2022-2023 AHIP FINAL
EXAM QUESTIONS AND
VERIFIED
ANSWERS/AGRADE
1. 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 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?:
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after
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.
2. 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?: Mildred may remain enrolled in Allcare and make a hospice
election. Hospice benefits will be paid for by Original Medicare under Part A and Allcare
will continue to pay for any non-hospice services.
,3. Mr. Diaz continued working with his company and was insured under his employer's
group plan until 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?: Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer's plan.
4. 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?: 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.
5. 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.
6. Mr. Bauer is 49 years old, but eighteen months ago he was 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?: After receiving
such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
7. 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?: Beneficiaries under Original Medicare have
,no cost-sharing for most preventive services which include immunizations such as annual
flu shots.
8. Mrs. PeHa 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.
9. 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.
10. Madeline Martinez was widowed several years ago. Her husband worked for many
years and 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?: 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 participation 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 substantial income.
11. 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.
, 12. To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.: 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.
13. Agent John Miller is meeting 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?: Tell prospect Jerry Smith
that he should consider adding a standalone Part D prescription drug coverage policy to his
present coverage.
14. 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.
15. 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?: 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.
16. 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.
EXAM QUESTIONS AND
VERIFIED
ANSWERS/AGRADE
1. 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 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?:
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after
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.
2. 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?: Mildred may remain enrolled in Allcare and make a hospice
election. Hospice benefits will be paid for by Original Medicare under Part A and Allcare
will continue to pay for any non-hospice services.
,3. Mr. Diaz continued working with his company and was insured under his employer's
group plan until 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?: Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer's plan.
4. 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?: 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.
5. 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.
6. Mr. Bauer is 49 years old, but eighteen months ago he was 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?: After receiving
such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
7. 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?: Beneficiaries under Original Medicare have
,no cost-sharing for most preventive services which include immunizations such as annual
flu shots.
8. Mrs. PeHa 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.
9. 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.
10. Madeline Martinez was widowed several years ago. Her husband worked for many
years and 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?: 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 participation 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 substantial income.
11. 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.
, 12. To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.: 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.
13. Agent John Miller is meeting 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?: Tell prospect Jerry Smith
that he should consider adding a standalone Part D prescription drug coverage policy to his
present coverage.
14. 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.
15. 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?: 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.
16. 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.
