2023 AHIP Exam With Correct Solutions
Davis vis v52 vyears vold vand vhas vrecently vbeen vdiagnosed vwith vend-stage vrenal vdisease
v(ESRD) vand v will vsoon vbegin vdialysis. vHe v is v wondering v if vhe vcan vobtain vcoverage vunder
vMedicare. vWhat vshould v you vtell vhim? v- vcorrect vanswer.He vmay vsign-up vfor vMedicare vat
vany vtime vhowever v coverage vusually v begins von vthe vfourth vmonth vafter vdialysis
vtreatments vstart.
Juan vPerez, vwho vis vturning vage v65 vnext vmonth, vintends vto vwork vfor vseveral vmore vyears
vat vSmallcap, vIncorporated. vSmallcap vhas va vworkforce vof15 vemployees vand voffers
vemployer-sponsored vhealthcare vcoverage. vJuan vis va vnaturalized vcitizen vand vhas
vcontributed vto vthe v Medicare vsystem vfor vover v20 v years. vJuan vasks v you vif vhe v will vbe
ventitled vto vMedicare vand vif vhe venrolls vhow vthat v will vimpact vhis vemployer-sponsored
vhealthcare vcoverage. vHow v would v you vrespond? v - vcorrect vanswer.Juan vis vlikely vto vbe
veligible vfor vMedicare vonce vhe vturns vage v65 vand vif vhe venrolls vMedicare v would vbecome
vthe vprimary v payor vof vhis vhealthcare vclaims vand vSmallcap vdoes vnot vhave vto vcontinue vto
voffer vhim vcoverage vcomparable vto vthose vunder vage v65 vunder v its vemployer-sponsored
vgroup vhealth vplan.
Moy's vwife vhas va vMedicare vAdvantage vplan, vbut vhe vwants vto vunderstand vwhat vcoverage
vMedicare vSupplemental vInsurance vprovides vsince vhis vhealth vcare vneeds vare vdifferent
vfrom vhis v wife's vneeds. vWhat vcould v you vtell vMr. v Moy? v - vcorrect vanswer.Medicare
vSupplemental vInsurance v would vhelp vcover vhis vPart vA vand vPart vB vdeductibles vor
vcoinsurance v in vOriginal vFee-for-Service v (FFS) v Medicare vas v well vas vpossibly vsome
vservices v that v Medicare vdoes vnot vcover.
Peňa vis v66 vyears vold, vhas vcoverage vunder van vemployer vplan, vand vwill vretire vnext vyear.
vShe vheard vshe vmust venroll v in vPart vB vat vthe vbeginning vof vthe v year vto vensure vno vgap vin
vcoverage. vWhat vcan v you vtell vher? v - vcorrect vanswer.She vmay venroll vat vany vtime v while
vshe v is vcovered vunder vher vemployer vplan, vbut vshe v will vhave va vspecial veight-month
venrollment vperiod vafter v the vlast vmonth von vher vemployer vplan vthat vdiffers vfrom vthe
vstandard v general venrollment vperiod, vduring v which vshe vmay venroll vin vMedicare vPart vB.
Chen vwill vbe v65 vsoon, vhas vbeen va vcitizen vfor vtwelve vyears, vhas vbeen vemployed vfull
vtime, vand vpaid vtaxes vduring v that ventire vperiod. vShe vis vconcerned vthat vshe v will vnot
vqualify vfor vcoverage vunder vpart vA vbecause vshe v was vnot vborn vin vthe vUnited vStates.
vWhat vshould v you vtell vher? v- vcorrect vanswer.Most vindividuals v who vare vcitizens vand vage
v65 vor vover vare vcovered vunder vPart vA vby v virtue vof vhaving v paid v Medicare vtaxes v while
v working, vthough vsome vmay vbe vcovered vas va vresult vof vpaying vmonthly v premiums.
