Ahip Study Guide Questions | Questions And Answers.
1. Mr. Davis is turning 65 next month and is already receiving Social Security benefits. He asks if he
needs to sign up for Medicare Part A. What should you tell him? - (answer)He will be automatically
enrolled in Part A and Part B when he turns 65, and the card will be mailed to him.
2. Ms. Smith is 42 years old and has been diagnosed with End-Stage Renal Disease (ESRD). She asks if
she is eligible for Medicare. What should you tell her? - (answer)Yes, individuals under age 65 with ESRD
are eligible for Medicare.
3. Mr. Johnson is 68 and still working for a company with 25 employees. He has group health insurance
through his employer. He asks if he needs to enroll in Medicare Part B now. What should you tell him? -
(answer)He can delay enrolling in Part B without a penalty because he has active employer coverage
through a large employer (20+ employees).
4. Mrs. White is 68 and retired. She missed her Initial Enrollment Period (IEP) and did not sign up for Part
B. She asks what will happen if she enrolls now. What should you tell her? - (answer)She will likely face a
late enrollment penalty for Part B because she did not have creditable coverage.
5. Mr. Green is a Medicare beneficiary and asks if Medicare covers prescription drugs. What should you
tell him? - (answer)Medicare Part D covers prescription drugs, and he can enroll in a standalone Part D
plan or a Medicare Advantage plan that includes drug coverage.
6. Ms. Black is turning 65 and asks about Medicare Advantage (Part C). What should you tell her? -
(answer)Medicare Advantage is an alternative to Original Medicare, offered by private companies, and
often includes extra benefits like dental, vision, and hearing.
7. Mr. Brown has Original Medicare and asks what services are NOT covered. What should you tell him? -
(answer)Original Medicare does not cover routine dental care, vision care, hearing aids, or long-term
custodial care.
8. Mrs. Grey is in a skilled nursing facility after a hip replacement. She asks if Medicare will cover her stay.
What should you tell her? - (answer)Medicare Part A covers up to 100 days of skilled nursing facility care
per benefit period if she meets specific criteria.
,9. Mr. Taylor asks about the "Donut Hole" in Part D. What should you tell him? - (answer)The Donut Hole is
the coverage gap phase where beneficiaries pay a higher share of drug costs until they reach
catastrophic coverage, though the gap has been largely closed under recent legislation.
10. Ms. Harris wants to know if she can have a Medigap policy and a Medicare Advantage plan at the
same time. What should you tell her? - (answer)No, it is illegal for an insurer to sell a Medigap policy to
someone who is enrolled in a Medicare Advantage plan.
11. Mr. Lewis is a Medicare beneficiary. A marketer calls him offering a free gift to switch plans. Is this
allowed? - (answer)No, marketing rules prohibit offering gifts worth more than a nominal value (currently
$15) to induce enrollment.
12. Ms. Clark is asking about the Annual Enrollment Period (AEP). When is it? - (answer)The AEP runs
from October 15 to December 7 each year, allowing beneficiaries to change their Medicare coverage.
13. Mr. Hall wants to switch from Original Medicare to Medicare Advantage during the Open Enrollment
Period (OEP). When is it? - (answer)The OEP runs from January 1 to March 31, allowing beneficiaries to
make a one-time change to their Medicare Advantage or Part D coverage.
14. Mrs. Allen is a dual-eligible beneficiary (Medicare and Medicaid). What does this mean? -
(answer)She qualifies for both Medicare and Medicaid, and Medicaid may help cover her Medicare
premiums, deductibles, and copayments.
15. Mr. Young asks about the Initial Enrollment Period (IEP). How long is it? - (answer)The IEP is a 7-
month period that begins three months before the month he turns 65, includes his birthday month, and
ends three months after.
16. Ms. King has been diagnosed with ALS (Lou Gehrig's disease). Is she eligible for Medicare? -
(answer)Yes, individuals with ALS are automatically eligible for Medicare upon diagnosis, regardless of
age.
17. Mr. Wright is 65 and not a U.S. citizen, but he has been a lawful permanent resident for 6 years. Is he
eligible for Medicare? - (answer)Yes, he is eligible because he is a lawful permanent resident who has
lived in the U.S. for at least 5 continuous years.
