AHIP FINAL EXAM SCRIPT SET 2 UPDATED
ACTUAL QUESTIONS AND CORRECT ANSWERS
⩥ Juan Perez, who is turning age 65 next month, intends to work for
several more years at Smallcap, Incorporated. Smallcap has a workforce
of15 employees 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.
⩥ 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 and Part B deductibles or coinsurance in
Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
⩥ Mrs. Peňa 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? Answer:
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.
⩥ 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?
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.
⩥ 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? Answer: 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.
⩥ 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? Answer: Medicare does not cover massage therapy,
or, in general, glasses or dentures.
,⩥ 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? 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.
⩥ 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? Answer: To obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher
incomes.
⩥ 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 expect to encounter when enrolling into a standard
MedicarePart D prescription drug plan. What should you tell him?
Answer: He generally would pay a monthly premium, annual deductible,
and per-prescription cost-sharing.
, ⩥ 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?
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.
⩥ 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? Answer: Beneficiaries under Original Medicare have no
cost-sharing for most preventive services which include immunizations
such as annual flu shots.
⩥ Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees
with a determination that partially denied one of her claims for services.
What advice would you give her? Answer: Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she
received the MSN in the mail.
⩥ 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.
ACTUAL QUESTIONS AND CORRECT ANSWERS
⩥ Juan Perez, who is turning age 65 next month, intends to work for
several more years at Smallcap, Incorporated. Smallcap has a workforce
of15 employees 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.
⩥ 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 and Part B deductibles or coinsurance in
Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
⩥ Mrs. Peňa 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? Answer:
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.
⩥ 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?
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.
⩥ 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? Answer: 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.
⩥ 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? Answer: Medicare does not cover massage therapy,
or, in general, glasses or dentures.
,⩥ 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? 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.
⩥ 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? Answer: To obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher
incomes.
⩥ 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 expect to encounter when enrolling into a standard
MedicarePart D prescription drug plan. What should you tell him?
Answer: He generally would pay a monthly premium, annual deductible,
and per-prescription cost-sharing.
, ⩥ 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?
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.
⩥ 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? Answer: Beneficiaries under Original Medicare have no
cost-sharing for most preventive services which include immunizations
such as annual flu shots.
⩥ Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees
with a determination that partially denied one of her claims for services.
What advice would you give her? Answer: Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she
received the MSN in the mail.
⩥ 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.
