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AHIP FINAL EXAM 2025-2026
What impact, if any, have recent regulatory changes had on Medigap
plans? - CORRECT ANSWER - The Part B deductible is no longer
covered for individuals newly eligible for Medicare starting January 1,
2020.
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.
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? - CORRECT ANSWER - 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.
Mrs. Quinn recently turned 66 and decided after many years of work to
retire and begin receiving Social Security benefits. Shortly thereafter
Mrs. Quinn received a letter informing her that she had been
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automatically enrolled in Medicare Part B. She wants to understand
what this means. What should you tell Mrs. Quinn? - CORRECT
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.
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? - CORRECT ANSWER - Original Medicare covers ambulance
services.
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.
Mrs. West wears glasses and dentures and has enjoyed considerable
pain relief from arthritis through massage therapy. She is concerned
about whether or not Medicare will cover these items and services.
What should you tell her? - CORRECT ANSWER - Medicare does not
cover massage therapy, or, in general, glasses or dentures.
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
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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. 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.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
you represent. It is one of three plans operated by the same organization
in Mr. Lombardi's area. The MA PPO plan does not include drug
coverage, but the other two plans do. Mr. Lombardi likes the PPO plan
that does not include drug coverage and intends to obtain his drug
coverage through a stand-alone Medicare prescription drug plan. What
should you tell him about this situation? - CORRECT ANSWER - He
could enroll either in one of the MA plans that include prescription drug
coverage or Original Medicare with a Medigap plan and standalone Part
D prescription drug coverage, but he cannot enroll in the MA-only PPO
plan and a stand-alone prescription drug plan.
Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are available
AHIP FINAL EXAM 2025-2026
What impact, if any, have recent regulatory changes had on Medigap
plans? - CORRECT ANSWER - The Part B deductible is no longer
covered for individuals newly eligible for Medicare starting January 1,
2020.
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.
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? - CORRECT ANSWER - 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.
Mrs. Quinn recently turned 66 and decided after many years of work to
retire and begin receiving Social Security benefits. Shortly thereafter
Mrs. Quinn received a letter informing her that she had been
,1
automatically enrolled in Medicare Part B. She wants to understand
what this means. What should you tell Mrs. Quinn? - CORRECT
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.
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? - CORRECT ANSWER - Original Medicare covers ambulance
services.
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.
Mrs. West wears glasses and dentures and has enjoyed considerable
pain relief from arthritis through massage therapy. She is concerned
about whether or not Medicare will cover these items and services.
What should you tell her? - CORRECT ANSWER - Medicare does not
cover massage therapy, or, in general, glasses or dentures.
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
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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. 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.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
you represent. It is one of three plans operated by the same organization
in Mr. Lombardi's area. The MA PPO plan does not include drug
coverage, but the other two plans do. Mr. Lombardi likes the PPO plan
that does not include drug coverage and intends to obtain his drug
coverage through a stand-alone Medicare prescription drug plan. What
should you tell him about this situation? - CORRECT ANSWER - He
could enroll either in one of the MA plans that include prescription drug
coverage or Original Medicare with a Medigap plan and standalone Part
D prescription drug coverage, but he cannot enroll in the MA-only PPO
plan and a stand-alone prescription drug plan.
Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are available