,Gonzalez vis venrolled vin vOriginal vMedicare vand vhas va vMedigap vpolicy vas vwell, vbut vit
vprovides vno vdrug vcoverage. vShe v would v like vto vkeep vthe vcoverage v she vhas vbut vreplace
vher vexisting v Medigap vplan v with vone vthat vprovides vdrug vcoverage. vWhat vshould v you vtell
vher? v - vcorrect vanswer.Mrs. v Gonzalez v cannot vpurchase va vMedigap vplan vthat vcovers
vdrugs, vbut vshe vcould vkeep vher v Medigap vpolicy v and venroll vin va vPart vD vprescription vdrug
vplan.
West vwears vglasses vand vdentures vand vhas venjoyed vconsiderable vpain vrelief vfrom
varthritis vthrough vmassage vtherapy. vShe v is vconcerned vabout v whether vor vnot v Medicare
v will vcover vthese vitems vand vservices. vWhat vshould v you vtell vher? v- vcorrect
vanswer.Medicare vdoes vnot vcover vmassage vtherapy, vor, vin v general, vglasses vor
vdentures.
Patel vis vin vgood vhealth vand vis vpreparing va vbudget vin vanticipation vof vhis vretirement vwhen
vhe vturns v66. vHe v wants vto vunderstand vthe vhealth vcare vcosts vhe vmight vbe vexposed vto
vunder vMedicare vif vhe vwere v to vrequire vhospitalization vas va v result vof van villness. vIn
vgeneral vterms, v what vcould v you vtell vhim vabout vhis vcosts vfor vinpatient vhospital vservices
under vOriginal vMedicare? v- vcorrect vanswer.Under vOriginal vMedicare, vthere vis va vsingle
vdeductible vamount vdue vfor vthe vfirst v60 vdays vof vany v inpatient vhospital vstay, vafter v which v it
vconverts vinto va vper-day v coinsurance vamount vthrough vday v90. vAfter vday v90, vhe v would
vpay va vdaily vamount vup vto v60 vdays vover vhis vlifetime, vafter v which vhe vwould vbe
vresponsible vfor vall vcosts.
Henderson vbelieves vthat vshe vwill vqualify vfor vMedicare vCoverage vwhen vshe vturns v65,
v without vpaying v any v premiums, vbecause vshe vhas vbeen v working vfor v40 v years vand vpaying
vMedicare vtaxes. vWhat vshould v you vtell vher? v - vcorrect vanswer.To vobtain vPart vB
vcoverage, vshe vmust vpay v a vstandard vmonthly vpremium, vthough v it vis vhigher vfor
vindividuals v with vhigher vincomes.
Alonso vreceives vsome vhelp vpaying vfor vhis vtwo vgeneric vprescription vdrugs vfrom vhis
vemployer's v retiree vcoverage, vbut vhe v wants vto vcompare v it vto va vPart v D vprescription vdrug
vplan. vHe vasks v you v what vcosts vhe v would v generally v expect vto vencounter v when venrolling
vinto va vstandard vMedicarePart v D vprescription vdrug vplan. vWhat vshould v you vtell vhim? v-
vcorrect vanswer.He v generally v would vpay va vmonthly vpremium, vannual vdeductible, vand
vper-prescription vcost-sharing.
Moore vplans vto vretire vwhen vshe vturns v65 vin va vfew vmonths. vShe vis vin vexcellent vhealth
vand v will vhave vconsiderable v income v when vshe vretires. vShe vis vconcerned vthat vher
vincome v will vmake vit v impossible vfor vher vto v qualify vfor vMedicare. vWhat vcould v you vtell vher
vto vaddress vher vconcern? v- vcorrect vanswer.Medicare v is va vprogram vfor vpeople vage v65 vor
volder vand vthose vunder vage v65 v with vcertain vdisabilities, vend-stage vrenal vdisease, vand
vLou vGehrig's vdisease vso vshe v will vbe veligible vfor v Medicare.
Xi vwill vsoon vturn vage v65 vand vhas vcome vto vyou vfor vadvice vas vto vwhat vservices vare
vprovided vunder vOriginal v Medicare. vWhat vshould v you vtell vMr. vXi vthat vbest vdescribes vthe
, vhealth vcoverage vprovided vto vMedicare vbeneficiaries? v- vcorrect vanswer.Beneficiaries
vunder vOriginal vMedicare vhave vno vcost-sharing vfor vmost vpreventive vservices v which
vinclude vimmunizations vsuch vas vannual vflu vshots.
