AHIP FINAL EXAM WITH GRADE A
SOLUTIONS
Mr.RWuRisReligibleRforRMedicare.RHeRhasRlimitedRfinancialRresourcesRbutRfailedRtoR
qualifyRforRtheRPartRDRlow-
incomeRsubsidy.RWhereRmightRheRturnRforRhelpRwithRhisRprescriptionRdrugRcosts?
R-RcorrectRanswer-
Mr.RWuRmayRstillRqualifyRforRhelpRinRpayingRPartRDRcostsRthroughRhisRStateRPhar
maceuticalRAssistanceRProgram.
Mr.RBauerRisR49RyearsRold,RbutReighteenRmonthsRagoRheRwasRdeclaredRdisabledR
byRtheRSocialRSecurityRAdministrationRandRhasRbeenRreceivingRdisabilityRpayment
s.RHeRisRwonderingRwhetherRheRcanRobtainRcoverageRunderRMedicare.RWhatRsho
uldRyouRtellRhim?R-RcorrectRanswer-
AfterRreceivingRsuchRdisabilityRpaymentsRforR24Rmonths,RheRwillRbeRautomaticallyR
enrolledRinRMedicare,RregardlessRofRage.
MildredRSavageRenrolledRinRAllcareRMedicareRAdvantageRplanRseveralRyearsRago.
RMildredRrecentlyRlearnedRthatRsheRisRsufferingRfromRinoperableRcancerRandRhasRj
ustRaRfewRmonthsRtoRlive.RSheRwouldRlikeRtoRspendRtheseRfinalRmonthsRinRhospic
eRcare.RMildred'sRfamilyRasksRyouRwhetherRhospiceRbenefitsRwillRbeRpaidRforRund
erRtheRAllcareRMedicareRAdvantageRplan.RWhatRshouldRyouRsay?R-
RcorrectRanswer-
MildredRmayRremainRenrolledRinRAllcareRandRmakeRaRhospiceRelection.RHospiceRb
enefitsRwillRbeRpaidRforRbyROriginalRMedicareRunderRPartRARandRAllcareRwillRconti
nueRtoRpayRforRanyRnon-hospiceRservices.
Mr.RSchmidtRwouldRlikeRtoRplanRforRretirementRandRhasRaskedRyouRwhatRisRcover
edRunderROriginalRFee-for-ServiceR(FFS)RMedicare.RWhatRcouldRyouRtellRhim?R-
RcorrectRanswer-
PartRA,RwhichRcoversRhospital,RskilledRnursingRfacility,Rhospice,RandRhomeRhealthR
servicesRandRPartRB,RwhichRcoversRprofessionalRservicesRsuchRasRthoseRprovided
RbyRaRdoctorRareRcoveredRunderROriginalRMedicare.
,AgentRJohnRMillerRisRmeetingRwithRJerryRSmith,RaRnewRprospect.RJerryRisRcurrentl
yRenrolledRinRMedicareRPartsRARandRB.RJerryRhasRalsoRpurchasedRaRMedicareRSu
pplementR(Medigap)RplanRwhichRheRhasRhadRforRseveralRyears.RHowever,RtheRpla
nRdoesRnotRprovideRdrugRbenefits.RHowRwouldRyouRadviseRAgentRJohnRMillerRtoR
proceed?R-RcorrectRanswer-
TellRprospectRJerryRSmithRthatRheRshouldRconsiderRaddingRaRstandaloneRPartRDRp
rescriptionRdrugRcoverageRpolicyRtoRhisRpresentRcoverage.
Mr.RDavisRisR52RyearsRoldRandRhasRrecentlyRbeenRdiagnosedRwithRend-
stageRrenalRdiseaseR(ESRD)RandRwillRsoonRbeginRdialysis.RHeRisRwonderingRifRhe
RcanRobtainRcoverageRunderRMedicare.RWhatRshouldRyouRtellRhim?R-
RcorrectRanswer-HeRmayRsign-
upRforRMedicareRatRanyRtimeRhoweverRcoverageRusuallyRbeginsRonRtheRfourthRmo
nthRafterRdialysisRtreatmentsRstart.
