AHIP Final Exam 2027 | Questions and Correct
Answers| Latest Update
Mrs. Andrews 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?
Original Medicare covers ambulance services.
What impact, if any, have recent regulatory changes had on Medigap plans?
The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Joan and Loretta are both enrolled in Medicare. Joan pays a premium for Part A
coverage. Loretta does not. Which of the following statements best explains this
difference?
Joan worked only a short time and did not accumulate sufficient work credits.
Loretta worked for well over 10 years accumulating credit for more than 40
quarters of contributions to the Medicare program.
Larry Miller is an Original Medicare beneficiary with Parts A and B coverage.
Larry is admitted to Good Care Hospital in January with pneumonia and stays for
three days before being discharged. Six months later in July, Larry takes a bad
fall and is admitted to Good Care Hospital with a broken leg. After emergency
surgery to repair his broken leg, Larry is hospitalized for a week before being
discharged home. In December, Larry is admitted to Mount Wellness Hospital
once again with a serious case of the flu. For how many Part A deductibles will
Larry be responsible for?
,Larry will be responsible for three Part A deductibles.
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has been
receiving rehabilitation services in a skilled nursing facility. He calls you to say
that he has just received a notice that Medicare will no longer cover his stay and
he still cannot walk properly. He thinks they are ending his services too soon.
What do you tell him?
He should follow the directions on the notice to file a fast appeal. Mr. Birch should
file it by noon of the calendar day following receipt of the provider's notice of
termination of services.
Mr. Ray would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
Mr. Ray 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.
Mrs. Sanders 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?
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.
Mrs. Carpenter is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her?
,Mrs. Carpenter should file an appeal of this initial determination within 120 days
of the date she received the MSN in the mail.
Mr. Hoffman 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 expect to
encounter when enrolling into a standard Medicare Part D prescription drug
plan. What should you tell him?
He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
Mrs. Larson is enrolled in Original Medicare and has a Medigap policy as well,
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?
Mrs. Larson cannot purchase a Medigap plan that covers drugs, but she could
keep her Medigap policy and enroll in a Part D prescription drug plan.
Mary Alice is covered by Original Medicare Parts A and B. During her initial
enrollment period she purchased a standard Medigap Plan A policy from you
because of its relatively low cost. After speaking to her friend Stan, she asks
whether any of the following are "core benefits" covered in her plan?
I. Coverage for Part A hospital coinsurance amount
II. Coverage for 365 additional days during an insured's lifetime after Medicare
benefits end
III. Coverage for 3 pints of blood
, Mr. Ellis continued working with his company and was insured under his
employer's group plan until he reached age 68 when he retired. Five months
later Mr. Ellis enrolled in Part B. He has heard that 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?
Mr. Ellis will not pay any penalty because he had continuous coverage under his
employer's plan and he enrolled in Part B within the 8-month period immediately
following the last month he had group coverage.
Mrs. Georgia 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?
Medigap plans do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Mr. Turner 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. Turner
that best describes the health coverage provided to Medicare beneficiaries?
Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
Mr. Harvey would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell
him?
It is illegal for you to sell Mr. Harvey a Medigap plan if he is enrolled in an MA plan,
and besides, Medigap only works with Original Medicare.
Answers| Latest Update
Mrs. Andrews 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?
Original Medicare covers ambulance services.
What impact, if any, have recent regulatory changes had on Medigap plans?
The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Joan and Loretta are both enrolled in Medicare. Joan pays a premium for Part A
coverage. Loretta does not. Which of the following statements best explains this
difference?
Joan worked only a short time and did not accumulate sufficient work credits.
Loretta worked for well over 10 years accumulating credit for more than 40
quarters of contributions to the Medicare program.
Larry Miller is an Original Medicare beneficiary with Parts A and B coverage.
Larry is admitted to Good Care Hospital in January with pneumonia and stays for
three days before being discharged. Six months later in July, Larry takes a bad
fall and is admitted to Good Care Hospital with a broken leg. After emergency
surgery to repair his broken leg, Larry is hospitalized for a week before being
discharged home. In December, Larry is admitted to Mount Wellness Hospital
once again with a serious case of the flu. For how many Part A deductibles will
Larry be responsible for?
,Larry will be responsible for three Part A deductibles.
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has been
receiving rehabilitation services in a skilled nursing facility. He calls you to say
that he has just received a notice that Medicare will no longer cover his stay and
he still cannot walk properly. He thinks they are ending his services too soon.
What do you tell him?
He should follow the directions on the notice to file a fast appeal. Mr. Birch should
file it by noon of the calendar day following receipt of the provider's notice of
termination of services.
Mr. Ray would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
Mr. Ray 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.
Mrs. Sanders 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?
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.
Mrs. Carpenter is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her?
,Mrs. Carpenter should file an appeal of this initial determination within 120 days
of the date she received the MSN in the mail.
Mr. Hoffman 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 expect to
encounter when enrolling into a standard Medicare Part D prescription drug
plan. What should you tell him?
He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
Mrs. Larson is enrolled in Original Medicare and has a Medigap policy as well,
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?
Mrs. Larson cannot purchase a Medigap plan that covers drugs, but she could
keep her Medigap policy and enroll in a Part D prescription drug plan.
Mary Alice is covered by Original Medicare Parts A and B. During her initial
enrollment period she purchased a standard Medigap Plan A policy from you
because of its relatively low cost. After speaking to her friend Stan, she asks
whether any of the following are "core benefits" covered in her plan?
I. Coverage for Part A hospital coinsurance amount
II. Coverage for 365 additional days during an insured's lifetime after Medicare
benefits end
III. Coverage for 3 pints of blood
, Mr. Ellis continued working with his company and was insured under his
employer's group plan until he reached age 68 when he retired. Five months
later Mr. Ellis enrolled in Part B. He has heard that 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?
Mr. Ellis will not pay any penalty because he had continuous coverage under his
employer's plan and he enrolled in Part B within the 8-month period immediately
following the last month he had group coverage.
Mrs. Georgia 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?
Medigap plans do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Mr. Turner 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. Turner
that best describes the health coverage provided to Medicare beneficiaries?
Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
Mr. Harvey would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell
him?
It is illegal for you to sell Mr. Harvey a Medigap plan if he is enrolled in an MA plan,
and besides, Medigap only works with Original Medicare.