Duarte vis venrolled vin vOriginal vMedicare vParts vA vand vB. vShe vhas vrecently vreviewed vher
vMedicare vSummary v Notice v(MSN) vand vdisagrees v with va vdetermination vthat vpartially
vdenied vone vof vher vclaims vfor vservices. vWhat vadvice v would v you vgive vher? v - vcorrect
vanswer.Mrs. v Duarte vshould vfile van vappeal vof vthis vinitial vdetermination v within v120 vdays
vof vthe vdate vshe vreceived vthe vMSN vin vthe vmail.
Capadona vwould vlike vto vpurchase va vMedicare vAdvantage v(MA) vplan vand va vMedigap
vplan vto vpick vup vcosts vnot vcovered vby vthat vplan.
What vshould vyou vtell vhim? v- vcorrect vanswer.It vis villegal vfor vyou vto vsell vMr. vCapadona va
vMedigap vplan v if vhe v is venrolled vin van vMA vplan, vand vbesides, v Medigap vonly v works v with
vOriginal vMedicare.
Park vis van velderly vretiree. vMrs. vPark vhas va vlow vfixed vincome. vWhat vcould vyou vtell vMrs.
vPark vthat vmight vbe vof vassistance? v- vcorrect vanswer.She vshould vcontact vher vstate
vMedicaid vagency vto vsee vif vshe vqualifies vfor vone vof vseveral vprograms vthat vcan vhelp v with
vMedicare vcosts vfor v which vshe vis vresponsible.
Rainey vis vexperiencing vparanoid vdelusions vand vhis vphysician vfeels vthat vhe vshould vbe
vhospitalized. vWhat vshould v you vtell v Mr. vRainey v (or vhis v representative) vabout vthe v length
vof van v inpatient vpsychiatric vhospital vstay vthat vMedicare v will vcover? v- vcorrect
vanswer.Medicare v will vcover v a vtotal vof v190 vdays v of vinpatient vpsychiatric v care vduring vMr.
vRainey's ventire vlifetime.
Schmidt vwould vlike vto vplan vfor vretirement vand vhas vasked vyou vwhat vis vcovered vunder
vOriginal vFee-for-Service v(FFS) vMedicare? vWhat vcould v you vtell vhim? v - vcorrect
vanswer.Part vA, v which vcovers v hospital, vskilled vnursing vfacility, vhospice, vand vhome
vhealth vservices v and vPart vB, v which vcovers vprofessional vservices v such vas vthose vprovided
vby va vdoctor vare vcovered vunder vOriginal vMedicare.
Agent vJohn vMiller vis vmeeting vwith vJerry vSmith, va vnew vprospect. vJerry vis vcurrently
venrolled vin v Medicare vParts vA vand vB. vJerry vhas valso vpurchased va vMedicare vSupplement
v(Medigap) vplan v which vhe vhas vhad vfor vseveral v years. vHowever, v the vplan vdoes vnot
vprovide vdrug vbenefits. vHow v would v you vadvise vAgent vJohn vMiller vto vproceed? v - vcorrect
vanswer.Tell vprospect vJerry vSmith vthat vhe vshould vconsider vadding va vstandalone vPart vD
vprescription vdrug vcoverage vpolicy vto vhis vpresent vcoverage.
Bauer vis v49 vyears vold, vbut veighteen vmonths vago vhe vwas vdeclared vdisabled vby vthe
vSocial vSecurity vAdministration vand vhas vbeen vreceiving v disability vpayments. vHe vis
v wondering v whether vhe vcan vobtain vcoverage vunder v Medicare. vWhat vshould v you vtell
vhim? v- vcorrect vanswer.After v receiving v such vdisability v payments vfor v24 vmonths, vhe v will
vbe vautomatically venrolled vin vMedicare, vregardless vof vage.
