AHIP 2023 Final Exam Test Questions and Answers
(Verified Answers)
1. 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
afterdialysis treatments start.
2. Juan Perez, who is turning age 65 next month, intends to work for several
more years at Smallcap, Incorporated. Smallcap has a workforce of15 employ-
ees 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
Juanis likely to be eligible for Medicare once he turns age 65 and if he enrolls
Medicarewould become the primary payor of his healthcare claims and Smallcap
does not have to continue to offer him coverage comparable to those under age 65
under itsemployer-sponsored group health plan.
3. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
,stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell Mr.
Moy ANS Medicare Supplemental Insurance would help cover his Part A and Part
B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well
as possibly some services that Medicare does not cover.
4. Mrs. PeHa is 66 years old, has coverage under an employer plan, and will retir
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 ANS 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.
5. 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 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.
6. Mrs. Gonzalez 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 ANS Mrs. Gonzalez cannot purchase a
Medigap
, plan that covers drugs, but she could keep her Medigap policy and enroll in a Part
D prescription drug plan.
7. Mrs. West wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through massage therapy. She is concerned about whether
or not Medicare will cover these items and services. What should you tell
her ANS Medicare does not cover massage therapy, or, in general, glasses or
dentures.
8. Mr. Patel is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he
might be exposed to under Medicare if he were to require hospitalization as a
result of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services
under Original Medicare ANS Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient hospital stay, after
which it convertsinto a per-day coinsurance amount through day 90. After day 90,
he would pay a daily amount up to 60 days over his lifetime, after which he would
be responsible forall costs.
9. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 years and paying Medicare taxes. What should you tell her ANS To
obtain Part B coverage, she must pay a standard monthly premium, though it is
higher forindividuals with higher incomes.
(Verified Answers)
1. 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
afterdialysis treatments start.
2. Juan Perez, who is turning age 65 next month, intends to work for several
more years at Smallcap, Incorporated. Smallcap has a workforce of15 employ-
ees 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
Juanis likely to be eligible for Medicare once he turns age 65 and if he enrolls
Medicarewould become the primary payor of his healthcare claims and Smallcap
does not have to continue to offer him coverage comparable to those under age 65
under itsemployer-sponsored group health plan.
3. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
,stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell Mr.
Moy ANS Medicare Supplemental Insurance would help cover his Part A and Part
B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well
as possibly some services that Medicare does not cover.
4. Mrs. PeHa is 66 years old, has coverage under an employer plan, and will retir
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 ANS 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.
5. 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 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.
6. Mrs. Gonzalez 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 ANS Mrs. Gonzalez cannot purchase a
Medigap
, plan that covers drugs, but she could keep her Medigap policy and enroll in a Part
D prescription drug plan.
7. Mrs. West wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through massage therapy. She is concerned about whether
or not Medicare will cover these items and services. What should you tell
her ANS Medicare does not cover massage therapy, or, in general, glasses or
dentures.
8. Mr. Patel is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he
might be exposed to under Medicare if he were to require hospitalization as a
result of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services
under Original Medicare ANS Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient hospital stay, after
which it convertsinto a per-day coinsurance amount through day 90. After day 90,
he would pay a daily amount up to 60 days over his lifetime, after which he would
be responsible forall costs.
9. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 years and paying Medicare taxes. What should you tell her ANS To
obtain Part B coverage, she must pay a standard monthly premium, though it is
higher forindividuals with higher incomes.
