AHIP 2024 Final Exam – Advanced TestBank
NB: 90% OF THESE QUESTIONS WERE PRESENT IN THE RECENT AHIP EXAMS. EACH
QUESTION AND ANSWERS ARE ANSWERED BY VERIFIED TUTORS
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance?
- ANSWER - She should contact her state Medicaid agency to see if she qualifies forprograms that can
help with Medicare costs for which she is responsible.
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?
- ANSWER - 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.
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
- ANSWER - After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
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? –
ANSWER - 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.
pg. 1
,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? -
ANSWER - 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.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare
Parts A 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?
- ANSWER - Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
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? -
ANSWER - The penalty will be a permanent 10% increase in his Part B premium for every 12-month
period that passed during which he could have enrolled and did not.
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? –
ANSWER - Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
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?
- ANSWER - 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.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to
do. What should you tell him? - ANSWER - He may receive health care services from any doctor allowed
pg. 2
,to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to
accept the PFFS plan's payment terms and conditions, which could include balance billing.
Mr. Kelly 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? –
ANSWER - You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS
plan's service area.
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the
benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could
you tell her? –
ANSWER - Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer
such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on Part A and
Part B services.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Castillo 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? –
ANSWER - He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mr. Barker 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? –
ANSWER - You can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in
a 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. Chi? –
ANSWER - Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
pg. 3
, Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
go to for her health care. What should you tell her? –
ANSWER - Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but
generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO
network.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? –
ANSWER - Medicare Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago
but is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and
contributed to the Medicare system. Juan 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? –
ANSWER - Juan is eligible to enroll in a Medicare Advantage as long as he is entitled to Part A and
enrolled in Part B. Juan 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. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the
Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to
purchase extra coverage that he will not need. What should you tell him? –
ANSWER - He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the
program in order to avoid a premium penalty. To reduce his expenses, he should look for a plan with a
zero premium.
Mr. Schultz was still working when he first qualified for Medicare. At that time, he had employer group
coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because
he was satisfied with his drug coverage. It is now a year later and Mr. Schultz has lost his employer group
coverage within the last two weeks. How would you advise him? –
ANSWER - Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to
avoid a premium penalty.
Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to
fill out the paperwork. What could you tell her? - ANSWER - The Part D low income subsidy could
pg. 4
NB: 90% OF THESE QUESTIONS WERE PRESENT IN THE RECENT AHIP EXAMS. EACH
QUESTION AND ANSWERS ARE ANSWERED BY VERIFIED TUTORS
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance?
- ANSWER - She should contact her state Medicaid agency to see if she qualifies forprograms that can
help with Medicare costs for which she is responsible.
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?
- ANSWER - 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.
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
- ANSWER - After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
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? –
ANSWER - 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.
pg. 1
,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? -
ANSWER - 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.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare
Parts A 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?
- ANSWER - Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
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? -
ANSWER - The penalty will be a permanent 10% increase in his Part B premium for every 12-month
period that passed during which he could have enrolled and did not.
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? –
ANSWER - Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
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?
- ANSWER - 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.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to
do. What should you tell him? - ANSWER - He may receive health care services from any doctor allowed
pg. 2
,to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to
accept the PFFS plan's payment terms and conditions, which could include balance billing.
Mr. Kelly 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? –
ANSWER - You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS
plan's service area.
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the
benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could
you tell her? –
ANSWER - Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer
such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on Part A and
Part B services.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Castillo 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? –
ANSWER - He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mr. Barker 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? –
ANSWER - You can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in
a 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. Chi? –
ANSWER - Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
pg. 3
, Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
go to for her health care. What should you tell her? –
ANSWER - Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but
generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO
network.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? –
ANSWER - Medicare Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago
but is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and
contributed to the Medicare system. Juan 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? –
ANSWER - Juan is eligible to enroll in a Medicare Advantage as long as he is entitled to Part A and
enrolled in Part B. Juan 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. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the
Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to
purchase extra coverage that he will not need. What should you tell him? –
ANSWER - He will need to enroll in a Medicare prescription drug plan upon becoming eligible for the
program in order to avoid a premium penalty. To reduce his expenses, he should look for a plan with a
zero premium.
Mr. Schultz was still working when he first qualified for Medicare. At that time, he had employer group
coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because
he was satisfied with his drug coverage. It is now a year later and Mr. Schultz has lost his employer group
coverage within the last two weeks. How would you advise him? –
ANSWER - Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to
avoid a premium penalty.
Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to
fill out the paperwork. What could you tell her? - ANSWER - The Part D low income subsidy could
pg. 4
