AHIP 2025 Final Exam Updated Questions and
Verified 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%
coinsurance for these services, in addition to an annual deductible. - ANSWER-Mrs.
Quinn recently turned 66 and decided after many years of work to begin receiving
Social Security benefits. Shortly thereafter Mrs. Quinn 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?
Original Medicare covers ambulance services. - ANSWER-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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan. - ANSWER-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?
You are sorry to disappoint Anita but a Medigap Part F plan is no longer available to
those who turn age 65 after January 1,2020. Anita might instead consider other
Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. -
ANSWER-Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Part F plan
in which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should you
tell her?
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. - ANSWER-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?
After receiving such disability payments for 24 months, he will be automatically enrolled
in Medicare, regardless of age. - ANSWER-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?
,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. - ANSWER-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?
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. - ANSWER-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?
Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the facility
for 100 days. - ANSWER-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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots. - ANSWER-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?
Part D covers prescription drugs and she should look at her premiums, formulary, and
cost-sharing among other factors to see if they have changed. - ANSWER-Mrs.
Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs.
Geisler can't remember what Part D is so she called you to ask what her neighbor was
talking about. What could you tell her?
The Part B deductible will no longer be covered for individuals newly eligible for
Medicare starting January 1, 2020. - ANSWER-What impact, if any, will recent
regulatory changes have upon Medigap plans?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program. - ANSWER-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?
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. - ANSWER-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?
Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage. - ANSWER-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?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles
for medically necessary services - ANSWER-Mrs. Paterson is concerned about the
deductibles and co-payments associated with Original Medicare. What can you tell her
about Medigap as an option to address this concern?
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. - ANSWER-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?
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. - ANSWER-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?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered
for Part A and Part B services through Original Fee-for-Service Medicare. - ANSWER-
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him?
Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare
would become the primary payor of his healthcare claims and Smallcap does not have
to continue to offer him coverage comparable to those under age 65 under its employer-
sponsored group health plan. - ANSWER-Juan Perez, who is turning age 65 next
month, intends to work for several more years at Smallcap, Incorporated. Smallcap has
a workforce of 15 employees and offers employer-sponsored healthcare coverage. Juan
is a naturalized citizen and has contributed to the Medicare system for over 20 years.
Juan asks you if he will be
Verified 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%
coinsurance for these services, in addition to an annual deductible. - ANSWER-Mrs.
Quinn recently turned 66 and decided after many years of work to begin receiving
Social Security benefits. Shortly thereafter Mrs. Quinn 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?
Original Medicare covers ambulance services. - ANSWER-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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan. - ANSWER-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?
You are sorry to disappoint Anita but a Medigap Part F plan is no longer available to
those who turn age 65 after January 1,2020. Anita might instead consider other
Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. -
ANSWER-Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Part F plan
in which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should you
tell her?
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. - ANSWER-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?
After receiving such disability payments for 24 months, he will be automatically enrolled
in Medicare, regardless of age. - ANSWER-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?
,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. - ANSWER-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?
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. - ANSWER-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?
Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the facility
for 100 days. - ANSWER-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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots. - ANSWER-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?
Part D covers prescription drugs and she should look at her premiums, formulary, and
cost-sharing among other factors to see if they have changed. - ANSWER-Mrs.
Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because features of Part D might have changed. Mrs.
Geisler can't remember what Part D is so she called you to ask what her neighbor was
talking about. What could you tell her?
The Part B deductible will no longer be covered for individuals newly eligible for
Medicare starting January 1, 2020. - ANSWER-What impact, if any, will recent
regulatory changes have upon Medigap plans?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program. - ANSWER-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?
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. - ANSWER-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?
Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage. - ANSWER-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?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles
for medically necessary services - ANSWER-Mrs. Paterson is concerned about the
deductibles and co-payments associated with Original Medicare. What can you tell her
about Medigap as an option to address this concern?
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. - ANSWER-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?
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. - ANSWER-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?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered
for Part A and Part B services through Original Fee-for-Service Medicare. - ANSWER-
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him?
Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare
would become the primary payor of his healthcare claims and Smallcap does not have
to continue to offer him coverage comparable to those under age 65 under its employer-
sponsored group health plan. - ANSWER-Juan Perez, who is turning age 65 next
month, intends to work for several more years at Smallcap, Incorporated. Smallcap has
a workforce of 15 employees and offers employer-sponsored healthcare coverage. Juan
is a naturalized citizen and has contributed to the Medicare system for over 20 years.
Juan asks you if he will be