, 18. Mrs. Scott wants to know about the late enrollment penalty for Part D. What should you tell her? -
(answer)The penalty is 1% of the national base beneficiary premium for every month she went without
creditable prescription drug coverage.
19. Mr. Adams asks if Medicare covers hospice care. What should you tell him? - (answer)Yes, Medicare
Part A covers hospice care for terminally ill beneficiaries with a life expectancy of 6 months or less.
20. Ms. Baker is concerned about her Medicare Summary Notice (MSN). What is it? - (answer)The MSN is
a summary of all services and supplies billed to Medicare, showing what Medicare paid and what she
may owe.
21. Mr. Carter asks about a "Special Enrollment Period" (SEP). What is it? - (answer)An SEP is a time
outside standard enrollment periods when a beneficiary can enroll or change plans due to certain life
events, such as moving or losing coverage.
22. Mrs. Diaz asks about the difference between Medicare and Medicaid. What should you tell her? -
(answer)Medicare is federal health insurance for people 65+ or with certain disabilities, while Medicaid
is a state and federal program for low-income individuals.
23. Mr. Evans wants to know if Medicare covers long-term care. What should you tell him? -
(answer)Medicare generally does not cover long-term custodial care, such as help with bathing,
dressing, or eating.
24. Ms. Foster asks about the Part B premium. Is it always the same for everyone? - (answer)No, the Part
B premium is income-based, meaning higher-income beneficiaries pay a higher premium.
25. Mr. Garcia is turning 65 and has group health coverage through his job. Does he need Part B? -
(answer)It depends on the size of his employer. If the employer has fewer than 20 employees, he should
enroll in Part B to avoid a penalty.
26. Mrs. Hughes wants to know about the "Welcome to Medicare" preventive visit. What should you tell
her? - (answer)It is a one-time preventive visit covered by Part B within the first 12 months of enrollment.
27. Mr. Irving asks about the Star Ratings for Medicare Advantage plans. What should you tell him? -
(answer)Star Ratings range from 1 to 5 stars, with 5 stars indicating excellent performance, helping
beneficiaries compare plan quality.
1. Mr. Davis is turning 65 next month and is already receiving Social Security benefits. He asks if he
needs to sign up for Medicare Part A. What should you tell him? - (answer)He will be automatically
enrolled in Part A and Part B when he turns 65, and the card will be mailed to him.
2. Ms. Smith is 42 years old and has been diagnosed with End-Stage Renal Disease (ESRD). She asks if
she is eligible for Medicare. What should you tell her? - (answer)Yes, individuals under age 65 with ESRD
are eligible for Medicare.
3. Mr. Johnson is 68 and still working for a company with 25 employees. He has group health insurance
through his employer. He asks if he needs to enroll in Medicare Part B now. What should you tell him? -
(answer)He can delay enrolling in Part B without a penalty because he has active employer coverage
through a large employer (20+ employees).
4. Mrs. White is 68 and retired. She missed her Initial Enrollment Period (IEP) and did not sign up for Part
B. She asks what will happen if she enrolls now. What should you tell her? - (answer)She will likely face a
late enrollment penalty for Part B because she did not have creditable coverage.
5. Mr. Green is a Medicare beneficiary and asks if Medicare covers prescription drugs. What should you
tell him? - (answer)Medicare Part D covers prescription drugs, and he can enroll in a standalone Part D
plan or a Medicare Advantage plan that includes drug coverage.
6. Ms. Black is turning 65 and asks about Medicare Advantage (Part C). What should you tell her? -
(answer)Medicare Advantage is an alternative to Original Medicare, offered by private companies, and
often includes extra benefits like dental, vision, and hearing.
7. Mr. Brown has Original Medicare and asks what services are NOT covered. What should you tell him? -
(answer)Original Medicare does not cover routine dental care, vision care, hearing aids, or long-term
custodial care.
8. Mrs. Grey is in a skilled nursing facility after a hip replacement. She asks if Medicare will cover her stay.
What should you tell her? - (answer)Medicare Part A covers up to 100 days of skilled nursing facility care
per benefit period if she meets specific criteria.
