AHIP EXAM REVIEW UNITS 1–5 WITH COMPLETE QUESTIONS AND ANSWERS | MEDICARE PROGRAM OVERVIEW
MODULE 1 | ELIGIBILITY, CHOICE & BENEFITS 100% VERIFIED
OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS
MODULE 1
1.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?
a. Medicare is a program for people of all ages with specific mental health disabilities. Since she is in
excellent health, she would not qualify, but should instead look into her state’s Medicaid program if she
wants further coverage. Incorrect
b. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal
government. If she or her husband were ever employed by the federal government, she can enroll in
Medicare. Incorrect
c. 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. Correct
d. Medicare is a program for people who have incomes and assets below specific limits, so you will have
to find out her exact financial situation before telling her whether she can obtain Medicare coverage.
Incorrect
1. Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that
might be of assistance?
a. She should not sign up for a Medigap or Medicare Advantage plan. Incorrect
b. She should only seek help from private organizations to cover her Medicare costs. Incorrect
c. She can apply to the Medicare agency for lower premiums and cost-sharing. Incorrect
d. She should contact her state Medicaid agency to see if she qualifies for one of several programs that
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, can help with Medicare costs for which she is responsible. Correct
2. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the
Part D low-income subsidy. Where might he turn for help with his prescription drug costs?
a. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging.
Incorrect
b. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his
state’s Medicaid program. Incorrect
c. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program. Correct
d. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical
Assistance Program. Incorrect
3. 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?
a. 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. Correct
b. Part C, which always covers dental and vision services, is covered under Original Medicare. Incorrect
c. Part A, which covers long term custodial care services, is covered under Original Medicare. Incorrect
d. Part D, which covers prescription drug services, is covered under Original Medicare. Incorrect
4. Mr. Buck has several family members who died from different cancers. He wants to know if
Medicare covers cancer screening. What should you tell him?
a. Medicare covers the periodic performance of a range of screening tests that are meant to provide
early detection of disease. Mr. Buck will need to check specific tests before obtaining them to see if they
will be covered. Correct
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, b. Medicare covers all screening tests that have been approved by the FDA on a frequency determined
by the treating physician. Incorrect
c. Medicare covers some screening tests that must be performed within the first year after enrollment.
Beyond that point expenses for screening tests is the responsibility of the beneficiary. Incorrect
d. Medicare covers treatments for existing disease, injury and malformed limbs or body parts. As such, it
does not cover any screening tests and these must be paid for by the beneficiary out of pocket.
Incorrect
5. 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?
a. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the
same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases
until day 90. After 90 days he would pay the full amount of all costs. Incorrect
b. 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 Correct
c. Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The
percentage increases after 60 days and again after 90 days. Incorrect
d. Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare
provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive
care from a non-participating provider. Incorrect
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?
a. Individuals who become eligible for such disability payments only have to wait 12 months before they
can apply for coverage under Medicare. Incorrect
b. He became eligible for Medicare when his disability eligibility determination was first made. Incorrect
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, c. After Breceiving Bsuch Bdisability Bpayments Bfor B24 Bmonths Bhe Bwill Bbe Bautomatically Benrolled Bin
Medicare,Bregardless Bof Bage. B BCorrect
B
d. Individuals Breceiving Bsuch Bdisability Bpayments Bfrom Bthe BSocial BSecurity BAdministration Bcontinue
toBreceive Bthose Bpayments, Bbut Bonly Bbecome Beligible Bfor BMedicare Bupon Breaching Bage B65.
B
B Incorrect
7. Mrs. BRoberts Bhas Bjust Breceived Ba Bnew BMedicare Bidentity Bcard Bin Bthe Bmail. BShe Bis Bconcerned
thatBit Bis Ba Bforgery Bsince Bit Bdoes Bnot Bhave Bher BSocial BSecurity Bnumber Bon Bit. BWhat Bshould Byou Btell
B
her?
