AHIP FINAL EXAM NEWEST 2025-2026 VERSION
QUESTIONS WITH GOLDEN TIPS SOLUTIONS AND
REVEWEIRS
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Terms in this set (106)
Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help in paying Part D costs
limited financial resources but failed to through his State Pharmaceutical Assistance Program.
qualify for the Part D low-income subsidy.
Where might he turn for help with
his prescription drug costs?
Mr. Bauer is 49 years old, but eighteen After receiving such disability payments for 24 months, he
months ago he was declared disabled will be automatically enrolled in Medicare, regardless of
by the Social Security Administration and age.
has been receiving disability payments.
He is wondering whether he can obtain
coverage under Medicare. What should
you tell him?
Mildred Savage enrolled in Allcare Mildred may remain enrolled in Allcare and make a hospice
Medicare Advantage plan several years ago. election. Hospice benefits will be paid for by Original
Mildred recently learned that she is Medicare under Part A and Allcare will continue to pay for any
suffering from inoperable cancer and has non-hospice services.
just a few months to live. She would like to
spend these final months in hospice care.
Mildred's family asks you whether hospice
benefits will be paid for under the Allcare
Medicare Advantage plan. What should you
say?
Mr. Schmidt would like to plan for Part A, which covers hospital, skilled nursing facility, hospice,
retirement and has asked you what is and home health services and Part B, which covers
covered under professional services such as those provided by a doctor are
Original Fee-for-Service (FFS) Medicare. covered under Original Medicare.
What could you tell him?
,Agent John Miller is meeting with Jerry Tell prospect Jerry Smith that he should consider adding a
Smith, a new prospect. Jerry is currently standalone Part D prescription drug coverage policy to his
enrolled in Medicare Parts A and B. Jerry has present coverage.
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?
Mr. Davis is 52 years old and has recently He may sign-up for Medicare at any time however coverage
been diagnosed with end-stage renal usually begins on the fourth month after dialysis
treatments disease (ESRD) and will soon begin dialysis. start.
He is wondering if he can obtain coverage
under Medicare. What should you tell him?
Mr. Diaz continued working with his Mr. Diaz will not pay any penalty because he had
continuous company and was insured under his coverage under his employer's plan.
employer's group plan until he reached age
68. 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?
Madeline Martinez was widowed several You should tell Madeline that she will be able to enroll in
years ago. Her husband worked for many Medicare Part A without paying monthly premiums due to her
years and contributed into the Medicare husband's long work record and participation in the Medicare
system. He also left a substantial estate system. You should also tell Madeline that she will pay Part B
which provides Madeline with an annual premiums at more than the standard lowest rate but less
than income of approximately $130,000. the highest rate due her substantial income.
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?
Edward IP suffered from serious kidney Individuals eligible for Medicare based on ESRD generally
disease. As a result. Edward became eligible lose eligibility 36 months after the month in
which the
for Medicare coverage due to end-stage individual receives a kidney transplant unless they are
eligible renal disease (ESRD). A close relative for Medicare on another basis such as age or
disability.
donated their kidney and Edward Edward may, however, remain enrolled in Part B but solely
for successfully underwent transplant surgery 12 coverage of immunosuppressive drugs if he has
no other months ago. Edward is now age 50 and asks health care coverage that would cover
the drugs.
you if his Medicare coverage will continue,
what should you say?
Mrs. Peňa is 66 years old, has coverage She may enroll at any time while she is covered under
her under an employer plan, and will retire next employer plan, but she will have a special
eight-month
year. She heard she must enroll in Part B at enrollment period after the last month on her employer plan
the beginning of the year to ensure no gap that differs from the standard general enrollment period,
in coverage. What can you tell her? during which she may enroll in Medicare Part B.
, Mr. Capadona would like to purchase a It is illegal for you to sell Mr. Capadona a Medigap plan if he is
Medicare Advantage (MA) plan and a enrolled in an MA plan, and besides, Medigap only works with
Medigap plan to pick up costs not covered Original Medicare.
by that plan. What should you tell him?
