AHIP UPDATED SET QUESTIONS AND ANSWERS
SET A+
✔✔Anthony Boniface turned 65 in 2024. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll in
Medicare, his entire area was impacted by a hurricane causing massive flooding and
severe wind damage. The Federal government declared this to be a natural disaster
which has recently ended. During this period Anthony's initial enrollment period expired.
Anthony asks you how he can now obtain Medicare coverage. What should you say? -
✔✔Anthony is eligible for a special enrollment period (SEP) because he missed an
enrollment period due to the impact of the Federally declared disaster. This SEP will
allow Anthony to enroll in Part B up to six months after the end of the emergency
declaration. Anthony may enroll in premium-free Part A at any time and his Part A
coverage will be retroactive for up to 6 months.
✔✔Ms. Lewis has aggressive cancer and would like to know if Medicare will cover
hospice services in case she needs them. What should you tell her? - ✔✔Medicare
covers hospice services, and they will be available for her.
✔✔Edward suffered from serious kidney disease. As a result, Edward became eligible
for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12 months ago.
Edward is now age 50 and asks you if his Medicare coverage will continue, what should
you say? - ✔✔Individuals eligible for Medicare based on ESRD generally lose eligibility
36 months after the month in which the individual receives a kidney transplant unless
they are eligible for Medicare on another basis such as age or disability. Edward may,
however, remain enrolled in Part B but solely for coverage of immunosuppressive drugs
if he has no other health care coverage that would cover the drugs.
✔✔Mrs. Foster 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? - ✔✔Medicare will cover Mrs. Foster'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.
✔✔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? -
✔✔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.
✔✔Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire
next year. She heard she must enroll in Part B at the beginning of the year to ensure no
gap in coverage. What can you tell her? - ✔✔She may enroll at any time while she is
covered under her employer plan, but she will have a special eight-month enrollment
period after the last month on her employer plan that differs from the standard general
enrollment period, during which she may enroll in Medicare Part B.
✔✔Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has 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? - ✔✔Mildred may remain enrolled in Allcare and
make a hospice election. Hospice benefits will be paid for by Original Medicare under
Part A and Allcare will continue to pay for any non-hospice services.
✔✔Which of the following statement(s) is/are correct about a Medicare Savings Account
(MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible
of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full. - ✔✔I, II, and IV only
✔✔Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Arias is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
, What should you tell him? - ✔✔He is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B.
✔✔Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income level.
She wishes to enroll in an MA MSA plan that she heard about from her neighbor. She
also wants to have prescription drug coverage since her doctor recently prescribed
several expensive medications. Currently, she is enrolled in Original Medicare and a
standalone Part D plan. How would you advise Mrs. Lester? - ✔✔Mrs. Lester may enroll
in an MA MSA plan and remain in her current standalone Part D prescription drug plan.
✔✔Herber Noble is turning 65 next month, Herber legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Herber has
worked at Smallcap Incorporated and contributed to the Medicare system. Herber
suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare
Advantage plan that you represent. How would you respond? - ✔✔Herber is eligible to
enroll in Medicare Advantage as long as he is entitled to Part A and enrolled in Part B.
Herber should go to the Social Security website to enroll in Medicare Part A and B if he
has not done so already. Once he is enrolled, he can choose a Medicare Advantage
plan.
✔✔Mr. Bryant enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - ✔✔You can offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
✔✔Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special Needs
Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing
amounts and Mr. Dalton would like to join that plan. What should you tell him? -
✔✔SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
✔✔Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - ✔✔In most Medicare Advantage
HMOs, Mr. Kumar must generally obtain his services only from providers within the
plan's network (except in an emergency or where care is unavailable within the
network).
✔✔Mr. Anderson wants to know whether he is eligible to sign up for a Private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his eligibility?
SET A+
✔✔Anthony Boniface turned 65 in 2024. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll in
Medicare, his entire area was impacted by a hurricane causing massive flooding and
severe wind damage. The Federal government declared this to be a natural disaster
which has recently ended. During this period Anthony's initial enrollment period expired.
Anthony asks you how he can now obtain Medicare coverage. What should you say? -
✔✔Anthony is eligible for a special enrollment period (SEP) because he missed an
enrollment period due to the impact of the Federally declared disaster. This SEP will
allow Anthony to enroll in Part B up to six months after the end of the emergency
declaration. Anthony may enroll in premium-free Part A at any time and his Part A
coverage will be retroactive for up to 6 months.
✔✔Ms. Lewis has aggressive cancer and would like to know if Medicare will cover
hospice services in case she needs them. What should you tell her? - ✔✔Medicare
covers hospice services, and they will be available for her.
✔✔Edward suffered from serious kidney disease. As a result, Edward became eligible
for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12 months ago.
Edward is now age 50 and asks you if his Medicare coverage will continue, what should
you say? - ✔✔Individuals eligible for Medicare based on ESRD generally lose eligibility
36 months after the month in which the individual receives a kidney transplant unless
they are eligible for Medicare on another basis such as age or disability. Edward may,
however, remain enrolled in Part B but solely for coverage of immunosuppressive drugs
if he has no other health care coverage that would cover the drugs.
✔✔Mrs. Foster 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? - ✔✔Medicare will cover Mrs. Foster'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.
✔✔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? -
✔✔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.
✔✔Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire
next year. She heard she must enroll in Part B at the beginning of the year to ensure no
gap in coverage. What can you tell her? - ✔✔She may enroll at any time while she is
covered under her employer plan, but she will have a special eight-month enrollment
period after the last month on her employer plan that differs from the standard general
enrollment period, during which she may enroll in Medicare Part B.
✔✔Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has 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? - ✔✔Mildred may remain enrolled in Allcare and
make a hospice election. Hospice benefits will be paid for by Original Medicare under
Part A and Allcare will continue to pay for any non-hospice services.
✔✔Which of the following statement(s) is/are correct about a Medicare Savings Account
(MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible
of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full. - ✔✔I, II, and IV only
✔✔Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Arias is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
, What should you tell him? - ✔✔He is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B.
✔✔Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income level.
She wishes to enroll in an MA MSA plan that she heard about from her neighbor. She
also wants to have prescription drug coverage since her doctor recently prescribed
several expensive medications. Currently, she is enrolled in Original Medicare and a
standalone Part D plan. How would you advise Mrs. Lester? - ✔✔Mrs. Lester may enroll
in an MA MSA plan and remain in her current standalone Part D prescription drug plan.
✔✔Herber Noble is turning 65 next month, Herber legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Herber has
worked at Smallcap Incorporated and contributed to the Medicare system. Herber
suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare
Advantage plan that you represent. How would you respond? - ✔✔Herber is eligible to
enroll in Medicare Advantage as long as he is entitled to Part A and enrolled in Part B.
Herber should go to the Social Security website to enroll in Medicare Part A and B if he
has not done so already. Once he is enrolled, he can choose a Medicare Advantage
plan.
✔✔Mr. Bryant enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - ✔✔You can offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
✔✔Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special Needs
Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing
amounts and Mr. Dalton would like to join that plan. What should you tell him? -
✔✔SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
✔✔Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - ✔✔In most Medicare Advantage
HMOs, Mr. Kumar must generally obtain his services only from providers within the
plan's network (except in an emergency or where care is unavailable within the
network).
✔✔Mr. Anderson wants to know whether he is eligible to sign up for a Private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his eligibility?
