AHIP EXAM
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1. Mr. Wendt suffers from diabetes which has got- d. If there is a special needs plan
ten progressively worse during the last year. He (SNP) in Mr. Wendt's area that
is currently enrolled in Original Medicare (Parts specializes in caring for individuals
A and B) and a Part D prescription drug plan and with diabetes, he may enroll in the
did not enroll in a Medicare Advantage (MA) plan SNP at any time under a special
during the last annual open enrollment period enrollment period (SEP). Correct
(AEP) which has just closed. Mr. Wendt has heard
that there are certain MA plans that might pro-
vide 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?
2. Agent John Miller is meeting with Jerry Smith, d. Tell prospect Jerry Smith that he
a new prospect. Jerry is currently enrolled in should consider adding a stand-
Medicare Parts A and B. Jerry has also purchased alone Part D prescription drug cov-
a Medicare Supplement (Medigap) plan which erage policy to his present cover-
he has had for several years. However, the plan age.
does not provide drug benefits. How would you
advise Agent John Miller to proceed?
3. Anita Magri will turn age 65 in August 2020. a. You are sorry to disappoint Ani-
Anita intends to enroll in Original Medicare Part ta but a Medigap Part F plan is
A and Part B. She would also like to enroll in no longer available to those who
a Medicare Supplement (Medigap) plan. Anita's turn age 65 after January 1,2020.
older neighbor Mel has told her about the Medi- Anita might instead consider other
gap Part F plan in which he is enrolled. It not only Medigap plans that offer foreign
provides foreign travel emergency benefits but travel benefits but do not cover the
also covers his Medicare Part B deductible. Anita Part B deductible.
comes to you for advice. What should you tell
her?
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4. Juan Perez, who is turning age 65 next month, d. Juan is likely to be eligible for
intends to work for several more years at Small- Medicare once he turns age 65
cap, Incorporated. Smallcap has a workforce of and if he enrolls Medicare would
15 employees and offers employer-sponsored become the primary payor of his
healthcare coverage. Juan is a naturalized citi- healthcare claims and Smallcap
zen and has contributed to the Medicare system does not have to continue to offer
for over 20 years. Juan asks you if he will be him coverage comparable to those
entitled to Medicare and if he enrolls how that under age 65 under its employ-
will impact his employer-sponsored healthcare er-sponsored group health plan.
coverage. How would you respond?
5. Madeline Martinez was widowed several years b. You should tell Madeline that she
ago. Her husband worked for many years and will be able to enroll in Medicare
contributed into the Medicare system. He also Part A without paying monthly pre-
left a substantial estate which provides Made- miums due to her husband's long
line with an annual income of approximate- work record and participation in
ly $130,000. Madeline, who has only worked the Medicare system. You should
part-time for the last three years, will soon turn also tell Madeline that she will pay
age 65 and hopes to enroll in Original Medicare. Part B premiums at more than the
She comes to you for advice. What should you standard lowest rate but less than
tell her? the highest rate due her substantial
income.
6. Mr. Bauer is 49 years old, but eighteen months b. After receiving such disability
ago he was declared disabled by the Social Se- payments for 24 months, he will be
curity Administration and has been receiving automatically enrolled in Medicare,
disability payments. He is wondering whether regardless of age.
he can obtain coverage under Medicare. What
should you tell him?
7. Mr. Davis is 52 years old and has recently been b. He may sign-up for Medicare at
diagnosed with end-stage renal disease (ESRD) any time however coverage usually
, AHIP EXAM
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and will soon begin dialysis. He is wondering if begins on the fourth month after
he can obtain coverage under Medicare. What dialysis treatments start.
should you tell him?
8. Mr. Diaz continued working with his company d. Mr. Diaz will not pay any penalty
and was insured under his employer's group because he had continuous cover-
plan until he reached age 68. He has heard that age under his employer's plan.
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?
9. Mr. Moy's wife has a Medicare Advantage b. Medicare Supplemental Insur-
plan, but he wants to understand what cover- ance would help cover his Part A
age Medicare Supplemental Insurance provides and Part B cost sharing in Original
since his health care needs are different from his Fee-for-Service (FFS) Medicare as
wife's needs. What could you tell Mr. Moy? well as possibly some services that
Medicare does not cover.
10. Mrs. Chen will be 65 soon, has been a citizen a. Most individuals who are citizens
for twelve years, has been employed full time, and age 65 or over are covered
and paid taxes during that entire period. She is under Part A by virtue of having
concerned that she will not qualify for coverage paid Medicare taxes while working,
under part A because she was not born in the though some may be covered as
United States. What should you tell her? a result of paying monthly premi-
ums.