Davis vis v52 vyears vold vand vhas vrecently vbeen vdiagnosed vwith vend-stage vrenal vdisease
v(ESRD) vand v will vsoon vbegin vdialysis. vHe v is v wondering v if vhe vcan vobtain vcoverage vunder
vMedicare. vWhat vshould v you vtell vhim? v- vcorrect vanswer.He vmay vsign-up vfor vMedicare vat
vany vtime vhowever v coverage vusually v begins von vthe vfourth vmonth vafter vdialysis
vtreatments vstart.
Juan vPerez, vwho vis vturning vage v65 vnext vmonth, vintends vto vwork vfor vseveral vmore vyears
vat vSmallcap, vIncorporated. vSmallcap vhas va vworkforce vof15 vemployees vand voffers
vemployer-sponsored vhealthcare vcoverage. vJuan vis va vnaturalized vcitizen vand vhas
vcontributed vto vthe v Medicare vsystem vfor vover v20 v years. vJuan vasks v you vif vhe v will vbe
ventitled vto vMedicare vand vif vhe venrolls vhow vthat v will vimpact vhis vemployer-sponsored
vhealthcare vcoverage. vHow v would v you vrespond? v - vcorrect vanswer.Juan vis vlikely vto vbe
veligible vfor vMedicare vonce vhe vturns vage v65 vand vif vhe venrolls vMedicare v would vbecome
vthe vprimary v payor vof vhis vhealthcare vclaims vand vSmallcap vdoes vnot vhave vto vcontinue vto
voffer vhim vcoverage vcomparable vto vthose vunder vage v65 vunder v its vemployer-sponsored
vgroup vhealth vplan.
Moy's vwife vhas va vMedicare vAdvantage vplan, vbut vhe vwants vto vunderstand vwhat vcoverage
vMedicare vSupplemental vInsurance vprovides vsince vhis vhealth vcare vneeds vare vdifferent
vfrom vhis v wife's vneeds. vWhat vcould v you vtell vMr. v Moy? v - vcorrect vanswer.Medicare
vSupplemental vInsurance v would vhelp vcover vhis vPart vA vand vPart vB vdeductibles vor
vcoinsurance v in vOriginal vFee-for-Service v (FFS) v Medicare vas v well vas vpossibly vsome
vservices v that v Medicare vdoes vnot vcover.
Peňa vis v66 vyears vold, vhas vcoverage vunder van vemployer vplan, vand vwill vretire vnext vyear.
vShe vheard vshe vmust venroll v in vPart vB vat vthe vbeginning vof vthe v year vto vensure vno vgap vin
vcoverage. vWhat vcan v you vtell vher? v - vcorrect vanswer.She vmay venroll vat vany vtime v while
vshe v is vcovered vunder vher vemployer vplan, vbut vshe v will vhave va vspecial veight-month
venrollment vperiod vafter v the vlast vmonth von vher vemployer vplan vthat vdiffers vfrom vthe
vstandard v general venrollment vperiod, vduring v which vshe vmay venroll vin vMedicare vPart vB.
Chen vwill vbe v65 vsoon, vhas vbeen va vcitizen vfor vtwelve vyears, vhas vbeen vemployed vfull
vtime, vand vpaid vtaxes vduring v that ventire vperiod. vShe vis vconcerned vthat vshe v will vnot
vqualify vfor vcoverage vunder vpart vA vbecause vshe v was vnot vborn vin vthe vUnited vStates.
vWhat vshould v you vtell vher? v- vcorrect vanswer.Most vindividuals v who vare vcitizens vand vage
v65 vor vover vare vcovered vunder vPart vA vby v virtue vof vhaving v paid v Medicare vtaxes v while
v working, vthough vsome vmay vbe vcovered vas va vresult vof vpaying vmonthly v premiums.
