AHIP 2025 Final Exam Questions and Verified
Answers.
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.
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 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.
Answers.
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.
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 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.
