AHIP EXAM QUESTIONS WITH
COMPLETE SOLUTIONS.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD
plan and was disappointed with the service she received from her primary
care physician because she was told she would have to wait five weeks to
get an appointment when she was feeling ill. She called you to ask what she
could do so she would not have to put up with such poor access to care.
What could you tell her? - Correct Answer-She could file a grievance with her
plan to complain about the lack of timeliness in getting an appointment.
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? - Correct 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? -
Correct 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?
,- Correct 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? -
Correct 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? - Correct
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? - Correct 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? -
Correct 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? - Correct 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? - Correct 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? - Correct
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? - Correct
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. - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct
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.
COMPLETE SOLUTIONS.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD
plan and was disappointed with the service she received from her primary
care physician because she was told she would have to wait five weeks to
get an appointment when she was feeling ill. She called you to ask what she
could do so she would not have to put up with such poor access to care.
What could you tell her? - Correct Answer-She could file a grievance with her
plan to complain about the lack of timeliness in getting an appointment.
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? - Correct 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? -
Correct 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?
,- Correct 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? -
Correct 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? - Correct
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? - Correct 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? -
Correct 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? - Correct 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? - Correct 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? - Correct
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? - Correct
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. - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct 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? - Correct
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.
