AHIP Modules 1-5 Questions and Correct
Answers (Verified Answers)
1.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.
2.Agent John Miller is meeting with Jerry Smith, a new prospect.
Jerry is cur- rently 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.
3.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 (SPAP).
4.Mr. Vasquez is in good health and is preparing a budget in
anticipation of his retirement when he turns 66. He wants to
understand the health care costs he might be exposed to under
Medicare if he were to require hospitalization because of an
illness. In general terms, what could you tell him about his
costs for inpatient hospital services under Original Medicare?
Answer Under Original Medicare, there is a single deductible amount
due for the first 60 days of any inpatient hospital stay, after which it
converts into a per-day coinsurance amount through day
90. After day 90, he would pay a daily amount up to 60 days over his
lifetime, after which he would be responsible for all costs.
5.Mr. Moy will soon turn age 65. He is slightly younger than his
wife. 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
deductible and Part B coinsurance or copayments in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare
does not cover.
,6.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 employ- ees 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 entitled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare
coverage. How would you respond?
Answer 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. 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 but Smallcap must
continue to offer him coverage under its employer-sponsored group
health plan and would become a secondary payor.
7.Ms. Kumar 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.
8.Mrs. Ellis recently turned 66 and decided after many years of
work to retire and begin receiving Social Security benefits.
Shortly thereafter Mrs. Ellis received a letter informing her that
she had been automatically enrolled in Medicare Part B. She
wants to understand what this means. What should you tell
Mrs. Ellis?
Answer Part B primarily covers physician services. She will be paying a
monthly premium and, except for many preventive and screening tests,
generally will have 20% co-payments for these services, in addition to
an annual deductible.
9.Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell
him?
Answer 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.
10.Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed
income. What could you tell Mrs. Cook that might be of
assistance?
Answer She should contact her state Medicaid agency to see if she
Answers (Verified Answers)
1.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.
2.Agent John Miller is meeting with Jerry Smith, a new prospect.
Jerry is cur- rently 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.
3.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 (SPAP).
4.Mr. Vasquez is in good health and is preparing a budget in
anticipation of his retirement when he turns 66. He wants to
understand the health care costs he might be exposed to under
Medicare if he were to require hospitalization because of an
illness. In general terms, what could you tell him about his
costs for inpatient hospital services under Original Medicare?
Answer Under Original Medicare, there is a single deductible amount
due for the first 60 days of any inpatient hospital stay, after which it
converts into a per-day coinsurance amount through day
90. After day 90, he would pay a daily amount up to 60 days over his
lifetime, after which he would be responsible for all costs.
5.Mr. Moy will soon turn age 65. He is slightly younger than his
wife. 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
deductible and Part B coinsurance or copayments in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare
does not cover.
,6.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 employ- ees 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 entitled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare
coverage. How would you respond?
Answer 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. 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 but Smallcap must
continue to offer him coverage under its employer-sponsored group
health plan and would become a secondary payor.
7.Ms. Kumar 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.
8.Mrs. Ellis recently turned 66 and decided after many years of
work to retire and begin receiving Social Security benefits.
Shortly thereafter Mrs. Ellis received a letter informing her that
she had been automatically enrolled in Medicare Part B. She
wants to understand what this means. What should you tell
Mrs. Ellis?
Answer Part B primarily covers physician services. She will be paying a
monthly premium and, except for many preventive and screening tests,
generally will have 20% co-payments for these services, in addition to
an annual deductible.
9.Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell
him?
Answer 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.
10.Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed
income. What could you tell Mrs. Cook that might be of
assistance?
Answer She should contact her state Medicaid agency to see if she