11. Mr. Schmidt would like to plan for retirement b. Part A, which covers hospi-
and has asked you what is covered under Orig- tal, skilled nursing facility, hospice,
inal Fee-for-Service (FFS) Medicare? What could and home health services and Part
you tell him? B, which covers professional ser-
vices such as those provided by a
, AHIP EXAM
Study online at https://quizlet.com/_hph3p6
doctor are covered under Original
Medicare.
12. Mrs. Geisler's neighbor told her she should c. Part D covers prescription drugs
look at her Part D options during the annual and she should look at her premi-
Medicare enrollment period because features of ums, formulary, and cost-sharing
Part D might have changed. Mrs. Geisler can't among other factors to see if they
remember what Part D is so she called you to have changed.
ask what her neighbor was talking about. What
could you tell her?
13. Mr. Singh would like drug coverage but does not d. Mr. Singh can enroll in a
want to be enrolled in a Medicare Advantage stand-alone prescription drug plan
plan. What should you tell him? and continue to be covered for Part
A and Part B services through Orig-
inal Fee-for-Service Medicare.
14. Mrs. Paterson is concerned about the de- c. Medigap plans help benefi-
ductibles and co-payments associated with ciaries cover coinsurance, co-pay-
Original Medicare. What can you tell her about ments, and/or deductibles for
Medigap as an option to address this concern? medically necessary services.
15. Mrs. Quinn recently turned 66 and decided after d. Part B primarily covers physi-
many years of work to begin receiving Social cian services. She will be paying
Security benefits. Shortly thereafter Mrs. Quinn a monthly premium and, with the
received a letter informing her that she has exception of many preventive and
been automatically enrolled in Medicare Part B. screening tests, generally will have
She wants to understand what this means. What 20% coinsurance for these services,
should you tell Mrs. Quinn? in addition to an annual deductible.
16. Mrs. Shields is covered by Original Medicare. b. Medicare will cover Mrs. Shield's
She sustained a hip fracture and is being suc- skilled nursing services provided
cessfully treated for that condition. Howev- during the first 20 days of her stay,
Study online at https://quizlet.com/_hph3p6
1. Mr. Wendt suffers from diabetes which has got- d. If there is a special needs plan
ten progressively worse during the last year. He (SNP) in Mr. Wendt's area that
is currently enrolled in Original Medicare (Parts specializes in caring for individuals
A and B) and a Part D prescription drug plan and with diabetes, he may enroll in the
did not enroll in a Medicare Advantage (MA) plan SNP at any time under a special
during the last annual open enrollment period enrollment period (SEP). Correct
(AEP) which has just closed. Mr. Wendt has heard
that there are certain MA plans that might pro-
vide 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?
2. Agent John Miller is meeting with Jerry Smith, d. Tell prospect Jerry Smith that he
a new prospect. Jerry is currently enrolled in should consider adding a stand-
Medicare Parts A and B. Jerry has also purchased alone Part D prescription drug cov-
a Medicare Supplement (Medigap) plan which erage policy to his present cover-
he has had for several years. However, the plan age.
does not provide drug benefits. How would you
advise Agent John Miller to proceed?
3. Anita Magri will turn age 65 in August 2020. a. You are sorry to disappoint Ani-
Anita intends to enroll in Original Medicare Part ta but a Medigap Part F plan is
A and Part B. She would also like to enroll in no longer available to those who
a Medicare Supplement (Medigap) plan. Anita's turn age 65 after January 1,2020.
older neighbor Mel has told her about the Medi- Anita might instead consider other
gap Part F plan in which he is enrolled. It not only Medigap plans that offer foreign
provides foreign travel emergency benefits but travel benefits but do not cover the
also covers his Medicare Part B deductible. Anita Part B deductible.
comes to you for advice. What should you tell
her?
, AHIP EXAM
Study online at https://quizlet.com/_hph3p6
4. Juan Perez, who is turning age 65 next month, d. Juan is likely to be eligible for
intends to work for several more years at Small- Medicare once he turns age 65
cap, Incorporated. Smallcap has a workforce of and if he enrolls Medicare would
15 employees and offers employer-sponsored become the primary payor of his
healthcare coverage. Juan is a naturalized citi- healthcare claims and Smallcap
zen and has contributed to the Medicare system does not have to continue to offer
for over 20 years. Juan asks you if he will be him coverage comparable to those
entitled to Medicare and if he enrolls how that under age 65 under its employ-
will impact his employer-sponsored healthcare er-sponsored group health plan.
coverage. How would you respond?