B
a. The Bcard Bis Bindeed Ba Bforgery Bsince Ball Bidentity Bcards Bare Bbeing Bphased Bout Bin Bfavor Bof Ba Bnew
electronicBidentity Bsystem Bdeveloped Bby Bthe BSocial BSecurity BAdministration. B Incorrect
B
b. The Bcard Bshe Breceived Bis Bvalid Bbut Bshe Bshould Bkeep Bher Bold Bcard Bfor Bat Bleast Btwo Byears Band
present BitBwhenever Bshe Breceives Bhealth Bcare. B Incorrect
B
c. The Bcard Bshe Breceived Bis Bvalid, Bthe Bchange Bhas Bbeen Bmade Bto Bprotect BMedicare Bbeneficiaries
fromBidentity Btheft, Band Bshe Bshould Bnow Bdestroy Bher Bold Bcard. B Correct
B
d. The Bcard Bis Bindeed Ba Bforgery Bsince Bnewly Bissued BMedicare Bcards Bwill Bhave Bboth Ba Bbeneficiary’s
SocialBSecurity Bnumber Band Bdate Bof Bbirth Bimprinted Bon Bthem. B Incorrect
B
8. Mrs. BKelly, Bage B65, Bis Bentitled Bto BPart BA Bbut Bhas Bnot Byet Benrolled Bin BPart BB. BShe Bis
B considering Benrollment Bin Ba BMedicare Bhealth Bplan B(Part BC). BWhat Bshould Byou Badvise Bher Bto Bdo
B before Bshe Bwill Bbe BableBto Benroll Bin Ba BMedicare Bhealth Bplan?
a. To Benroll Bin Ba BMedicare Bhealth Bplan, Bshe Bneed Bonly Bbe Bentitled Bto BPart BA, Bso Bshe Bdoes Bnot Bneed Bto
takeBany Bfurther Bsteps. B Incorrect
B
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c. Since Bshe Bis Bage B65 Bshe Bmay Benroll Bin Bany BMedicare Bhealth Bplan, Bregardless Bof Bwhether Bshe Bis
entitled BtoBPart BA Bor BPart BB Bcoverage. B Incorrect
B
d. In Border Bto Bjoin Ba BMedicare Bhealth Bplan, Bshe Balso Bmust Benroll Bin BPart BB. B Correct
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MODULE 1 | ELIGIBILITY, CHOICE & BENEFITS 100% VERIFIED
OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND BENEFITS
MODULE 1
1.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?
a. Medicare is a program for people of all ages with specific mental health disabilities. Since she is in
excellent health, she would not qualify, but should instead look into her state’s Medicaid program if she
wants further coverage. Incorrect
b. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal
government. If she or her husband were ever employed by the federal government, she can enroll in
Medicare. Incorrect
c. 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. Correct
d. Medicare is a program for people who have incomes and assets below specific limits, so you will have
to find out her exact financial situation before telling her whether she can obtain Medicare coverage.
Incorrect
1. Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that
might be of assistance?
a. She should not sign up for a Medigap or Medicare Advantage plan. Incorrect
b. She should only seek help from private organizations to cover her Medicare costs. Incorrect
c. She can apply to the Medicare agency for lower premiums and cost-sharing. Incorrect
d. She should contact her state Medicaid agency to see if she qualifies for one of several programs that
https://www.stuvia.com/user/Mboffin
, can help with Medicare costs for which she is responsible. Correct
2. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the
Part D low-income subsidy. Where might he turn for help with his prescription drug costs?
a. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging.
Incorrect
b. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his
state’s Medicaid program. Incorrect
c. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program. Correct
d. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical
Assistance Program. Incorrect
3. 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?
a. 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. Correct
b. Part C, which always covers dental and vision services, is covered under Original Medicare. Incorrect
c. Part A, which covers long term custodial care services, is covered under Original Medicare. Incorrect
d. Part D, which covers prescription drug services, is covered under Original Medicare. Incorrect
4. Mr. Buck has several family members who died from different cancers. He wants to know if
Medicare covers cancer screening. What should you tell him?
a. Medicare covers the periodic performance of a range of screening tests that are meant to provide
early detection of disease. Mr. Buck will need to check specific tests before obtaining them to see if they
will be covered. Correct
https://www.stuvia.com/user/Mboffin
, b. Medicare covers all screening tests that have been approved by the FDA on a frequency determined
by the treating physician. Incorrect
c. Medicare covers some screening tests that must be performed within the first year after enrollment.
