ghealth gcare gneeds gare gdifferent gfrom ghis gwife's gneeds. gWhat
gcould gyou gtell gMr. gMoy?:
g g g g g g g g gANS>> g g- gMedicare gSupplemental gInsurance gwould ghelp gcover
ghis gPart gA gdeductible gand gPart gB gcoinsurance gor gcopayments gin
gOriginal gFee-for-Service g(FFS) gMedicare gas gwell gas gpossibly gsome
gservices gthat gMedicare gdoes gnot gcover.
1 g/
g35
, AHIP FINAL EXAM TEST
QUESTIONS AND
ANSWERS
6.Juan gPerez, gwho gis gturning gage g65 gnext gmonth, gintends gto gwork gfor
gseveral gmore gyears gat gSmallcap, gIncorporated. gSmallcap ghas ga gworkforce
gof g15 gemploy- gees gand goffers gemployer-sponsored ghealthcare gcoverage.
gJuan gis ga gnaturalized gcitizen gand ghas gcontributed gto gthe gMedicare gsystem
gfor gover g20 gyears. gJuan gasks gyou gif ghe gwill gbe gentitled gto gMedicare gand gif
ghe genrolls ghow gthat gwill gimpact ghis gemployer- gsponsored ghealthcare
gcoverage. gHow gwould gyou grespond?:
g g g g g g g g gANS>> g gJuan gis glikely gto gbe geligible gfor gMedicare gonce ghe
gturns gage g65 gand gif ghe genrolls, gMedicare gwould gbecome gthe gprimary
gpayor gof ghis ghealthcare gclaims gand gSmallcap gdoes gnot ghave gto
gcontinue gto goffer ghim gcoverage gcomparable gto gthose gunder gage g65
gunder
2 g/
g35
, AHIP FINAL EXAM TEST
QUESTIONS AND
ANSWERS
its gemployer-sponsored ggroup ghealth gplan. gJuan gis glikely gto gbe geligible
gfor gMedicare gonce ghe gturns gage g65 gand gif ghe genrolls, gMedicare gwould
gbecome gthe gprimary gpayor gof ghis ghealthcare gclaims gbut gSmallcap
gmust gcontinue gto goffer ghim gcoverage gunder gits gemployer-sponsored
ggroup ghealth gplan gand gwould gbecome ga gsecondary gpayor.
7.Ms. gKumar gplans gto gretire gwhen gshe gturns g65 gin ga gfew gmonths. gShe
gis gin gexcellent ghealth gand gwill ghave gconsiderable gincome gwhen gshe
gretires. gShe gis gconcerned gthat gher gincome gwill gmake git gimpossible gfor
gher gto gqualify gfor gMedicare. gWhat gcould gyou gtell gher gto gaddress gher
gconcern?:
g g g g g g g g g g g g gANS>> g gMedicare gis ga
program gfor gpeople gage g65 gor golder gand gthose gunder gage g65 gwith
gcertain gdisabilities, gend-stage grenal gdisease, gand gLou gGehrig's
gdisease gso gshe gwill gbe geligible gfor gMedicare.
8.Mrs. gEllis grecently gturned g66 gand gdecided gafter gmany gyears gof gwork gto
gretire gand gbegin greceiving gSocial gSecurity gbenefits. gShortly gthereafter
gMrs. gEllis greceived ga gletter ginforming gher gthat gshe ghad gbeen
gautomatically genrolled gin gMedicare gPart gB. gShe gwants gto gunderstand gwhat
gthis gmeans. gWhat gshould gyou gtell gMrs. gEllis?:
g g g g g g g g g g gANS>> g gPart gB gprimarily gcovers gphysician gservices. gShe gwill
gbe gpaying ga gmonthly gpremium gand, gexcept gfor gmany gpreventive gand
gscreening gtests, ggenerally gwill ghave g20% gco-payments gfor gthese
gservices, gin gaddition gto gan gannual gdeductible.
