AHIP ALL MODULES
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1. 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?: To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
2. Mr. Patel 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 as a
result of an illness. In general terms, what could you tell him about his costs for
inpatient hospital services under Original Medicare?: 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.
3. 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?: 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.
4. 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?: Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
5. Mrs. PeH a 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?: 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.
6. 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
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him?: 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.
7. 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 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. Mr. Buck has several family members who died from different cancers. He
wants to know if Medicare covers cancer screening. What should you tell
him?: Medicare covers the periodic performance of a range of screening tests that
are meant to provide early detection of disease. Mr. Buck will need to check specific
tests before obtaining them to see if they will be covered.
9. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determi-
nation that partially denied one of her claims for services. What advice would
you give her?: Mrs. Duarte should file an appeal of this initial determination within
120 days of the date she received the MSN in the mail.
10. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy
as well, but it provides no drug coverage. She would like to keep the coverage
she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her?: 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.
11. Mr. Alonso receives some help paying for his two generic prescription
drugs from his employer's retiree coverage, but he wants to compare it to a
Part D prescription drug plan. He asks you what costs he would generally ex-
pect to encounter when enrolling into a standard Medicare Part D prescription
drug plan. What should you tell him?: He generally would pay a monthly premium,
annual deductible, and per-prescription cost-sharing.
12. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell Mr.
Moy?: 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.
13. Mr. Rainey is experiencing paranoid delusions and his physician feels that
he should be hospitalized. What should you tell Mr. Rainey (or his representa-
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tive) about the length of an inpatient psychiatric hospital stay that Medicare
will cover?: Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.
14. 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?: 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.
15. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance?: 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.
16. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
abled 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?: After receiving such disability payments for 24 months,
he will be automatically enrolled in Medicare, regardless of age
17. 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?: He may sign-up
for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
18. 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?: Medicare does not cover massage therapy, or, in general, glasses or dentures.
19. 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?: 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.
20. 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?: Ben-
eficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots.
Study online at https://quizlet.com/_9zf2dv
1. 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?: To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
2. Mr. Patel 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 as a
result of an illness. In general terms, what could you tell him about his costs for
inpatient hospital services under Original Medicare?: 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.
3. 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?: 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.
4. 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?: Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
5. Mrs. PeH a 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?: 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.
6. 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
, AHIP ALL MODULES
Study online at https://quizlet.com/_9zf2dv
him?: 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.
7. 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 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. Mr. Buck has several family members who died from different cancers. He
wants to know if Medicare covers cancer screening. What should you tell
him?: Medicare covers the periodic performance of a range of screening tests that
are meant to provide early detection of disease. Mr. Buck will need to check specific
tests before obtaining them to see if they will be covered.
9. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determi-
nation that partially denied one of her claims for services. What advice would
you give her?: Mrs. Duarte should file an appeal of this initial determination within
120 days of the date she received the MSN in the mail.
10. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy
as well, but it provides no drug coverage. She would like to keep the coverage
she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her?: 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.
11. Mr. Alonso receives some help paying for his two generic prescription
drugs from his employer's retiree coverage, but he wants to compare it to a
Part D prescription drug plan. He asks you what costs he would generally ex-
pect to encounter when enrolling into a standard Medicare Part D prescription
drug plan. What should you tell him?: He generally would pay a monthly premium,
annual deductible, and per-prescription cost-sharing.
12. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife's needs. What could you tell Mr.
Moy?: 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.
13. Mr. Rainey is experiencing paranoid delusions and his physician feels that
he should be hospitalized. What should you tell Mr. Rainey (or his representa-
, AHIP ALL MODULES
Study online at https://quizlet.com/_9zf2dv
tive) about the length of an inpatient psychiatric hospital stay that Medicare
will cover?: Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.
14. 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?: 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.
15. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance?: 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.
16. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
abled 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?: After receiving such disability payments for 24 months,
he will be automatically enrolled in Medicare, regardless of age
17. 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?: He may sign-up
for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
18. 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?: Medicare does not cover massage therapy, or, in general, glasses or dentures.
19. 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?: 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.
20. 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?: Ben-
eficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots.