Mr.RDiazRcontinuedRworkingRwithRhisRcompanyRandRwasRinsuredRunderRhisRemplo
yer'sRgroupRplanRuntilRheRreachedRageR68.RHeRhasRheardRthatRthereRisRaRpremiu
mRpenaltyRforRthoseRwhoRdidRnotRsignRupRforRPartRBRwhenRfirstReligibleRandRwant
sRtoRknowRhowRmuchRheRwillRhaveRtoRpay.RWhatRshouldRyouRtellRhim?R-
RcorrectRanswer-
Mr.RDiazRwillRnotRpayRanyRpenaltyRbecauseRheRhadRcontinuousRcoverageRunderRh
isRemployer'sRplan.
MadelineRMartinezRwasRwidowedRseveralRyearsRago.RHerRhusbandRworkedRforRm
anyRyearsRandRcontributedRintoRtheRMedicareRsystem.RHeRalsoRleftRaRsubstantialR
estateRwhichRprovidesRMadelineRwithRanRannualRincomeRofRapproximatelyR$130,0
00.RMadeline,RwhoRhasRonlyRworkedRpart-
timeRforRtheRlastRthreeRyears,RwillRsoonRturnRageR65RandRhopesRtoRenrollRinROrigi
nalRMedicare.RSheRcomesRtoRyouRforRadvice.RWhatRshouldRyouRtellRher?R-
RcorrectRanswer-
YouRshouldRtellRMadelineRthatRsheRwillRbeRableRtoRenrollRinRMedicareRPartRARwith
outRpayingRmonthlyRpremiumsRdueRtoRherRhusband'sRlongRworkRrecordRandRpartic
ipationRinRtheRMedicareRsystem.RYouRshouldRalsoRtellRMadelineRthatRsheRwillRpay
RPartRBRpremiumsRatRmoreRthanRtheRstandardRlowestRrateRbutRlessRthanRtheRhigh
estRrateRdueRherRsubstantialRincome.
EdwardRIPRsufferedRfromRseriousRkidneyRdisease.RAsRaRresult.REdwardRbecameRe
ligibleRforRMedicareRcoverageRdueRtoRend-
stageRrenalRdiseaseR(ESRD).RARcloseRrelativeRdonatedRtheirRkidneyRandREdwardR
successfullyRunderwentRtransplantRsurgeryR12RmonthsRago.REdwardRisRnowRageR
50RandRasksRyouRifRhisRMedicareRcoverageRwillRcontinue,RwhatRshouldRyouRsay?
R-RcorrectRanswer-
IndividualsReligibleRforRMedicareRbasedRonRESRDRgenerallyRloseReligibilityR36Rmo
nthsRafterRtheRmonthRinRwhichRtheRindividualRreceivesRaRkidneyRtransplantRunless
RtheyRareReligibleRforRMedicareRonRanotherRbasisRsuchRasRageRorRdisability.REdw
ardRmay,Rhowever,RremainRenrolledRinRPartRBRbutRsolelyRforRcoverageRofRimmuno
suppressiveRdrugsRifRheRhasRnoRotherRhealthRcareRcoverageRthatRwouldRcoverRth
eRdrugs.
, Mrs.RPeňaRisR66RyearsRold,RhasRcoverageRunderRanRemployerRplan,RandRwillRretir
eRnextRyear.RSheRheardRsheRmustRenrollRinRPartRBRatRtheRbeginningRofRtheRyearR
toRensureRnoRgapRinRcoverage.RWhatRcanRyouRtellRher?R-RcorrectRanswer-
SheRmayRenrollRatRanyRtimeRwhileRsheRisRcoveredRunderRherRemployerRplan,RbutR
sheRwillRhaveRaRspecialReight-
monthRenrollmentRperiodRafterRtheRlastRmonthRonRherRemployerRplanRthatRdiffersRf
romRtheRstandardRgeneralRenrollmentRperiod,RduringRwhichRsheRmayRenrollRinRMe
dicareRPartRB.
