AHIP Final Exam - Modules 1-5
Mr. Capadona would like to purchase a Medicare It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
Advantage (MA) plan and a Medigap plan to pick up plan, and besides, Medigap only works with Original Medicare.
costs not covered by that plan. What should you tell him?
Agent John Miller is meeting with Jerry Smith, a new Tell prospect Jerry Smith that he should consider adding a standalone Part D
prospect. Jerry is currently enrolled in Medicare Parts A prescription drug coverage policy to his present coverage.
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?
Mr. Wu is eligible for Medicare. He has limited financial Mr. Wu may still qualify for help in paying Part D costs through his State
resources but failed to qualify for the Part D low-income Pharmaceutical Assistance Program (SPAP).
subsidy. Where might he turn for help with his
prescription drug costs?
Mr. Vasquez is in good health and is preparing a budget Under Original Medicare, there is a single deductible amount due for the first 60
in anticipation of his retirement when he turns 66. He days of any inpatient hospital stay, after which it converts into a per-day
wants to understand the health care costs he might be coinsurance amount through day 90. After day 90, he would pay a daily amount
exposed to under Medicare if he were to require up to 60 days over his lifetime, after which he would be responsible for all costs.
hospitalization because of an illness. In general terms,
what could you tell him about his costs for inpatient
hospital services under Original Medicare?
Mr. Moy will soon turn age 65. He is slightly younger than Medicare Supplemental Insurance would help cover his Part A deductible and
his wife. Mr. Moy's wife has a Medicare Advantage plan, Part B coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as
but he wants to understand what coverage Medicare well as possibly some services that Medicare does not cover.
Supplemental Insurance provides since his health care
needs are different from his wife's needs. What could
you tell Mr. Moy?
Juan Perez, who is turning age 65 next month, intends to Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
work for several more years at Smallcap, Incorporated. Medicare would become the primary payor of his healthcare claims and
Smallcap has a workforce of 15 employees and offers Smallcap does not have to continue to offer him coverage comparable to those
employer-sponsored healthcare coverage. Juan is a under age 65 under its employer-sponsored group health plan. Juan is likely to
naturalized citizen and has contributed to the Medicare be eligible for Medicare once he turns age 65 and if he enrolls, Medicare would
system for over 20 years. Juan asks you if he will be become the primary payor of his healthcare claims but Smallcap must continue
entitled to Medicare and if he enrolls how that will impact to offer him coverage under its employer-sponsored group health plan and would
his employer- sponsored healthcare coverage. How become a secondary payor.
would you respond?
Ms. Kumar plans to retire when she turns 65 in a few Medicare is a program for people age 65 or older and those under age 65 with
months. She is in excellent health and will have certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will
considerable income when she retires. She is concerned be eligible for Medicare.
that her income will make it impossible for her to qualify
for Medicare. What could you tell her to address her
concern?
Mrs. Ellis recently turned 66 and decided after many Part B primarily covers physician services. She will be paying a monthly premium
years of work to retire and begin receiving Social and, except for many preventive and screening tests, generally will have 20% co-
Security benefits. Shortly thereafter Mrs. Ellis received a payments for these services, in addition to an annual deductible.
letter informing her that she had been automatically
enrolled in Medicare Part B. She wants to understand
what this means. What should you tell Mrs. Ellis?
Mr. Singh would like drug coverage but does not want to Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
be enrolled in a Medicare Advantage plan. What should covered for Part A and Part B services through Original Fee-for-Service
you tell him? Medicare.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed She should contact her state Medicaid agency to see if she qualifies for one of
income. What could you tell Mrs. Cook that might be of several programs that can help with Medicare costs for which she is responsible.
assistance?
Ms. Henderson believes that she will qualify for Medicare To obtain Part B coverage, she must pay a standard monthly premium, though it
Coverage when she turns 65, without paying any is higher for individuals with higher incomes.
premiums, because she has been working for 40 years
and paying Medicare taxes. What should you tell her?
, AHIP Final Exam - Modules 1-5
Mr. Bauer is 49 years old, but eighteen months ago he After receiving such disability payments for 24 months, he will be automatically
was declared disabled by the Social Security enrolled in Medicare, regardless of age.
Administration and has been receiving disability
payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him?
Mr. Schmidt would like to plan for retirement and has Part A, which covers hospital, skilled nursing facility, hospice, and home health
asked you what is covered under Original Fee-for- services and Part B, which covers professional services such as those provided
Service (FFS) Medicare. What could you tell him? by a doctor are covered under Original Medicare.
Anthony Boniface turned 65 in 2024. He was not Anthony is eligible for a special enrollment period (SEP) because he missed an
receiving Social Security or Railroad Retirement Benefits enrollment period due to the impact of the Federally declared disaster. This SEP
on his 65th birthday. He was interested in obtaining will allow Anthony to enroll in Part B up to six months after the end of the
Medicare coverage and is eligible for premium-free Part emergency declaration. Anthony may enroll in premium-free Part A at any time
A. Before he could enroll in Medicare, his entire area and his Part A coverage will be retroactive for up to 6 months.
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?
