AHIP 2023
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Terms in this set (100)
Mr. Xi will soon turn age 65 and has Medicare Part B generally covers medically necessary physician and
come to you for advice as to what other health care professional services.
services are provided under
Original Medicare. What should you
tell Mr. Xi that best describes the
health coverage provided to
Medicare beneficiaries?
Mr. Diaz continued working with his Mr. Diaz will not pay any penalty because he had continuous coverage
company and was insured under his under his employer's plan
employer's group plan until 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?
Mr. Wu is eligible for Medicare. He Mr. Wu may still qualify for help in paying Part D costs through his State
has limited financial resources but Pharmaceutical Assistance Program
failed to qualify for the part D low-
income subsidy. Where might he
turn for help with his prescription
drug costs?
Edward IP suffered from serious Individuals eligible for Medicare based on ESRD generally lose
kidney disease. As a result, Edward eligibility 36 months after the month in which the individual receives a
became eligible for Medicare kidney transplant
coverage due to end-stage renal
disease. A close relative donated
their kidney and Edward
successfully underwent transplant
surgery 12 months ago. Edward is
now age 50 and asks you if his
Medicare coverage will continue,
what should you say?
,Anthony Retirement Benefits on his Anthony is eligible for a SEP because he missed an enrollment period
65th birthday. He was interested in due to the impact of the Federally declared disaster. This SEP will allow
obtaining Medicare coverage and is Anthony to enroll in Part B up to 6 months after the end of the
eligible for premium-free Part A. emergency declaration. Anthony may enroll in premium-free Part A at
Before he could enroll in Medicare, any time and his Part A coverage will be retroactive for up to 6 months
his entire area was impacted by a
hurricane causing massive flooding
and severe wind damage. The
Federal government declared this
to be a natural disaster which has
recently ended. During this period
Anthony's initial enrollment period
expired. Anthony asks you how he
can now obtain Medicare coverage.
What should you say?
Shirly Thomas was enrolled in Shirley is eligible for SEP for up to 6 months after the termination of her
Medicaid during the Public Health Medicaid coverage. Under this SEP, Shirley can choose retroactive
Emergency. This coverage has coverage back to the date of termination from Medicaid or coverage
recently been terminated due to the beginning the month after the month of enrollment
end of the PHE. While Shirley was
enrolled in Medicaid, she missed an
opportunity to enroll in Medicare
and now wants Part B. Which of the
following statements best describes
Shirley's ability to now enroll in
Medicare Part B?
Mrs. Pena is years old, has coverage Mrs. Pena may enroll in Part B at any time while she has employer-
under an employer plan, and will sponsored coverage. Upon retirement, she will be able to enroll in Part
retire next year. She heard she must B during SEP that lasts 8 months following the last month of her
enroll in Part B at the beginning of employer coverage
the year to ensure no gap in
coverage. What can you tell her?
Mr. Bauer is 49 years old, but After receiving such disability payments for months, he will be
eighteen months ago he was automatically enrolled in Medicare, regardless of age
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?
Mr. Capadona would like to The purpose of Medigap plans is to supplement Original Medicare
purchase a Medicare Advantage benefits. Medigap plans do not work with Medicare Advantage plans. It
(MA) plan and a Medigap plan to is illegal to sell a Medigap plan to someone already in a Medicare
pick up costs not covered by that Advantage health plan.
plan. What should you tell him?
, Mr. Davis is 52 years old and has Medicare coverage for individuals with ESRD typically begins on the
recently been diagnosed with end- 4th month after dialysis treatments start.
stage renal disease (ESRD) and will
soon begin dialysis. He is
wondering if he can obtain
coverage under Medicare. What
should you tell him?
Mrs. Gonzalez is enrolled in Original Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but
Medicare and has a Medigap policy she could keep her Medicap policy and enroll in a Part D prescription
as well, but it provides no drug drug plan.
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?
Madeline Martinez was widowed Individuals pay Part B premiums based on their income levels. An
several years ago. Her husband income level of $100,000 would mean Mrs. Martinez would pay a
worked for many years and premium more than the standard
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?
Ms. Henderson believes that she Current employment and/or work history does not entitle a person to
will qualify for Medicare Coverage Part B coverage without paying a monthly premium. Typically, people
when she turns 65, without paying eligible for Medicare pay the standard monthly premium rate for Part B.
any premiums, because she has However, this amount can vary based on an individual's income.
been working for 40 years and
paying Medicare taxes. What should
you tell her?
Ms. Moore plans to retire when she Medicare is a program for people age 65 or older and those under age
turns 65 in a few months. She is in 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's
excellent health and will have disease so she will be eligible for Medicare.