9.Mr. gSingh gwould glike gdrug gcoverage gbut gdoes gnot gwant gto gbe genrolled
gin ga gMedicare gAdvantage gplan. gWhat gshould gyou gtell ghim?:
g g g g g g g g g gANS>> g gMr. gSingh gcan genroll gin ga gstand-alone gprescription
gdrug gplan gand gcontinue gto gbe gcovered gfor gPart gA gand gPart gB
gservices gthrough gOriginal gFee-for-Service gMedicare.
10.Mrs. gCook gis gan gelderly gretiree. gMrs. gCook ghas ga glow gfixed gincome.
gWhat gcould gyou gtell gMrs. gCook gthat gmight gbe gof gassistance?:
g g g g g g g g g g gANS>> g gShe gshould gcontact gher gstate gMedicaid gagency gto
gsee gif gshe gqualifies gfor gone gof gseveral gprograms gthat gcan ghelp gwith
gMedicare gcosts gfor gwhich gshe gis gresponsible.
11.Ms. gHenderson gbelieves gthat gshe gwill gqualify gfor gMedicare gCoverage
gwhen gshe gturns g65, gwithout gpaying gany gpremiums, gbecause gshe ghas
gbeen gworking gfor g40 gyears gand gpaying gMedicare gtaxes. gWhat gshould gyou
gtell gher?:
g g g g g g g g g gANS>> g gTo gobtain gPart gB gcoverage, gshe gmust gpay ga
gstandard gmonthly gpremium, gthough git gis ghigher gfor gindividuals gwith
3 g/
g35
, AHIP FINAL EXAM TEST
QUESTIONS AND
ANSWERS
ghigher gincomes.
12.Mr. gBauer gis g49 gyears gold, gbut geighteen gmonths gago ghe gwas gdeclared
gdis- gabled gby gthe gSocial gSecurity gAdministration gand ghas gbeen greceiving
gdisability gpayments. gHe gis gwondering gwhether ghe gcan gobtain gcoverage
gunder gMedicare. gWhat gshould gyou gtell ghim?:
g g g g g g g g g g gANS>> g gAfter greceiving gsuch gdisability gpayments gfor g24
gmonths, ghe gwill gbe gautomatically genrolled gin gMedicare, gregardless gof
gage.
13.Mr. gSchmidt gwould glike gto gplan gfor gretirement gand ghas gasked gyou
gwhat gis gcovered gunder gOriginal gFee-for-Service g(FFS) gMedicare. gWhat
gcould gyou gtell ghim?:
g g g g g g g g g g gANS>> g gPart gA, gwhich gcovers ghospital, gskilled gnursing
gfacility, ghospice, gand ghome
4 g/
g35
QUESTIONS AND
ANSWERS
1.Mr. gCapadona gwould glike gto gpurchase ga gMedicare gAdvantage g(MA) gplan
gand ga gMedigap gplan gto gpick gup gcosts gnot gcovered gby gthat gplan. gWhat
gshould gyou gtell ghim?:
g g g g gANS>> gIt gis gillegal gfor gyou gto gsell gMr. gCapadona ga gMedigap gplan
gif ghe gis genrolled gin gan gMA gplan, gand gbesides, gMedigap gonly gworks
gwith gOriginal gMedicare.
2.Agent gJohn gMiller gis gmeeting gwith gJerry gSmith, ga gnew gprospect. gJerry gis
gcur- grently genrolled gin gMedicare gParts gA gand gB. gJerry ghas galso gpurchased
ga gMedicare gSupplement g(Medigap) gplan gwhich ghe ghas ghad gfor gseveral
gyears. gHowever, gthe gplan gdoes gnot gprovide gdrug gbenefits. gHow gwould gyou
gadvise gAgent gJohn gMiller gto gproceed?: g
g g g g g g gANS>> gTell gprospect gJerry gSmith gthat ghe gshould gconsider gadding
ga gstandalone gPart gD gprescription gdrug gcoverage gpolicy gto ghis gpresent
gcoverage
3.Mr. gWu gis geligible gfor gMedicare. gHe ghas glimited gfinancial gresources gbut
gfailed gto gqualify gfor gthe gPart gD glow-income gsubsidy. gWhere gmight ghe gturn
gfor ghelp gwith ghis gprescription gdrug gcosts?:
g g g g g g g g gANS>> g gMr. gWu gmay gstill gqualify gfor ghelp gin gpaying gPart gD
gcosts gthrough ghis gState gPharmaceutical gAssistance gProgram g(SPAP).