Ms. Lewis has aggressive cancer and would like to know Medicare covers hospice services, and they will be available for her.
if Medicare will cover hospice services in case she needs
them. What should you tell her?
Edward suffered from serious kidney disease. As a Individuals eligible for Medicare based on ESRD generally lose eligibility 36
result, Edward became eligible for Medicare coverage months after the month in which the individual receives a kidney transplant
due to end-stage renal disease (ESRD). A close relative unless they are eligible for Medicare on another basis such as age or disability.
donated their kidney and Edward successfully underwent Edward may, however, remain enrolled in Part B but solely for coverage of
transplant surgery 12 months ago. Edward is now age 50 immunosuppressive drugs if he has no other health care coverage that would
and asks you if his Medicare coverage will continue, cover the drugs.
what should you say?
Mrs. Foster is covered by Original Medicare. She Medicare will cover Mrs. Foster's skilled nursing services provided during the first
sustained a hip fracture and is being successfully treated 20 days of her stay, after which she would have a copay until she has been in the
for that condition. However, she and her physicians feel facility for 100 days.
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?
Madeline Martinez was widowed several years ago. Her You should tell Madeline that she will be able to enroll in Medicare Part A without
husband worked for many years and contributed into the paying monthly premiums due to her husband's long work record and
Medicare system. He also left a substantial estate which participation in the Medicare system. You should also tell Madeline that she will
provides Madeline with an annual income of pay Part B premiums at more than the standard lowest rate but less than the
approximately $130,000. Madeline, who has only worked highest rate due her substantial income.
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?
Mrs. Thomas is 66 years old, has coverage under an She may enroll at any time while she is covered under her employer plan, but
employer plan, and will retire next year. She heard she she will have a special eight-month enrollment period after the last month on her
must enroll in Part B at the beginning of the year to employer plan that differs from the standard general enrollment period, during
ensure no gap in coverage. What can you tell her? which she may enroll in Medicare Part B.
Mildred Savage enrolled in Allcare Medicare Advantage Mildred may remain enrolled in Allcare and make a hospice election. Hospice
plan several years ago. Mildred recently learned that she benefits will be paid for by Original Medicare under Part A and Allcare will
is suffering from inoperable cancer and has just a few continue to pay for any non-hospice services.
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. Capadona would like to purchase a Medicare It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
Advantage (MA) plan and a Medigap plan to pick up plan, and besides, Medigap only works with Original Medicare.
costs not covered by that plan. What should you tell him?
Agent John Miller is meeting with Jerry Smith, a new Tell prospect Jerry Smith that he should consider adding a standalone Part D
prospect. Jerry is currently enrolled in Medicare Parts A prescription drug coverage policy to his present coverage.
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?
Mr. Wu is eligible for Medicare. He has limited financial Mr. Wu may still qualify for help in paying Part D costs through his State
resources but failed to qualify for the Part D low-income Pharmaceutical Assistance Program (SPAP).
subsidy. Where might he turn for help with his
prescription drug costs?
Mr. Vasquez is in good health and is preparing a budget Under Original Medicare, there is a single deductible amount due for the first 60
in anticipation of his retirement when he turns 66. He days of any inpatient hospital stay, after which it converts into a per-day
wants to understand the health care costs he might be coinsurance amount through day 90. After day 90, he would pay a daily amount
exposed to under Medicare if he were to require up to 60 days over his lifetime, after which he would be responsible for all costs.
hospitalization because of an illness. In general terms,
what could you tell him about his costs for inpatient
hospital services under Original Medicare?
Mr. Moy will soon turn age 65. He is slightly younger than Medicare Supplemental Insurance would help cover his Part A deductible and
his wife. Mr. Moy's wife has a Medicare Advantage plan, Part B coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as
but he wants to understand what coverage Medicare well as possibly some services that Medicare does not cover.
Supplemental Insurance provides since his health care
needs are different from his wife's needs. What could
you tell Mr. Moy?
Juan Perez, who is turning age 65 next month, intends to Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
work for several more years at Smallcap, Incorporated. Medicare would become the primary payor of his healthcare claims and
Smallcap has a workforce of 15 employees and offers Smallcap does not have to continue to offer him coverage comparable to those
employer-sponsored healthcare coverage. Juan is a under age 65 under its employer-sponsored group health plan. Juan is likely to
naturalized citizen and has contributed to the Medicare be eligible for Medicare once he turns age 65 and if he enrolls, Medicare would
system for over 20 years. Juan asks you if he will be become the primary payor of his healthcare claims but Smallcap must continue
entitled to Medicare and if he enrolls how that will impact to offer him coverage under its employer-sponsored group health plan and would
his employer- sponsored healthcare coverage. How become a secondary payor.
would you respond?
