AHIP FINAL
Mr. Wu may s ll qualify for help in paying Part D costs through his State Pharmaceu cal
Assistance Program.
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 prescrip on drug costs?
A#er receiving such disability payments for 24 months, he will be automa cally enrolled in
Medicare, regardless of age.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social
Security Administra on and has been receiving disability payments. He is wondering
whether he can obtain coverage under Medicare. What should you tell him?
Mildred may remain enrolled in Allcare and make a hospice elec on. Hospice benefits will be
paid for by Original Medicare under Part A and Allcare will con nue to pay for any non-
hospice services.
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?
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.
Mr. Schmidt would like to plan for re rement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare. What could you tell him?
Tell prospect Jerry Smith that he should consider adding a standalone Part D prescrip on
drug coverage policy to his present coverage.
Agent John Miller is mee ng 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?
He may sign-up for Medicare at any me however coverage usually begins on the fourth
month a#er dialysis treatments start.
,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?
Mr. Diaz will not pay any penalty because he had con nuous coverage under his employer's
plan.
Mr. Diaz con nued working with his company and was insured under his employer's group
plan un l 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?
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 par cipa on 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 substan al income.
Madeline Mar nez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also le# a substan al estate which provides
Madeline with an annual income of approximately $130,000. Madeline, who has only
worked part- me 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?
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months a#er the
month in which the individual receives a kidney transplant unless they are eligible for
Medicare on another basis such as age or disability. Edward may, however, remain enrolled
in Part B but solely for coverage of immunosuppressive drugs if he has no other health care
coverage that would cover the drugs.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close rela ve 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 con nue, what should you say?
She may enroll at any me while she is covered under her employer plan, but she will have a
special eight-month enrollment period a#er the last month on her employer plan that differs
from the standard general enrollment period, during which she may enroll in Medicare Part
B.
Mrs. Peňa is 66 years old, has coverage under an employer plan, and will re re 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?
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.
, 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?
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
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?
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. Park is an elderly re ree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance?
Shirley is eligible for a Special Enrollment Period (SEP) for up to six months a#er the
termina on of her Medicaid coverage. Under this SEP, Shirley can choose retroac ve
coverage back to the date of termina on from Medicaid or coverage beginning the month
a#er the month of enrollment.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This
coverage has recently been terminated due to the 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?
Medicare is a program for people age 65 or older and those under age 65 with certain
disabili es, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for
Medicare.
Ms. Moore plans to re re when she turns 65 in a few months. She is in excellent health and
will have considerable income when she re res. 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?
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her
Medigap policy and enroll in a Part D prescrip on drug plan.
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
exis ng Medigap plan with one that provides drug coverage. What should you tell her?
Most individuals who are ci zens 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. Wu may s ll qualify for help in paying Part D costs through his State Pharmaceu cal
Assistance Program.
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 prescrip on drug costs?
A#er receiving such disability payments for 24 months, he will be automa cally enrolled in
Medicare, regardless of age.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social
Security Administra on and has been receiving disability payments. He is wondering
whether he can obtain coverage under Medicare. What should you tell him?
Mildred may remain enrolled in Allcare and make a hospice elec on. Hospice benefits will be
paid for by Original Medicare under Part A and Allcare will con nue to pay for any non-
hospice services.
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?
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.
Mr. Schmidt would like to plan for re rement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare. What could you tell him?
Tell prospect Jerry Smith that he should consider adding a standalone Part D prescrip on
drug coverage policy to his present coverage.
Agent John Miller is mee ng 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?
He may sign-up for Medicare at any me however coverage usually begins on the fourth
month a#er dialysis treatments start.
,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?
Mr. Diaz will not pay any penalty because he had con nuous coverage under his employer's
plan.
Mr. Diaz con nued working with his company and was insured under his employer's group
plan un l 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?
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 par cipa on 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 substan al income.
Madeline Mar nez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also le# a substan al estate which provides
Madeline with an annual income of approximately $130,000. Madeline, who has only
worked part- me 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?
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months a#er the
month in which the individual receives a kidney transplant unless they are eligible for
Medicare on another basis such as age or disability. Edward may, however, remain enrolled
in Part B but solely for coverage of immunosuppressive drugs if he has no other health care
coverage that would cover the drugs.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close rela ve 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 con nue, what should you say?
She may enroll at any me while she is covered under her employer plan, but she will have a
special eight-month enrollment period a#er the last month on her employer plan that differs
from the standard general enrollment period, during which she may enroll in Medicare Part
B.
Mrs. Peňa is 66 years old, has coverage under an employer plan, and will re re 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?
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.
, 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?
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
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?
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. Park is an elderly re ree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance?
Shirley is eligible for a Special Enrollment Period (SEP) for up to six months a#er the
termina on of her Medicaid coverage. Under this SEP, Shirley can choose retroac ve
coverage back to the date of termina on from Medicaid or coverage beginning the month
a#er the month of enrollment.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This
coverage has recently been terminated due to the 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?
Medicare is a program for people age 65 or older and those under age 65 with certain
disabili es, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for
Medicare.
Ms. Moore plans to re re when she turns 65 in a few months. She is in excellent health and
will have considerable income when she re res. 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?
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her
Medigap policy and enroll in a Part D prescrip on drug plan.
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
exis ng Medigap plan with one that provides drug coverage. What should you tell her?
Most individuals who are ci zens 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.