Mr.RCapadonaRwouldRlikeRtoRpurchaseRaRMedicareRAdvantageR(MA)RplanRandRaR
MedigapRplanRtoRpickRupRcostsRnotRcoveredRbyRthatRplan.RWhatRshouldRyouRtellR
him?R-RcorrectRanswer-
ItRisRillegalRforRyouRtoRsellRMr.RCapadonaRaRMedigapRplanRifRheRisRenrolledRinRan
RMARplan,RandRbesides,RMedigapRonlyRworksRwithROriginalRMedicare.
Ms.RHendersonRbelievesRthatRsheRwillRqualifyRforRMedicareRCoverageRwhenRsheRt
urnsR65,RwithoutRpayingRanyRpremiums,RbecauseRsheRhasRbeenRworkingRforR40Ry
earsRandRpayingRMedicareRtaxes.RWhatRshouldRyouRtellRher?R-RcorrectRanswer-
ToRobtainRPartRBRcoverage,RsheRmustRpayRaRstandardRmonthlyRpremium,Rthough
RitRisRhigherRforRindividualsRwithRhigherRincomes.
Mrs.RParkRisRanRelderlyRretiree.RMrs.RParkRhasRaRlowRfixedRincome.RWhatRcouldR
youRtellRMrs.RParkRthatRmightRbeRofRassistance?R-RcorrectRanswer-
SheRshouldRcontactRherRstateRMedicaidRagencyRtoRseeRifRsheRqualifiesRforRoneRof
RseveralRprogramsRthatRcanRhelpRwithRMedicareRcostsRforRwhichRsheRisRresponsib
le.
ShirlyRThomasRwasRenrolledRinRMedicaidRduringRtheRPublicRHealthREmergencyR(P
HE).RThisRcoverageRhasRrecentlyRbeenRterminatedRdueRtoRtheRendRofRtheRPHE.R
WhileRShirleyRwasRenrolledRinRMedicaid,RsheRmissedRanRopportunityRtoRenrollRinR
MedicareRandRnowRwantsRPartRB.RWhichRofRtheRfollowingRstatementsRbestRdescri
besRShirley'sRabilityRtoRnowRenrollRinRMedicareRPartRB?R-RcorrectRanswer-
ShirleyRisReligibleRforRaRSpecialREnrollmentRPeriodR(SEP)RforRupRtoRsixRmonthsRaf
terRtheRterminationRofRherRMedicaidRcoverage.RUnderRthisRSEP,RShirleyRcanRchoo
seRretroactiveRcoverageRbackRtoRtheRdateRofRterminationRfromRMedicaidRorRcover
ageRbeginningRtheRmonthRafterRtheRmonthRofRenrollment.
Ms.RMooreRplansRtoRretireRwhenRsheRturnsR65RinRaRfewRmonths.RSheRisRinRexcell
entRhealthRandRwillRhaveRconsiderableRincomeRwhenRsheRretires.RSheRisRconcern
edRthatRherRincomeRwillRmakeRitRimpossibleRforRherRtoRqualifyRforRMedicare.RWhat
RcouldRyouRtellRherRtoRaddressRherRconcern?R-RcorrectRanswer-
MedicareRisRaRprogramRforRpeopleRageR65RorRolderRandRthoseRunderRageR65Rwit
hRcertainRdisabilities,Rend-
stageRrenalRdisease,RandRLouRGehrig'sRdiseaseRsoRsheRwillRbeReligibleRforRMedic
are.
Mrs.RGonzalezRisRenrolledRinROriginalRMedicareRandRhasRaRMedigapRpolicyRasRw
ell,RbutRitRprovidesRnoRdrugRcoverage.RSheRwouldRlikeRtoRkeepRtheRcoverageRshe
RhasRbutRreplaceRherRexistingRMedigapRplanRwithRoneRthatRprovidesRdrugRcoverag
e.RWhatRshouldRyouRtellRher?R-RcorrectRanswer-
SOLUTIONS
Mr.RWuRisReligibleRforRMedicare.RHeRhasRlimitedRfinancialRresourcesRbutRfailedRtoR
qualifyRforRtheRPartRDRlow-
incomeRsubsidy.RWhereRmightRheRturnRforRhelpRwithRhisRprescriptionRdrugRcosts?