Ms. Henderson believes that she will qualify To obtain Part B coverage, she must pay a standard
monthly for Medicare Coverage when she turns 65, premium, though it is higher for individuals with
higher
without paying any premiums, because she incomes.
has been working for 40 years and paying
Medicare taxes. What should you tell her?
Mrs. Park is an elderly retiree. Mrs. Park hasShe should contact her state Medicaid agency to see if she
a low fixed income. What could you tell Mrs. qualifies for one of several programs that can
help with Park that might be of assistance? Medicare costs for which she is responsible.
Shirly Thomas was enrolled in Medicaid Shirley is eligible for a Special Enrollment Period (SEP) for up
during the Public Health Emergency (PHE). to six months after the termination of her Medicaid
coverage. This coverage has recently been terminated Under this SEP, Shirley can choose retroactive
coverage back due to the end of the PHE. While Shirley was to the date of termination from
Medicaid or coverage
enrolled in Medicaid, she missed an beginning the month after the month of
enrollment. opportunity to enroll in Medicare and now
wants Part B. Which of the following
statements best describes Shirley's ability to
now enroll in Medicare Part B?
Ms. Moore plans to retire when she turns 65Medicare is a program for people age 65 or older and
those in a few months. She is in excellent health under age 65 with certain disabilities, end-stage
renal disease, and will have considerable income when and Lou Gehrig's disease so she will be
eligible for Medicare. 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?
Mrs. Gonzalez is enrolled in Original Mrs. Gonzalez cannot purchase a Medigap plan that
covers Medicare and has a Medigap policy as well, drugs, but she could keep her Medigap policy and
enroll in a but it provides no drug coverage. She Part D prescription drug plan.
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. Chen will be 65 soon, has been a Most individuals who are citizens and age 65 or over are
citizen for twelve years, has been employed covered under Part A by virtue of having paid
Medicare taxes full time, and paid taxes during that entire while working, though some may be
covered as a result of period. She is concerned that she will not paying monthly premiums.
qualify for coverage under part A
because she was not born in the United
States. What should you tell her?
QUESTIONS WITH GOLDEN TIPS SOLUTIONS AND
REVEWEIRS
Students also studied
Flashcard sets Study guides
C
Terms in this set (106)
Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help in paying Part D costs
limited financial resources but failed to through his State Pharmaceutical Assistance Program.
qualify for the Part D low-income subsidy.
Where might he turn for help with
his prescription drug costs?
Mr. Bauer is 49 years old, but eighteen After receiving such disability payments for 24 months, he
months ago he was declared disabled will be automatically enrolled in Medicare, regardless of
by the Social Security Administration and age.
has been receiving disability payments.
He is wondering whether he can obtain
coverage under Medicare. What should
you tell him?
Mildred Savage enrolled in Allcare Mildred may remain enrolled in Allcare and make a hospice
Medicare Advantage plan several years ago. election. Hospice benefits will be paid for by Original
Mildred recently learned that she is Medicare under Part A and Allcare will continue to pay for any
suffering from inoperable cancer and has non-hospice services.
just a few months to live. She would like to
spend these final months in hospice care.
Mildred's family asks you whether hospice
benefits will be paid for under the Allcare
Medicare Advantage plan. What should you
say?
Mr. Schmidt would like to plan for Part A, which covers hospital, skilled nursing facility, hospice,
retirement and has asked you what is and home health services and Part B, which covers
covered under professional services such as those provided by a doctor are
Original Fee-for-Service (FFS) Medicare. covered under Original Medicare.
What could you tell him?
,Agent John Miller is meeting with Jerry Tell prospect Jerry Smith that he should consider adding a
Smith, a new prospect. Jerry is currently standalone Part D prescription drug coverage policy to his
enrolled in Medicare Parts A and B. Jerry has present coverage.
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?
Mr. Davis is 52 years old and has recently He may sign-up for Medicare at any time however coverage
been diagnosed with end-stage renal usually begins on the fourth month after dialysis
treatments disease (ESRD) and will soon begin dialysis. start.
He is wondering if he can obtain coverage
under Medicare. What should you tell him?