,Gonzalez vis venrolled vin vOriginal vMedicare vand vhas va vMedigap vpolicy vas vwell, vbut vit
vprovides vno vdrug vcoverage. vShe v would v like vto vkeep vthe vcoverage v she vhas vbut vreplace
vher vexisting v Medigap vplan v with vone vthat vprovides vdrug vcoverage. vWhat vshould v you vtell
vher? v - vcorrect vanswer.Mrs. v Gonzalez v cannot vpurchase va vMedigap vplan vthat vcovers
vdrugs, vbut vshe vcould vkeep vher v Medigap vpolicy v and venroll vin va vPart vD vprescription vdrug
vplan.
West vwears vglasses vand vdentures vand vhas venjoyed vconsiderable vpain vrelief vfrom
varthritis vthrough vmassage vtherapy. vShe v is vconcerned vabout v whether vor vnot v Medicare
v will vcover vthese vitems vand vservices. vWhat vshould v you vtell vher? v- vcorrect
vanswer.Medicare vdoes vnot vcover vmassage vtherapy, vor, vin v general, vglasses vor
vdentures.
Patel vis vin vgood vhealth vand vis vpreparing va vbudget vin vanticipation vof vhis vretirement vwhen
vhe vturns v66. vHe v wants vto vunderstand vthe vhealth vcare vcosts vhe vmight vbe vexposed vto
vunder vMedicare vif vhe vwere v to vrequire vhospitalization vas va v result vof van villness. vIn
vgeneral vterms, v what vcould v you vtell vhim vabout vhis vcosts vfor vinpatient vhospital vservices
under vOriginal vMedicare? v- vcorrect vanswer.Under vOriginal vMedicare, vthere vis va vsingle
vdeductible vamount vdue vfor vthe vfirst v60 vdays vof vany v inpatient vhospital vstay, vafter v which v it
vconverts vinto va vper-day v coinsurance vamount vthrough vday v90. vAfter vday v90, vhe v would
vpay va vdaily vamount vup vto v60 vdays vover vhis vlifetime, vafter v which vhe vwould vbe
vresponsible vfor vall vcosts.
Henderson vbelieves vthat vshe vwill vqualify vfor vMedicare vCoverage vwhen vshe vturns v65,
v without vpaying v any v premiums, vbecause vshe vhas vbeen v working vfor v40 v years vand vpaying
vMedicare vtaxes. vWhat vshould v you vtell vher? v - vcorrect vanswer.To vobtain vPart vB
vcoverage, vshe vmust vpay v a vstandard vmonthly vpremium, vthough v it vis vhigher vfor
vindividuals v with vhigher vincomes.
Alonso vreceives vsome vhelp vpaying vfor vhis vtwo vgeneric vprescription vdrugs vfrom vhis
vemployer's v retiree vcoverage, vbut vhe v wants vto vcompare v it vto va vPart v D vprescription vdrug
vplan. vHe vasks v you v what vcosts vhe v would v generally v expect vto vencounter v when venrolling
vinto va vstandard vMedicarePart v D vprescription vdrug vplan. vWhat vshould v you vtell vhim? v-
vcorrect vanswer.He v generally v would vpay va vmonthly vpremium, vannual vdeductible, vand
vper-prescription vcost-sharing.
Moore vplans vto vretire vwhen vshe vturns v65 vin va vfew vmonths. vShe vis vin vexcellent vhealth
vand v will vhave vconsiderable v income v when vshe vretires. vShe vis vconcerned vthat vher
vincome v will vmake vit v impossible vfor vher vto v qualify vfor vMedicare. vWhat vcould v you vtell vher
vto vaddress vher vconcern? v- vcorrect vanswer.Medicare v is va vprogram vfor vpeople vage v65 vor
volder vand vthose vunder vage v65 v with vcertain vdisabilities, vend-stage vrenal vdisease, vand
vLou vGehrig's vdisease vso vshe v will vbe veligible vfor v Medicare.
Xi vwill vsoon vturn vage v65 vand vhas vcome vto vyou vfor vadvice vas vto vwhat vservices vare
vprovided vunder vOriginal v Medicare. vWhat vshould v you vtell vMr. vXi vthat vbest vdescribes vthe
, vhealth vcoverage vprovided vto vMedicare vbeneficiaries? v- vcorrect vanswer.Beneficiaries
vunder vOriginal vMedicare vhave vno vcost-sharing vfor vmost vpreventive vservices v which
vinclude vimmunizations vsuch vas vannual vflu vshots.