Beyond that point expenses for screening tests is the responsibility of the beneficiary. Incorrect
d. Medicare covers treatments for existing disease, injury and malformed limbs or body parts. As such, it
does not cover any screening tests and these must be paid for by the beneficiary out of pocket.
Incorrect
5. 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?
a. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the
same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases
until day 90. After 90 days he would pay the full amount of all costs. Incorrect
b. 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 Correct
c. Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The
percentage increases after 60 days and again after 90 days. Incorrect
d. Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare
provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive
care from a non-participating provider. Incorrect
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?
a. Individuals who become eligible for such disability payments only have to wait 12 months before they
can apply for coverage under Medicare. Incorrect
b. He became eligible for Medicare when his disability eligibility determination was first made. Incorrect
https://www.stuvia.com/user/Mboffin
, c. After Breceiving Bsuch Bdisability Bpayments Bfor B24 Bmonths Bhe Bwill Bbe Bautomatically Benrolled Bin
Medicare,Bregardless Bof Bage. B BCorrect
B
d. Individuals Breceiving Bsuch Bdisability Bpayments Bfrom Bthe BSocial BSecurity BAdministration Bcontinue
toBreceive Bthose Bpayments, Bbut Bonly Bbecome Beligible Bfor BMedicare Bupon Breaching Bage B65.
B
B Incorrect
7. Mrs. BRoberts Bhas Bjust Breceived Ba Bnew BMedicare Bidentity Bcard Bin Bthe Bmail. BShe Bis Bconcerned
thatBit Bis Ba Bforgery Bsince Bit Bdoes Bnot Bhave Bher BSocial BSecurity Bnumber Bon Bit. BWhat Bshould Byou Btell
B
her?
B
a. The Bcard Bis Bindeed Ba Bforgery Bsince Ball Bidentity Bcards Bare Bbeing Bphased Bout Bin Bfavor Bof Ba Bnew
electronicBidentity Bsystem Bdeveloped Bby Bthe BSocial BSecurity BAdministration. B Incorrect
B
b. The Bcard Bshe Breceived Bis Bvalid Bbut Bshe Bshould Bkeep Bher Bold Bcard Bfor Bat Bleast Btwo Byears Band
present BitBwhenever Bshe Breceives Bhealth Bcare. B Incorrect
B
c. The Bcard Bshe Breceived Bis Bvalid, Bthe Bchange Bhas Bbeen Bmade Bto Bprotect BMedicare Bbeneficiaries
fromBidentity Btheft, Band Bshe Bshould Bnow Bdestroy Bher Bold Bcard. B Correct
B
d. The Bcard Bis Bindeed Ba Bforgery Bsince Bnewly Bissued BMedicare Bcards Bwill Bhave Bboth Ba Bbeneficiary’s
SocialBSecurity Bnumber Band Bdate Bof Bbirth Bimprinted Bon Bthem. B Incorrect
B
8. Mrs. BKelly, Bage B65, Bis Bentitled Bto BPart BA Bbut Bhas Bnot Byet Benrolled Bin BPart BB. BShe Bis
B considering Benrollment Bin Ba BMedicare Bhealth Bplan B(Part BC). BWhat Bshould Byou Badvise Bher Bto Bdo
B before Bshe Bwill Bbe BableBto Benroll Bin Ba BMedicare Bhealth Bplan?
a. To Benroll Bin Ba BMedicare Bhealth Bplan, Bshe Bneed Bonly Bbe Bentitled Bto BPart BA, Bso Bshe Bdoes Bnot Bneed Bto
takeBany Bfurther Bsteps. B Incorrect
B
b. In Border Bto Bjoin Ba BMedicare Bhealth Bplan, Bshe Bmust Bbe Benrolled Bin BParts BA, BB, Band BD. B Incorrect
c. Since Bshe Bis Bage B65 Bshe Bmay Benroll Bin Bany BMedicare Bhealth Bplan, Bregardless Bof Bwhether Bshe Bis
entitled BtoBPart BA Bor BPart BB Bcoverage. B Incorrect
B
d. In Border Bto Bjoin Ba BMedicare Bhealth Bplan, Bshe Balso Bmust Benroll Bin BPart BB. B Correct
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