AHIP 2024 FINAL EXAM WITH APPROVVED AND VALID
ANSWERS 2025-2026
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
go to for her health care. What should you tell her? - ANSWER Mrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she
sees a provider who/that is not a part of the PPO network.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What
would be a correct description? - ANSWER Medicare Advantage is a way of covering all the Original
Medicare benefits through private health insurance companies.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago but
is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and contributed
to the Medicare system. Juan suffers from diabetes. He will soon retire and asks you if he can enroll in a
Medicare Advantage plan that you represent. How would you respond? - ANSWER Juan is eligible to enroll
in a Medicare Advantage as long as he is entitled to Part A and enrolled in Part B. Juan should go to the
Social Security website to enroll in Medicare Part A and B if he has not done so already. Once he is
enrolled, he can choose a Medicare Advantage plan.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the
Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to
purchase extra coverage that he will not need. What should you tell him? - ANSWER He will need to enroll
in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium
penalty. To reduce his expenses, he should look for a plan with a zero premium.
Mr. Schultz was still working when he first qualified for Medicare. At that time, he had employer group
coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he
was satisfied with his drug coverage. It is now a year later and Mr. Schultz has lost his employer group
coverage within the last two weeks. How would you advise him? - ANSWER Mr. Schultz should enroll in a
Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty.
, Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance? - ANSWER She should contact her state Medicaid agency to see if she qualifies
forprograms that can help with Medicare costs for which she is responsible.
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? -
ANSWER 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.
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 - ANSWER After receiving such disability payments for
24 months, he will be automatically enrolled in Medicare, regardless of age.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-
Service (FFS) Medicare? What could you tell him? - ANSWER 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.
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 that differs from the standard general enrollment period, during which
she may enroll in Medicare Part B.
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? - ANSWER Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
ANSWERS 2025-2026
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
go to for her health care. What should you tell her? - ANSWER Mrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she
sees a provider who/that is not a part of the PPO network.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What
would be a correct description? - ANSWER Medicare Advantage is a way of covering all the Original
Medicare benefits through private health insurance companies.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago but
is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and contributed
to the Medicare system. Juan suffers from diabetes. He will soon retire and asks you if he can enroll in a
Medicare Advantage plan that you represent. How would you respond? - ANSWER Juan is eligible to enroll
in a Medicare Advantage as long as he is entitled to Part A and enrolled in Part B. Juan should go to the
Social Security website to enroll in Medicare Part A and B if he has not done so already. Once he is
enrolled, he can choose a Medicare Advantage plan.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the
Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to
purchase extra coverage that he will not need. What should you tell him? - ANSWER He will need to enroll
in a Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium
penalty. To reduce his expenses, he should look for a plan with a zero premium.
Mr. Schultz was still working when he first qualified for Medicare. At that time, he had employer group
coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he
was satisfied with his drug coverage. It is now a year later and Mr. Schultz has lost his employer group
coverage within the last two weeks. How would you advise him? - ANSWER Mr. Schultz should enroll in a
Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty.
, Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance? - ANSWER She should contact her state Medicaid agency to see if she qualifies
forprograms that can help with Medicare costs for which she is responsible.
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? -
ANSWER 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.
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 - ANSWER After receiving such disability payments for
24 months, he will be automatically enrolled in Medicare, regardless of age.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-
Service (FFS) Medicare? What could you tell him? - ANSWER 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.
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 that differs from the standard general enrollment period, during which
she may enroll in Medicare Part B.
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? - ANSWER Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
