AHIP 2024 Final Exam Latest Questions and
Answers
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health
and will have considerable income when 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? - ANSWERS Medicare is a program for people age 65 or older and those
under age 65 with certain disabilities, end stage renal disease or Lou Gehrig's disease,
so she will be eligible for Medicare
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - ANSWERS Part A,
which covers hospital, skilled nursing facility, hospice and home health services and
Part B, which covers professional services such as those provided by a doctor are
covered under Original Medicare.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the
health plan may, at some time in the future, reduce his benefits below what is available
in Original Medicare. What should you tell him about his concern? - ANSWERS
Medicare health plans must cover all benefits available under Medicare Part A and Part
B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
weeks. She concerned about having prescription drug coverage. Which of the following
statements provides the best advice? - ANSWERS Prescription drug coverage can be
obtained by enrolling in a Medicare Advantage plan that includes Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefit package of a Medicare Health Plan before she starts looking at
specific plans. What could you tell her? - ANSWERS Medicare Health Plans may offer
extra benefits that Original Medicare does not offer such as vision, hearing, and dental
services and must include a maximum out-of-pocket limit on Part A and Part B services.
Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr.Meoni? - ANSWERS Medicare
Supplemental Insurance would help cover his Part A and Part B cost sharing in Original
Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does
not cover.
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? - ANSWERS Most individuals who are citizens and over age 65 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.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him? -
ANSWERS After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
Mr. Davis is 49 years old and has been receiving disability benefits from the Social
Security Administration for 12 months. Can you sell him a Medicare Advantage or Part
D Prescription Drug policy? - ANSWERS No, he cannot purchase a Medicare
Advantage or Part D policy because he has not received Social Security or Railroad
Retirement disability benefits for 24 months.
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? - ANSWERS In order to obtain Part B
coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes.
Mr. Diaz continued working with his company and was insured under his 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? - ANSWERS Mr. Diaz will not pay any
penalty because he had continuous coverage under his employer's plan.
Mrs. Peňa 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? - ANSWERS She may enroll at any time while she
is covered under her employer plan, but she will have a special eight-month enrollment
period that differs from the standard general enrollment period, during which she may
enroll in Medicare Part B.
Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering
enrollment in a Medicare health plan. What should you advise her to do before she will
be able to enroll into a Medicare health plan? - ANSWERS In order to join a Medicare
health plan, she also must enroll in Part B.
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance?
- ANSWERS She should contact her state Medicaid agency to see if she qualifies for
one of several programs that can help with Medicare costs for which she is responsible.
, Mr. Yu has limited income and resources so you have encouraged him to see if he
qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble
to apply and wants to know what the assistance could do for him if he qualifies. What
could you tell him? - ANSWERS He might qualify for help with Part D prescription drug
costs and help paying Part A and/or Part B premiums, deductibles, and/or cost sharing.
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? - ANSWERS Under Original Medicare, there is a single deductible
amount due for the first 60 days of any inpatient hospital stay, after which it converts
into a per-day 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 for all costs
Mrs. Shields 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? - ANSWERS Medicare will cover Mrs. Schmidt's skilled nursing services
provided during the first 20 days of her stay, after which she would have a coinsurance
until she has been in the facility for 100 days
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should
be hospitalized. What should you tell Mr. Rainey (or his representative) about the length
of an inpatient psychiatric hospital stay that Medicare will cover? - ANSWERS Medicare
will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire
lifetime.
Mrs. Quinn has just turned 65 and received a letter informing her that she has been
automatically enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Quinn? - ANSWERS Part B primarily covers physician
services. She will be paying a monthly premium and, with the exception of many
preventive and screening tests, generally will have 20% co-payments for these services,
in addition to an annual deductible.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - ANSWERS
Medicare covers periodic performance of a range of screening tests that are meant to
provide early detection of disease. Mr. Buck will need to check specific tests before
obtaining them to see if they will be covered.
Mrs. Turner 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? - ANSWERS Original Medicare
covers ambulance services.
