2024 AHIP | 169 QUESTIONS | WITH
CORRECT SOLUTIONS GRADED A+
Edward IP suffered from serious kidney disease. As a result. Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant surgery
12 months ago. Edward is now age 50 and asks you if his Medicare coverage will
continue, what should you say? Answer- Individuals eligible for Medicare based on
ESRD generally lose eligibility 36 months after the month in which the individual
receives a kidney transplant unless they are eligible for Medicare on another basis
such as age or disability. Edward may, however, remain enrolled in Part B but solely
for coverage of immunosuppressive drugs if he has no other health care coverage
that would cover the drugs.
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. 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- Mr. Diaz will not pay any
penalty because he had continuous coverage under his employer's plan.
Mr. Moy'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. Moy? Answer- 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.
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? Answer- 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.
,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. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries? Answer- Beneficiaries under
Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
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 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.
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? Answer- He may sign-up for
Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
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.
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? Answer- To obtain Part B
coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes. Answer- 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.
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.
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.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
Answer- It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in
an MA plan, and besides, Medigap only works with Original Medicare.
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 for one of several programs that can help
with Medicare costs for which she is responsible.
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.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
for the Part D low-income subsidy. Where might he turn for help with his prescription
drug costs? Answer- Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE).
This coverage has recently been terminated due to the end of the PHE. While
Shirley was enrolled in Medicaid, she missed an opportunity to enroll in Medicare
and now wants Part B. Which of the following statements best describes Shirley's
ability to now enroll in Medicare Part B? Answer- Shirley is eligible for a Special
Enrollment Period (SEP) for up to six months after the termination of her Medicaid
coverage. Under this SEP, Shirley can choose retroactive coverage back to the date
of termination from Medicaid or coverage beginning the month after the month of
enrollment.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll in
Medicare, his entire area 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
CORRECT SOLUTIONS GRADED A+
Edward IP suffered from serious kidney disease. As a result. Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant surgery
12 months ago. Edward is now age 50 and asks you if his Medicare coverage will
continue, what should you say? Answer- Individuals eligible for Medicare based on
ESRD generally lose eligibility 36 months after the month in which the individual
receives a kidney transplant unless they are eligible for Medicare on another basis
such as age or disability. Edward may, however, remain enrolled in Part B but solely
for coverage of immunosuppressive drugs if he has no other health care coverage
that would cover the drugs.
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. 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- Mr. Diaz will not pay any
penalty because he had continuous coverage under his employer's plan.
Mr. Moy'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. Moy? Answer- 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.
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? Answer- 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.
,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. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries? Answer- Beneficiaries under
Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
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 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.
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? Answer- He may sign-up for
Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
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.
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? Answer- To obtain Part B
coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes. Answer- 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.
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.
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.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
Answer- It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in
an MA plan, and besides, Medigap only works with Original Medicare.
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 for one of several programs that can help
with Medicare costs for which she is responsible.
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.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
for the Part D low-income subsidy. Where might he turn for help with his prescription
drug costs? Answer- Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE).
This coverage has recently been terminated due to the end of the PHE. While
Shirley was enrolled in Medicaid, she missed an opportunity to enroll in Medicare
and now wants Part B. Which of the following statements best describes Shirley's
ability to now enroll in Medicare Part B? Answer- Shirley is eligible for a Special
Enrollment Period (SEP) for up to six months after the termination of her Medicaid
coverage. Under this SEP, Shirley can choose retroactive coverage back to the date
of termination from Medicaid or coverage beginning the month after the month of
enrollment.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll in
Medicare, his entire area 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