R-RcorrectRanswer-
Mr.RWuRmayRstillRqualifyRforRhelpRinRpayingRPartRDRcostsRthroughRhisRStateRPhar
maceuticalRAssistanceRProgram.
Mr.RBauerRisR49RyearsRold,RbutReighteenRmonthsRagoRheRwasRdeclaredRdisabledR
byRtheRSocialRSecurityRAdministrationRandRhasRbeenRreceivingRdisabilityRpayment
s.RHeRisRwonderingRwhetherRheRcanRobtainRcoverageRunderRMedicare.RWhatRsho
uldRyouRtellRhim?R-RcorrectRanswer-
AfterRreceivingRsuchRdisabilityRpaymentsRforR24Rmonths,RheRwillRbeRautomaticallyR
enrolledRinRMedicare,RregardlessRofRage.
MildredRSavageRenrolledRinRAllcareRMedicareRAdvantageRplanRseveralRyearsRago.
RMildredRrecentlyRlearnedRthatRsheRisRsufferingRfromRinoperableRcancerRandRhasRj
ustRaRfewRmonthsRtoRlive.RSheRwouldRlikeRtoRspendRtheseRfinalRmonthsRinRhospic
eRcare.RMildred'sRfamilyRasksRyouRwhetherRhospiceRbenefitsRwillRbeRpaidRforRund
erRtheRAllcareRMedicareRAdvantageRplan.RWhatRshouldRyouRsay?R-
RcorrectRanswer-
MildredRmayRremainRenrolledRinRAllcareRandRmakeRaRhospiceRelection.RHospiceRb
enefitsRwillRbeRpaidRforRbyROriginalRMedicareRunderRPartRARandRAllcareRwillRconti
nueRtoRpayRforRanyRnon-hospiceRservices.
Mr.RSchmidtRwouldRlikeRtoRplanRforRretirementRandRhasRaskedRyouRwhatRisRcover
edRunderROriginalRFee-for-ServiceR(FFS)RMedicare.RWhatRcouldRyouRtellRhim?R-
RcorrectRanswer-
PartRA,RwhichRcoversRhospital,RskilledRnursingRfacility,Rhospice,RandRhomeRhealthR
servicesRandRPartRB,RwhichRcoversRprofessionalRservicesRsuchRasRthoseRprovided
RbyRaRdoctorRareRcoveredRunderROriginalRMedicare.
,AgentRJohnRMillerRisRmeetingRwithRJerryRSmith,RaRnewRprospect.RJerryRisRcurrentl
yRenrolledRinRMedicareRPartsRARandRB.RJerryRhasRalsoRpurchasedRaRMedicareRSu
pplementR(Medigap)RplanRwhichRheRhasRhadRforRseveralRyears.RHowever,RtheRpla
nRdoesRnotRprovideRdrugRbenefits.RHowRwouldRyouRadviseRAgentRJohnRMillerRtoR
proceed?R-RcorrectRanswer-
TellRprospectRJerryRSmithRthatRheRshouldRconsiderRaddingRaRstandaloneRPartRDRp
rescriptionRdrugRcoverageRpolicyRtoRhisRpresentRcoverage.
Mr.RDavisRisR52RyearsRoldRandRhasRrecentlyRbeenRdiagnosedRwithRend-
stageRrenalRdiseaseR(ESRD)RandRwillRsoonRbeginRdialysis.RHeRisRwonderingRifRhe
RcanRobtainRcoverageRunderRMedicare.RWhatRshouldRyouRtellRhim?R-
RcorrectRanswer-HeRmayRsign-
upRforRMedicareRatRanyRtimeRhoweverRcoverageRusuallyRbeginsRonRtheRfourthRmo
nthRafterRdialysisRtreatmentsRstart.