Answers
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health
and will have considerable income when 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? - ANSWERS Medicare is a program for people age 65 or older and those
under age 65 with certain disabilities, end stage renal disease or Lou Gehrig's disease,
so she will be eligible for Medicare
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - ANSWERS Part A,
which covers hospital, skilled nursing facility, hospice and home health services and
Part B, which covers professional services such as those provided by a doctor are
covered under Original Medicare.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the
health plan may, at some time in the future, reduce his benefits below what is available
in Original Medicare. What should you tell him about his concern? - ANSWERS
Medicare health plans must cover all benefits available under Medicare Part A and Part
B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
weeks. She concerned about having prescription drug coverage. Which of the following
statements provides the best advice? - ANSWERS Prescription drug coverage can be
obtained by enrolling in a Medicare Advantage plan that includes Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefit package of a Medicare Health Plan before she starts looking at
specific plans. What could you tell her? - ANSWERS Medicare Health Plans may offer
extra benefits that Original Medicare does not offer such as vision, hearing, and dental
services and must include a maximum out-of-pocket limit on Part A and Part B services.
Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr.Meoni? - ANSWERS Medicare
Supplemental Insurance would help cover his Part A and Part B cost sharing in Original
Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does
not cover.
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? - ANSWERS Most individuals who are citizens and over age 65 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.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him? -
ANSWERS After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
Mr. Davis is 49 years old and has been receiving disability benefits from the Social
Security Administration for 12 months. Can you sell him a Medicare Advantage or Part
D Prescription Drug policy? - ANSWERS No, he cannot purchase a Medicare
Advantage or Part D policy because he has not received Social Security or Railroad
Retirement disability benefits for 24 months.
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? - ANSWERS In order to obtain Part B
coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes.
Mr. Diaz continued working with his company and was insured under his 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? - ANSWERS Mr. Diaz will not pay any
penalty because he had continuous coverage under his employer's plan.
Mrs. Peňa 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? - ANSWERS She may enroll at any time while she
is covered under her employer plan, but she will have a special eight-month enrollment
period that differs from the standard general enrollment period, during which she may
enroll in Medicare Part B.
Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering
enrollment in a Medicare health plan. What should you advise her to do before she will
be able to enroll into a Medicare health plan? - ANSWERS In order to join a Medicare
health plan, she also must enroll in Part B.
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance?
- ANSWERS She should contact her state Medicaid agency to see if she qualifies for
one of several programs that can help with Medicare costs for which she is responsible.
, Mr. Yu has limited income and resources so you have encouraged him to see if he
qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble
to apply and wants to know what the assistance could do for him if he qualifies. What
could you tell him? - ANSWERS He might qualify for help with Part D prescription drug
costs and help paying Part A and/or Part B premiums, deductibles, and/or cost sharing.
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? - ANSWERS Under Original Medicare, there is a single deductible
amount due for the first 60 days of any inpatient hospital stay, after which it converts
into a per-day 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 for all costs
Mrs. Shields 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? - ANSWERS Medicare will cover Mrs. Schmidt's skilled nursing services
provided during the first 20 days of her stay, after which she would have a coinsurance
until she has been in the facility for 100 days
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should
be hospitalized. What should you tell Mr. Rainey (or his representative) about the length
of an inpatient psychiatric hospital stay that Medicare will cover? - ANSWERS Medicare
will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire
lifetime.
Mrs. Quinn has just turned 65 and received a letter informing her that she has been
automatically enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Quinn? - ANSWERS Part B primarily covers physician
services. She will be paying a monthly premium and, with the exception of many
preventive and screening tests, generally will have 20% co-payments for these services,
in addition to an annual deductible.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - ANSWERS
Medicare covers periodic performance of a range of screening tests that are meant to
provide early detection of disease. Mr. Buck will need to check specific tests before
obtaining them to see if they will be covered.
Mrs. Turner 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? - ANSWERS Original Medicare
covers ambulance services.
