AHIP 1-5
AHIP 1-5 (2022) QUESTIONS AND ANSWERS / STUDY GUIDE
100% GUARANTEED SUCCESS.
AHIP - 1
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 help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? ANS >> 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.
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.
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
,AHIP 1-5
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 >> Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
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 >> Tell prospect
Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage.
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 >>
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 >> After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
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 >> Most individuals who are citizens and age 65 or over are
,AHIP 1-5
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.
What impact, if any, will recent regulatory changes have upon Medigap plans? ANS >>
The Part B deductible will no longer be covered for individuals newly eligible for
Medicare starting January 1, 2020.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
small cap, Incorporated. Small cap 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 >> 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 small cap does not have to continue to offer him coverage
comparable to those under age 65 under its employer-sponsored group health plan
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 that best describes the
health coverage provided to Medicare beneficiaries? ANS >> Beneficiaries under
Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
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 >> 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
, AHIP 1-5
about. What could you tell her? ANS >> 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. 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 >> He may sign-up for Medicare at any
time however coverage usually begins on the fourth month after dialysis treatments start.
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 >> 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 >> 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 >> Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
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 >> Part B primarily covers
physician services. She will be paying a monthly premium and, with the exception of
AHIP 1-5 (2022) QUESTIONS AND ANSWERS / STUDY GUIDE
100% GUARANTEED SUCCESS.
AHIP - 1
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 help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? ANS >> 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.
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.
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
,AHIP 1-5
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 >> Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
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 >> Tell prospect
Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage.
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 >>
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 >> After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
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 >> Most individuals who are citizens and age 65 or over are
,AHIP 1-5
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.
What impact, if any, will recent regulatory changes have upon Medigap plans? ANS >>
The Part B deductible will no longer be covered for individuals newly eligible for
Medicare starting January 1, 2020.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
small cap, Incorporated. Small cap 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 >> 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 small cap does not have to continue to offer him coverage
comparable to those under age 65 under its employer-sponsored group health plan
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 that best describes the
health coverage provided to Medicare beneficiaries? ANS >> Beneficiaries under
Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
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 >> 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
, AHIP 1-5
about. What could you tell her? ANS >> 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. 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 >> He may sign-up for Medicare at any
time however coverage usually begins on the fourth month after dialysis treatments start.
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 >> 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 >> 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 >> Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
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 >> Part B primarily covers
physician services. She will be paying a monthly premium and, with the exception of