Mr.RDiazRcontinuedRworkingRwithRhisRcompanyRandRwasRinsuredRunderRhisRemplo
yer'sRgroupRplanRuntilRheRreachedRageR68.RHeRhasRheardRthatRthereRisRaRpremiu
mRpenaltyRforRthoseRwhoRdidRnotRsignRupRforRPartRBRwhenRfirstReligibleRandRwant
sRtoRknowRhowRmuchRheRwillRhaveRtoRpay.RWhatRshouldRyouRtellRhim?R-
RcorrectRanswer-
Mr.RDiazRwillRnotRpayRanyRpenaltyRbecauseRheRhadRcontinuousRcoverageRunderRh
isRemployer'sRplan.
MadelineRMartinezRwasRwidowedRseveralRyearsRago.RHerRhusbandRworkedRforRm
anyRyearsRandRcontributedRintoRtheRMedicareRsystem.RHeRalsoRleftRaRsubstantialR
estateRwhichRprovidesRMadelineRwithRanRannualRincomeRofRapproximatelyR$130,0
00.RMadeline,RwhoRhasRonlyRworkedRpart-
timeRforRtheRlastRthreeRyears,RwillRsoonRturnRageR65RandRhopesRtoRenrollRinROrigi
nalRMedicare.RSheRcomesRtoRyouRforRadvice.RWhatRshouldRyouRtellRher?R-
RcorrectRanswer-
YouRshouldRtellRMadelineRthatRsheRwillRbeRableRtoRenrollRinRMedicareRPartRARwith
outRpayingRmonthlyRpremiumsRdueRtoRherRhusband'sRlongRworkRrecordRandRpartic
ipationRinRtheRMedicareRsystem.RYouRshouldRalsoRtellRMadelineRthatRsheRwillRpay
RPartRBRpremiumsRatRmoreRthanRtheRstandardRlowestRrateRbutRlessRthanRtheRhigh
estRrateRdueRherRsubstantialRincome.
EdwardRIPRsufferedRfromRseriousRkidneyRdisease.RAsRaRresult.REdwardRbecameRe
ligibleRforRMedicareRcoverageRdueRtoRend-
stageRrenalRdiseaseR(ESRD).RARcloseRrelativeRdonatedRtheirRkidneyRandREdwardR
successfullyRunderwentRtransplantRsurgeryR12RmonthsRago.REdwardRisRnowRageR
50RandRasksRyouRifRhisRMedicareRcoverageRwillRcontinue,RwhatRshouldRyouRsay?
R-RcorrectRanswer-
IndividualsReligibleRforRMedicareRbasedRonRESRDRgenerallyRloseReligibilityR36Rmo
nthsRafterRtheRmonthRinRwhichRtheRindividualRreceivesRaRkidneyRtransplantRunless
RtheyRareReligibleRforRMedicareRonRanotherRbasisRsuchRasRageRorRdisability.REdw
ardRmay,Rhowever,RremainRenrolledRinRPartRBRbutRsolelyRforRcoverageRofRimmuno
suppressiveRdrugsRifRheRhasRnoRotherRhealthRcareRcoverageRthatRwouldRcoverRth
eRdrugs.
, Mrs.RPeňaRisR66RyearsRold,RhasRcoverageRunderRanRemployerRplan,RandRwillRretir
eRnextRyear.RSheRheardRsheRmustRenrollRinRPartRBRatRtheRbeginningRofRtheRyearR
toRensureRnoRgapRinRcoverage.RWhatRcanRyouRtellRher?R-RcorrectRanswer-
SheRmayRenrollRatRanyRtimeRwhileRsheRisRcoveredRunderRherRemployerRplan,RbutR
sheRwillRhaveRaRspecialReight-
monthRenrollmentRperiodRafterRtheRlastRmonthRonRherRemployerRplanRthatRdiffersRf
romRtheRstandardRgeneralRenrollmentRperiod,RduringRwhichRsheRmayRenrollRinRMe
dicareRPartRB.