4.Mr. gVasquez gis gin ggood ghealth gand gis gpreparing ga gbudget gin
ganticipation gof ghis gretirement gwhen ghe gturns g66. gHe gwants gto gunderstand
gthe ghealth gcare gcosts ghe gmight gbe gexposed gto gunder gMedicare gif ghe gwere
gto grequire ghospitalization gbecause gof gan gillness. gIn ggeneral gterms, gwhat
gcould gyou gtell ghim gabout ghis gcosts gfor ginpatient ghospital gservices gunder
gOriginal gMedicare?:
g g g g g g g gANS>> g gUnder gOriginal gMedicare, gthere gis ga gsingle gdeductible
gamount gdue gfor gthe gfirst g60 gdays gof gany ginpatient ghospital gstay, gafter
gwhich git gconverts ginto ga gper-day gcoinsurance gamount gthrough gday
90. gAfter gday g90, ghe gwould gpay ga gdaily gamount gup gto g60 gdays gover
ghis glifetime, gafter gwhich ghe gwould gbe gresponsible gfor gall gcosts.
5.Mr. gMoy gwill gsoon gturn gage g65. gHe gis gslightly gyounger gthan ghis gwife.
gMr. gMoy's gwife ghas ga gMedicare gAdvantage gplan, gbut ghe gwants gto
gunderstand gwhat gcoverage gMedicare gSupplemental gInsurance gprovides
gsince ghis ghealth gcare gneeds gare gdifferent gfrom ghis gwife's gneeds. gWhat
gcould gyou gtell gMr. gMoy?:
g g g g g g g g gANS>> g g- gMedicare gSupplemental gInsurance gwould ghelp gcover
ghis gPart gA gdeductible gand gPart gB gcoinsurance gor gcopayments gin
gOriginal gFee-for-Service g(FFS) gMedicare gas gwell gas gpossibly gsome
gservices gthat gMedicare gdoes gnot gcover.
1 g/
g35
, AHIP FINAL EXAM TEST
QUESTIONS AND
ANSWERS
6.Juan gPerez, gwho gis gturning gage g65 gnext gmonth, gintends gto gwork gfor
gseveral gmore gyears gat gSmallcap, gIncorporated. gSmallcap ghas ga gworkforce
gof g15 gemploy- gees gand goffers gemployer-sponsored ghealthcare gcoverage.
gJuan gis ga gnaturalized gcitizen gand ghas gcontributed gto gthe gMedicare gsystem
gfor gover g20 gyears. gJuan gasks gyou gif ghe gwill gbe gentitled gto gMedicare gand gif
ghe genrolls ghow gthat gwill gimpact ghis gemployer- gsponsored ghealthcare
gcoverage. gHow gwould gyou grespond?:
g g g g g g g g gANS>> g gJuan gis glikely gto gbe geligible gfor gMedicare gonce ghe
gturns gage g65 gand gif ghe genrolls, gMedicare gwould gbecome gthe gprimary
gpayor gof ghis ghealthcare gclaims gand gSmallcap gdoes gnot ghave gto
gcontinue gto goffer ghim gcoverage gcomparable gto gthose gunder gage g65
gunder
2 g/
g35
, AHIP FINAL EXAM TEST
QUESTIONS AND
ANSWERS
its gemployer-sponsored ggroup ghealth gplan. gJuan gis glikely gto gbe geligible
gfor gMedicare gonce ghe gturns gage g65 gand gif ghe genrolls, gMedicare gwould
gbecome gthe gprimary gpayor gof ghis ghealthcare gclaims gbut gSmallcap
gmust gcontinue gto goffer ghim gcoverage gunder gits gemployer-sponsored
ggroup ghealth gplan gand gwould gbecome ga gsecondary gpayor.