Duarte vis venrolled vin vOriginal vMedicare vParts vA vand vB. vShe vhas vrecently vreviewed vher
vMedicare vSummary v Notice v(MSN) vand vdisagrees v with va vdetermination vthat vpartially
vdenied vone vof vher vclaims vfor vservices. vWhat vadvice v would v you vgive vher? v - vcorrect
vanswer.Mrs. v Duarte vshould vfile van vappeal vof vthis vinitial vdetermination v within v120 vdays
vof vthe vdate vshe vreceived vthe vMSN vin vthe vmail.
Capadona vwould vlike vto vpurchase va vMedicare vAdvantage v(MA) vplan vand va vMedigap
vplan vto vpick vup vcosts vnot vcovered vby vthat vplan.
What vshould vyou vtell vhim? v- vcorrect vanswer.It vis villegal vfor vyou vto vsell vMr. vCapadona va
vMedigap vplan v if vhe v is venrolled vin van vMA vplan, vand vbesides, v Medigap vonly v works v with
vOriginal vMedicare.
Park vis van velderly vretiree. vMrs. vPark vhas va vlow vfixed vincome. vWhat vcould vyou vtell vMrs.
vPark vthat vmight vbe vof vassistance? v- vcorrect vanswer.She vshould vcontact vher vstate
vMedicaid vagency vto vsee vif vshe vqualifies vfor vone vof vseveral vprograms vthat vcan vhelp v with
vMedicare vcosts vfor v which vshe vis vresponsible.
Rainey vis vexperiencing vparanoid vdelusions vand vhis vphysician vfeels vthat vhe vshould vbe
vhospitalized. vWhat vshould v you vtell v Mr. vRainey v (or vhis v representative) vabout vthe v length
vof van v inpatient vpsychiatric vhospital vstay vthat vMedicare v will vcover? v- vcorrect
vanswer.Medicare v will vcover v a vtotal vof v190 vdays v of vinpatient vpsychiatric v care vduring vMr.
vRainey's ventire vlifetime.
Schmidt vwould vlike vto vplan vfor vretirement vand vhas vasked vyou vwhat vis vcovered vunder
vOriginal vFee-for-Service v(FFS) vMedicare? vWhat vcould v you vtell vhim? v - vcorrect
vanswer.Part vA, v which vcovers v hospital, vskilled vnursing vfacility, vhospice, vand vhome
vhealth vservices v and vPart vB, v which vcovers vprofessional vservices v such vas vthose vprovided
vby va vdoctor vare vcovered vunder vOriginal vMedicare.
Agent vJohn vMiller vis vmeeting vwith vJerry vSmith, va vnew vprospect. vJerry vis vcurrently
venrolled vin v Medicare vParts vA vand vB. vJerry vhas valso vpurchased va vMedicare vSupplement
v(Medigap) vplan v which vhe vhas vhad vfor vseveral v years. vHowever, v the vplan vdoes vnot
vprovide vdrug vbenefits. vHow v would v you vadvise vAgent vJohn vMiller vto vproceed? v - vcorrect
vanswer.Tell vprospect vJerry vSmith vthat vhe vshould vconsider vadding va vstandalone vPart vD
vprescription vdrug vcoverage vpolicy vto vhis vpresent vcoverage.
Bauer vis v49 vyears vold, vbut veighteen vmonths vago vhe vwas vdeclared vdisabled vby vthe
vSocial vSecurity vAdministration vand vhas vbeen vreceiving v disability vpayments. vHe vis
v wondering v whether vhe vcan vobtain vcoverage vunder v Medicare. vWhat vshould v you vtell
vhim? v- vcorrect vanswer.After v receiving v such vdisability v payments vfor v24 vmonths, vhe v will
vbe vautomatically venrolled vin vMedicare, vregardless vof vage.