5. Madeline Martinez was widowed several years b. You should tell Madeline that she
ago. Her husband worked for many years and will be able to enroll in Medicare
contributed into the Medicare system. He also Part A without paying monthly pre-
left a substantial estate which provides Made- miums due to her husband's long
line with an annual income of approximate- work record and participation in
ly $130,000. Madeline, who has only worked the Medicare system. You should
part-time for the last three years, will soon turn also tell Madeline that she will pay
age 65 and hopes to enroll in Original Medicare. Part B premiums at more than the
She comes to you for advice. What should you standard lowest rate but less than
tell her? the highest rate due her substantial
income.
6. Mr. Bauer is 49 years old, but eighteen months b. After receiving such disability
ago he was declared disabled by the Social Se- payments for 24 months, he will be
curity Administration and has been receiving automatically enrolled in Medicare,
disability payments. He is wondering whether regardless of age.
he can obtain coverage under Medicare. What
should you tell him?
7. Mr. Davis is 52 years old and has recently been b. He may sign-up for Medicare at
diagnosed with end-stage renal disease (ESRD) any time however coverage usually
, AHIP EXAM
Study online at https://quizlet.com/_hph3p6
and will soon begin dialysis. He is wondering if begins on the fourth month after
he can obtain coverage under Medicare. What dialysis treatments start.
should you tell him?
8. Mr. Diaz continued working with his company d. Mr. Diaz will not pay any penalty
and was insured under his employer's group because he had continuous cover-
plan until he reached age 68. He has heard that age under his employer's plan.
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?
9. Mr. Moy's wife has a Medicare Advantage b. Medicare Supplemental Insur-
plan, but he wants to understand what cover- ance would help cover his Part A
age Medicare Supplemental Insurance provides and Part B cost sharing in Original
since his health care needs are different from his Fee-for-Service (FFS) Medicare as
wife's needs. What could you tell Mr. Moy? well as possibly some services that
Medicare does not cover.
10. Mrs. Chen will be 65 soon, has been a citizen a. Most individuals who are citizens
for twelve years, has been employed full time, and age 65 or over are covered
and paid taxes during that entire period. She is under Part A by virtue of having
concerned that she will not qualify for coverage paid Medicare taxes while working,
under part A because she was not born in the though some may be covered as
United States. What should you tell her? a result of paying monthly premi-
ums.
11. Mr. Schmidt would like to plan for retirement b. Part A, which covers hospi-
and has asked you what is covered under Orig- tal, skilled nursing facility, hospice,
inal Fee-for-Service (FFS) Medicare? What could and home health services and Part
you tell him? B, which covers professional ser-
vices such as those provided by a
, AHIP EXAM
Study online at https://quizlet.com/_hph3p6
doctor are covered under Original
Medicare.
12. Mrs. Geisler's neighbor told her she should c. Part D covers prescription drugs
look at her Part D options during the annual and she should look at her premi-
Medicare enrollment period because features of ums, formulary, and cost-sharing
Part D might have changed. Mrs. Geisler can't among other factors to see if they
remember what Part D is so she called you to have changed.
ask what her neighbor was talking about. What
could you tell her?
13. Mr. Singh would like drug coverage but does not d. Mr. Singh can enroll in a
want to be enrolled in a Medicare Advantage stand-alone prescription drug plan
plan. What should you tell him? and continue to be covered for Part
A and Part B services through Orig-
inal Fee-for-Service Medicare.
14. Mrs. Paterson is concerned about the de- c. Medigap plans help benefi-
ductibles and co-payments associated with ciaries cover coinsurance, co-pay-
Original Medicare. What can you tell her about ments, and/or deductibles for
Medigap as an option to address this concern? medically necessary services.
15. Mrs. Quinn recently turned 66 and decided after d. Part B primarily covers physi-
many years of work to begin receiving Social cian services. She will be paying
Security benefits. Shortly thereafter Mrs. Quinn a monthly premium and, with the
received a letter informing her that she has exception of many preventive and
been automatically enrolled in Medicare Part B. screening tests, generally will have
She wants to understand what this means. What 20% coinsurance for these services,
should you tell Mrs. Quinn? in addition to an annual deductible.
16. Mrs. Shields is covered by Original Medicare. b. Medicare will cover Mrs. Shield's
She sustained a hip fracture and is being suc- skilled nursing services provided
cessfully treated for that condition. Howev- during the first 20 days of her stay,