Ms. Kumar plans to retire when she turns 65 in a few Medicare is a program for people age 65 or older and those under age 65 with
months. She is in excellent health and will have certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will
considerable income when she retires. She is concerned be eligible for Medicare.
that her income will make it impossible for her to qualify
for Medicare. What could you tell her to address her
concern?
Mrs. Ellis recently turned 66 and decided after many Part B primarily covers physician services. She will be paying a monthly premium
years of work to retire and begin receiving Social and, except for many preventive and screening tests, generally will have 20% co-
Security benefits. Shortly thereafter Mrs. Ellis received a payments for these services, in addition to an annual deductible.
letter informing her that she had been automatically
enrolled in Medicare Part B. She wants to understand
what this means. What should you tell Mrs. Ellis?
Mr. Singh would like drug coverage but does not want to Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
be enrolled in a Medicare Advantage plan. What should covered for Part A and Part B services through Original Fee-for-Service
you tell him? Medicare.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed She should contact her state Medicaid agency to see if she qualifies for one of
income. What could you tell Mrs. Cook that might be of several programs that can help with Medicare costs for which she is responsible.
assistance?
Ms. Henderson believes that she will qualify for Medicare To obtain Part B coverage, she must pay a standard monthly premium, though it
Coverage when she turns 65, without paying any is higher for individuals with higher incomes.
premiums, because she has been working for 40 years
and paying Medicare taxes. What should you tell her?
, AHIP Final Exam - Modules 1-5
Mr. Bauer is 49 years old, but eighteen months ago he After receiving such disability payments for 24 months, he will be automatically
was declared disabled by the Social Security enrolled in Medicare, regardless of age.
Administration and has been receiving disability
payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him?
Mr. Schmidt would like to plan for retirement and has Part A, which covers hospital, skilled nursing facility, hospice, and home health
asked you what is covered under Original Fee-for- services and Part B, which covers professional services such as those provided
Service (FFS) Medicare. What could you tell him? by a doctor are covered under Original Medicare.
Anthony Boniface turned 65 in 2024. He was not Anthony is eligible for a special enrollment period (SEP) because he missed an
receiving Social Security or Railroad Retirement Benefits enrollment period due to the impact of the Federally declared disaster. This SEP
on his 65th birthday. He was interested in obtaining will allow Anthony to enroll in Part B up to six months after the end of the
Medicare coverage and is eligible for premium-free Part emergency declaration. Anthony may enroll in premium-free Part A at any time
A. Before he could enroll in Medicare, his entire area and his Part A coverage will be retroactive for up to 6 months.
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?
Ms. Lewis has aggressive cancer and would like to know Medicare covers hospice services, and they will be available for her.
if Medicare will cover hospice services in case she needs
them. What should you tell her?
Edward suffered from serious kidney disease. As a Individuals eligible for Medicare based on ESRD generally lose eligibility 36
result, Edward became eligible for Medicare coverage months after the month in which the individual receives a kidney transplant
due to end-stage renal disease (ESRD). A close relative unless they are eligible for Medicare on another basis such as age or disability.
donated their kidney and Edward successfully underwent Edward may, however, remain enrolled in Part B but solely for coverage of
transplant surgery 12 months ago. Edward is now age 50 immunosuppressive drugs if he has no other health care coverage that would
and asks you if his Medicare coverage will continue, cover the drugs.
what should you say?
Mrs. Foster is covered by Original Medicare. She Medicare will cover Mrs. Foster's skilled nursing services provided during the first
sustained a hip fracture and is being successfully treated 20 days of her stay, after which she would have a copay until she has been in the
for that condition. However, she and her physicians feel facility for 100 days.
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?
Madeline Martinez was widowed several years ago. Her You should tell Madeline that she will be able to enroll in Medicare Part A without
husband worked for many years and contributed into the paying monthly premiums due to her husband's long work record and
Medicare system. He also left a substantial estate which participation in the Medicare system. You should also tell Madeline that she will
provides Madeline with an annual income of pay Part B premiums at more than the standard lowest rate but less than the
approximately $130,000. Madeline, who has only worked highest rate due her substantial income.
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?
Mrs. Thomas is 66 years old, has coverage under an She may enroll at any time while she is covered under her employer plan, but
employer plan, and will retire next year. She heard she she will have a special eight-month enrollment period after the last month on her
must enroll in Part B at the beginning of the year to employer plan that differs from the standard general enrollment period, during
ensure no gap in coverage. What can you tell her? which she may enroll in Medicare Part B.
Mildred Savage enrolled in Allcare Medicare Advantage Mildred may remain enrolled in Allcare and make a hospice election. Hospice
plan several years ago. Mildred recently learned that she benefits will be paid for by Original Medicare under Part A and Allcare will
is suffering from inoperable cancer and has just a few continue to pay for any non-hospice services.
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?