,9. Mr. Taylor asks about the "Donut Hole" in Part D. What should you tell him? - (answer)The Donut Hole is
the coverage gap phase where beneficiaries pay a higher share of drug costs until they reach
catastrophic coverage, though the gap has been largely closed under recent legislation.
10. Ms. Harris wants to know if she can have a Medigap policy and a Medicare Advantage plan at the
same time. What should you tell her? - (answer)No, it is illegal for an insurer to sell a Medigap policy to
someone who is enrolled in a Medicare Advantage plan.
11. Mr. Lewis is a Medicare beneficiary. A marketer calls him offering a free gift to switch plans. Is this
allowed? - (answer)No, marketing rules prohibit offering gifts worth more than a nominal value (currently
$15) to induce enrollment.
12. Ms. Clark is asking about the Annual Enrollment Period (AEP). When is it? - (answer)The AEP runs
from October 15 to December 7 each year, allowing beneficiaries to change their Medicare coverage.
13. Mr. Hall wants to switch from Original Medicare to Medicare Advantage during the Open Enrollment
Period (OEP). When is it? - (answer)The OEP runs from January 1 to March 31, allowing beneficiaries to
make a one-time change to their Medicare Advantage or Part D coverage.
14. Mrs. Allen is a dual-eligible beneficiary (Medicare and Medicaid). What does this mean? -
(answer)She qualifies for both Medicare and Medicaid, and Medicaid may help cover her Medicare
premiums, deductibles, and copayments.
15. Mr. Young asks about the Initial Enrollment Period (IEP). How long is it? - (answer)The IEP is a 7-
month period that begins three months before the month he turns 65, includes his birthday month, and
ends three months after.
16. Ms. King has been diagnosed with ALS (Lou Gehrig's disease). Is she eligible for Medicare? -
(answer)Yes, individuals with ALS are automatically eligible for Medicare upon diagnosis, regardless of
age.
17. Mr. Wright is 65 and not a U.S. citizen, but he has been a lawful permanent resident for 6 years. Is he
eligible for Medicare? - (answer)Yes, he is eligible because he is a lawful permanent resident who has
lived in the U.S. for at least 5 continuous years.
, 18. Mrs. Scott wants to know about the late enrollment penalty for Part D. What should you tell her? -
(answer)The penalty is 1% of the national base beneficiary premium for every month she went without
creditable prescription drug coverage.
19. Mr. Adams asks if Medicare covers hospice care. What should you tell him? - (answer)Yes, Medicare
Part A covers hospice care for terminally ill beneficiaries with a life expectancy of 6 months or less.
20. Ms. Baker is concerned about her Medicare Summary Notice (MSN). What is it? - (answer)The MSN is
a summary of all services and supplies billed to Medicare, showing what Medicare paid and what she
may owe.
21. Mr. Carter asks about a "Special Enrollment Period" (SEP). What is it? - (answer)An SEP is a time
outside standard enrollment periods when a beneficiary can enroll or change plans due to certain life
events, such as moving or losing coverage.
22. Mrs. Diaz asks about the difference between Medicare and Medicaid. What should you tell her? -
(answer)Medicare is federal health insurance for people 65+ or with certain disabilities, while Medicaid
is a state and federal program for low-income individuals.
23. Mr. Evans wants to know if Medicare covers long-term care. What should you tell him? -
(answer)Medicare generally does not cover long-term custodial care, such as help with bathing,
dressing, or eating.
24. Ms. Foster asks about the Part B premium. Is it always the same for everyone? - (answer)No, the Part
B premium is income-based, meaning higher-income beneficiaries pay a higher premium.
25. Mr. Garcia is turning 65 and has group health coverage through his job. Does he need Part B? -
(answer)It depends on the size of his employer. If the employer has fewer than 20 employees, he should
enroll in Part B to avoid a penalty.
26. Mrs. Hughes wants to know about the "Welcome to Medicare" preventive visit. What should you tell
her? - (answer)It is a one-time preventive visit covered by Part B within the first 12 months of enrollment.
27. Mr. Irving asks about the Star Ratings for Medicare Advantage plans. What should you tell him? -
(answer)Star Ratings range from 1 to 5 stars, with 5 stars indicating excellent performance, helping
beneficiaries compare plan quality.