Mr.RCapadonaRwouldRlikeRtoRpurchaseRaRMedicareRAdvantageR(MA)RplanRandRaR
MedigapRplanRtoRpickRupRcostsRnotRcoveredRbyRthatRplan.RWhatRshouldRyouRtellR
him?R-RcorrectRanswer-
ItRisRillegalRforRyouRtoRsellRMr.RCapadonaRaRMedigapRplanRifRheRisRenrolledRinRan
RMARplan,RandRbesides,RMedigapRonlyRworksRwithROriginalRMedicare.
Ms.RHendersonRbelievesRthatRsheRwillRqualifyRforRMedicareRCoverageRwhenRsheRt
urnsR65,RwithoutRpayingRanyRpremiums,RbecauseRsheRhasRbeenRworkingRforR40Ry
earsRandRpayingRMedicareRtaxes.RWhatRshouldRyouRtellRher?R-RcorrectRanswer-
ToRobtainRPartRBRcoverage,RsheRmustRpayRaRstandardRmonthlyRpremium,Rthough
RitRisRhigherRforRindividualsRwithRhigherRincomes.
Mrs.RParkRisRanRelderlyRretiree.RMrs.RParkRhasRaRlowRfixedRincome.RWhatRcouldR
youRtellRMrs.RParkRthatRmightRbeRofRassistance?R-RcorrectRanswer-
SheRshouldRcontactRherRstateRMedicaidRagencyRtoRseeRifRsheRqualifiesRforRoneRof
RseveralRprogramsRthatRcanRhelpRwithRMedicareRcostsRforRwhichRsheRisRresponsib
le.
ShirlyRThomasRwasRenrolledRinRMedicaidRduringRtheRPublicRHealthREmergencyR(P
HE).RThisRcoverageRhasRrecentlyRbeenRterminatedRdueRtoRtheRendRofRtheRPHE.R
WhileRShirleyRwasRenrolledRinRMedicaid,RsheRmissedRanRopportunityRtoRenrollRinR
MedicareRandRnowRwantsRPartRB.RWhichRofRtheRfollowingRstatementsRbestRdescri
besRShirley'sRabilityRtoRnowRenrollRinRMedicareRPartRB?R-RcorrectRanswer-
ShirleyRisReligibleRforRaRSpecialREnrollmentRPeriodR(SEP)RforRupRtoRsixRmonthsRaf
terRtheRterminationRofRherRMedicaidRcoverage.RUnderRthisRSEP,RShirleyRcanRchoo
seRretroactiveRcoverageRbackRtoRtheRdateRofRterminationRfromRMedicaidRorRcover
ageRbeginningRtheRmonthRafterRtheRmonthRofRenrollment.
Ms.RMooreRplansRtoRretireRwhenRsheRturnsR65RinRaRfewRmonths.RSheRisRinRexcell
entRhealthRandRwillRhaveRconsiderableRincomeRwhenRsheRretires.RSheRisRconcern
edRthatRherRincomeRwillRmakeRitRimpossibleRforRherRtoRqualifyRforRMedicare.RWhat
RcouldRyouRtellRherRtoRaddressRherRconcern?R-RcorrectRanswer-
MedicareRisRaRprogramRforRpeopleRageR65RorRolderRandRthoseRunderRageR65Rwit
hRcertainRdisabilities,Rend-
stageRrenalRdisease,RandRLouRGehrig'sRdiseaseRsoRsheRwillRbeReligibleRforRMedic
are.
Mrs.RGonzalezRisRenrolledRinROriginalRMedicareRandRhasRaRMedigapRpolicyRasRw
ell,RbutRitRprovidesRnoRdrugRcoverage.RSheRwouldRlikeRtoRkeepRtheRcoverageRshe
RhasRbutRreplaceRherRexistingRMedigapRplanRwithRoneRthatRprovidesRdrugRcoverag
e.RWhatRshouldRyouRtellRher?R-RcorrectRanswer-