Mr. Diaz continued working with his Mr. Diaz will not pay any penalty because he had
continuous company and was insured under his coverage under his employer's plan.
employer's group plan until he reached age
68. 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?
Madeline Martinez was widowed several You should tell Madeline that she will be able to enroll in
years ago. Her husband worked for many Medicare Part A without paying monthly premiums due to her
years and contributed into the Medicare husband's long work record and participation in the Medicare
system. He also left a substantial estate system. You should also tell Madeline that she will pay Part B
which provides Madeline with an annual premiums at more than the standard lowest rate but less
than income of approximately $130,000. the highest rate due her substantial income.
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?
Edward IP suffered from serious kidney Individuals eligible for Medicare based on ESRD generally
disease. As a result. Edward became eligible lose eligibility 36 months after the month in
which the
for Medicare coverage due to end-stage individual receives a kidney transplant unless they are
eligible renal disease (ESRD). A close relative for Medicare on another basis such as age or
disability.
donated their kidney and Edward Edward may, however, remain enrolled in Part B but solely
for successfully underwent transplant surgery 12 coverage of immunosuppressive drugs if he has
no other months ago. Edward is now age 50 and asks health care coverage that would cover
the drugs.
you if his Medicare coverage will continue,
what should you say?
Mrs. Peňa is 66 years old, has coverage She may enroll at any time while she is covered under
her under an employer plan, and will retire next employer plan, but she will have a special
eight-month
year. She heard she must enroll in Part B at enrollment period after the last month on her employer plan
the beginning of the year to ensure no gap that differs from the standard general enrollment period,
in coverage. What can you tell her? during which she may enroll in Medicare Part B.
, Mr. Capadona would like to purchase a It is illegal for you to sell Mr. Capadona a Medigap plan if he is
Medicare Advantage (MA) plan and a enrolled in an MA plan, and besides, Medigap only works with
Medigap plan to pick up costs not covered Original Medicare.
by that plan. What should you tell him?
Ms. Henderson believes that she will qualify To obtain Part B coverage, she must pay a standard
monthly for Medicare Coverage when she turns 65, premium, though it is higher for individuals with
higher
without paying any premiums, because she incomes.
has been working for 40 years and paying
Medicare taxes. What should you tell her?
Mrs. Park is an elderly retiree. Mrs. Park hasShe should contact her state Medicaid agency to see if she
a low fixed income. What could you tell Mrs. qualifies for one of several programs that can
help with Park that might be of assistance? Medicare costs for which she is responsible.
Shirly Thomas was enrolled in Medicaid Shirley is eligible for a Special Enrollment Period (SEP) for up
during the Public Health Emergency (PHE). to six months after the termination of her Medicaid
coverage. This coverage has recently been terminated Under this SEP, Shirley can choose retroactive
coverage back due to the end of the PHE. While Shirley was to the date of termination from
Medicaid or coverage
enrolled in Medicaid, she missed an beginning the month after the month of
enrollment. opportunity to enroll in Medicare and now
wants Part B. Which of the following
statements best describes Shirley's ability to
now enroll in Medicare Part B?
Ms. Moore plans to retire when she turns 65Medicare is a program for people age 65 or older and
those in a few months. She is in excellent health under age 65 with certain disabilities, end-stage
renal disease, and will have considerable income when and Lou Gehrig's disease so she will be
eligible for Medicare. 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?
Mrs. Gonzalez is enrolled in Original Mrs. Gonzalez cannot purchase a Medigap plan that
covers Medicare and has a Medigap policy as well, drugs, but she could keep her Medigap policy and
enroll in a but it provides no drug coverage. She Part D prescription drug plan.
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. Chen will be 65 soon, has been a Most individuals who are citizens and age 65 or over are
citizen for twelve years, has been employed covered under Part A by virtue of having paid
Medicare taxes full time, and paid taxes during that entire while working, though some may be
covered as a result of period. She is concerned that she will not paying monthly premiums.
qualify for coverage under part A
because she was not born in the United
States. What should you tell her?