7.Ms. gKumar gplans gto gretire gwhen gshe gturns g65 gin ga gfew gmonths. gShe
gis gin gexcellent ghealth gand gwill ghave gconsiderable gincome gwhen gshe
gretires. gShe gis gconcerned gthat gher gincome gwill gmake git gimpossible gfor
gher gto gqualify gfor gMedicare. gWhat gcould gyou gtell gher gto gaddress gher
gconcern?:
g g g g g g g g g g g g gANS>> g gMedicare gis ga
program gfor gpeople gage g65 gor golder gand gthose gunder gage g65 gwith
gcertain gdisabilities, gend-stage grenal gdisease, gand gLou gGehrig's
gdisease gso gshe gwill gbe geligible gfor gMedicare.
8.Mrs. gEllis grecently gturned g66 gand gdecided gafter gmany gyears gof gwork gto
gretire gand gbegin greceiving gSocial gSecurity gbenefits. gShortly gthereafter
gMrs. gEllis greceived ga gletter ginforming gher gthat gshe ghad gbeen
gautomatically genrolled gin gMedicare gPart gB. gShe gwants gto gunderstand gwhat
gthis gmeans. gWhat gshould gyou gtell gMrs. gEllis?:
g g g g g g g g g g gANS>> g gPart gB gprimarily gcovers gphysician gservices. gShe gwill
gbe gpaying ga gmonthly gpremium gand, gexcept gfor gmany gpreventive gand
gscreening gtests, ggenerally gwill ghave g20% gco-payments gfor gthese
gservices, gin gaddition gto gan gannual gdeductible.
9.Mr. gSingh gwould glike gdrug gcoverage gbut gdoes gnot gwant gto gbe genrolled
gin ga gMedicare gAdvantage gplan. gWhat gshould gyou gtell ghim?:
g g g g g g g g g gANS>> g gMr. gSingh gcan genroll gin ga gstand-alone gprescription
gdrug gplan gand gcontinue gto gbe gcovered gfor gPart gA gand gPart gB
gservices gthrough gOriginal gFee-for-Service gMedicare.
10.Mrs. gCook gis gan gelderly gretiree. gMrs. gCook ghas ga glow gfixed gincome.
gWhat gcould gyou gtell gMrs. gCook gthat gmight gbe gof gassistance?:
g g g g g g g g g g gANS>> g gShe gshould gcontact gher gstate gMedicaid gagency gto
gsee gif gshe gqualifies gfor gone gof gseveral gprograms gthat gcan ghelp gwith
gMedicare gcosts gfor gwhich gshe gis gresponsible.
11.Ms. gHenderson gbelieves gthat gshe gwill gqualify gfor gMedicare gCoverage
gwhen gshe gturns g65, gwithout gpaying gany gpremiums, gbecause gshe ghas
gbeen gworking gfor g40 gyears gand gpaying gMedicare gtaxes. gWhat gshould gyou
gtell gher?:
g g g g g g g g g gANS>> g gTo gobtain gPart gB gcoverage, gshe gmust gpay ga
gstandard gmonthly gpremium, gthough git gis ghigher gfor gindividuals gwith
3 g/
g35
, AHIP FINAL EXAM TEST
QUESTIONS AND
ANSWERS
ghigher gincomes.
12.Mr. gBauer gis g49 gyears gold, gbut geighteen gmonths gago ghe gwas gdeclared
gdis- gabled gby gthe gSocial gSecurity gAdministration gand ghas gbeen greceiving
gdisability gpayments. gHe gis gwondering gwhether ghe gcan gobtain gcoverage
gunder gMedicare. gWhat gshould gyou gtell ghim?:
g g g g g g g g g g gANS>> g gAfter greceiving gsuch gdisability gpayments gfor g24
gmonths, ghe gwill gbe gautomatically genrolled gin gMedicare, gregardless gof
gage.
13.Mr. gSchmidt gwould glike gto gplan gfor gretirement gand ghas gasked gyou
gwhat gis gcovered gunder gOriginal gFee-for-Service g(FFS) gMedicare. gWhat
gcould gyou gtell ghim?:
g g g g g g g g g g gANS>> g gPart gA, gwhich gcovers ghospital, gskilled gnursing
gfacility, ghospice, gand ghome
4 g/
g35