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?
Save
Terms in this set (100)
Mr. Xi will soon turn age 65 and has Medicare Part B generally covers medically necessary physician and
come to you for advice as to what other health care professional services.
services are provided under
Original Medicare. What should you
tell Mr. Xi that best describes the
health coverage provided to
Medicare beneficiaries?
Mr. Diaz continued working with his Mr. Diaz will not pay any penalty because he had continuous coverage
company and was insured under his under his employer's plan
employer's group plan until 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?
Mr. Wu is eligible for Medicare. He Mr. Wu may still qualify for help in paying Part D costs through his State
has limited financial resources but Pharmaceutical Assistance Program
failed to qualify for the part D low-
income subsidy. Where might he
turn for help with his prescription
drug costs?
Edward IP suffered from serious Individuals eligible for Medicare based on ESRD generally lose
kidney disease. As a result, Edward eligibility 36 months after the month in which the individual receives a
became eligible for Medicare kidney transplant
coverage due to end-stage renal
disease. A close relative donated
their kidney and Edward
successfully underwent transplant
surgery 12 months ago. Edward is
now age 50 and asks you if his
Medicare coverage will continue,
what should you say?
,Anthony Retirement Benefits on his Anthony is eligible for a SEP because he missed an enrollment period
65th birthday. He was interested in due to the impact of the Federally declared disaster. This SEP will allow
obtaining Medicare coverage and is Anthony to enroll in Part B up to 6 months after the end of the
eligible for premium-free Part A. emergency declaration. Anthony may enroll in premium-free Part A at
Before he could enroll in Medicare, any time and his Part A coverage will be retroactive for up to 6 months
his entire area was impacted by a
hurricane causing massive flooding
and severe wind damage. The
Federal government declared this
to be a natural disaster which has
recently ended. During this period
Anthony's initial enrollment period
expired. Anthony asks you how he
can now obtain Medicare coverage.
What should you say?
Shirly Thomas was enrolled in Shirley is eligible for SEP for up to 6 months after the termination of her
Medicaid during the Public Health Medicaid coverage. Under this SEP, Shirley can choose retroactive
Emergency. This coverage has coverage back to the date of termination from Medicaid or coverage
recently been terminated due to the beginning the month after the month of enrollment
end of the PHE. While Shirley was
enrolled in Medicaid, she missed an
opportunity to enroll in Medicare
and now wants Part B. Which of the
following statements best describes
Shirley's ability to now enroll in
Medicare Part B?
Mrs. Pena is years old, has coverage Mrs. Pena may enroll in Part B at any time while she has employer-
under an employer plan, and will sponsored coverage. Upon retirement, she will be able to enroll in Part
retire next year. She heard she must B during SEP that lasts 8 months following the last month of her
enroll in Part B at the beginning of employer coverage
the year to ensure no gap in
coverage. What can you tell her?
Mr. Bauer is 49 years old, but After receiving such disability payments for months, he will be
eighteen months ago he was automatically enrolled in Medicare, regardless of age
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?
Mr. Capadona would like to The purpose of Medigap plans is to supplement Original Medicare
purchase a Medicare Advantage benefits. Medigap plans do not work with Medicare Advantage plans. It
(MA) plan and a Medigap plan to is illegal to sell a Medigap plan to someone already in a Medicare
pick up costs not covered by that Advantage health plan.
plan. What should you tell him?
, Mr. Davis is 52 years old and has Medicare coverage for individuals with ESRD typically begins on the
recently been diagnosed with end- 4th month after dialysis treatments start.
stage renal disease (ESRD) and will
soon begin dialysis. He is
wondering if he can obtain
coverage under Medicare. What
should you tell him?
Mrs. Gonzalez is enrolled in Original Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but
Medicare and has a Medigap policy she could keep her Medicap policy and enroll in a Part D prescription
as well, but it provides no drug drug plan.
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?
Madeline Martinez was widowed Individuals pay Part B premiums based on their income levels. An
several years ago. Her husband income level of $100,000 would mean Mrs. Martinez would pay a
worked for many years and premium more than the standard
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?
Ms. Henderson believes that she Current employment and/or work history does not entitle a person to
will qualify for Medicare Coverage Part B coverage without paying a monthly premium. Typically, people
when she turns 65, without paying eligible for Medicare pay the standard monthly premium rate for Part B.
any premiums, because she has However, this amount can vary based on an individual's income.
been working for 40 years and
paying Medicare taxes. What should
you tell her?
Ms. Moore plans to retire when she Medicare is a program for people age 65 or older and those under age
turns 65 in a few months. She is in 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's
excellent health and will have disease so she will be eligible for Medicare.
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?
