AHIP 2026 - Modules 1-5
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1. MOD ! - Review - Mrs. Ellis recently turned 66 and c.Part B primarily covers
decided after many years of work to retire and begin physician services. She will be
receiving Social Security benefits. Shortly thereafter paying a monthly premium
Mrs. Ellis received a letter informing her that she had and, except for many preven-
been automatically enrolled in Medicare Part B. She tive and screening tests, gen-
wants to understand what this means. erally will have 20% co-pay-
What should you tell Mrs. Ellis? ments for these services, in
addition to an annual de-
a.She should disenroll if she does not want to pay ductible.
the monthly premiums. There is no disadvantage in
doing so.
b.She will need to pay no premiums for Part B as
she qualifies for premium-free coverage due to the
number of quarters she has worked.
c.Part B primarily covers physician services. She will
be paying a monthly premium and, except for many
preventive and screening tests, generally will have
20% co-payments for these services, in addition to
an annual deductible.
d.Part B will cover her routine dental and vision
needs.
2. MOD 1 - Review -Juan Perez, who is turning age 65 d.Juan is likely to be eligi-
next month, intends to work for several more years ble for Medicare once he
at Smallcap, Incorporated. Smallcap has a workforce turns age 65 and if he en-
of 15 employees and offers employer-sponsored rolls, Medicare would be-
healthcare coverage. Juan is a naturalized citizen and come the primary payor of his
has contributed to the Medicare system for over 20 healthcare claims and Small-
years. Juan asks you if he will be entitled to Medicare cap does not have to contin-
and if he enrolls how that will impact his employer- ue to offer him coverage com-
sponsored healthcare coverage. How would you re- parable to those under age
spond? 65 under its employer-spon-
, AHIP 2026 - Modules 1-5
Study online at https://quizlet.com/_hiuu5b
sored group health plan and
a.Juan is likely to be ineligible for Medicare since he would become a secondary
was born outside the United States and has only payor.
contributed to the Medicare system for 20 years.
b.Juan is likely to be eligible for Medicare once he
turns age 65 and if he enrolls his employer-spon-
sored coverage would continue to be the primary
payor while Medicare would be considered a sec-
ondary payor of his healthcare claims.
c.Juan is likely to be eligible for Medicare once he
turns age 65 and if h
3. MOD 1 - Review - Agent John Miller is meeting with a.Tell prospect Jerry Smith that
Jerry Smith, a new prospect. Jerry is currently en- he should consider adding a
rolled in Medicare Parts A and B. Jerry has also standalone Part D prescrip-
purchased a Medicare Supplement (Medigap) plan tion drug coverage policy to
which he has had for several years. However, the his present coverage.
plan does not provide drug benefits. How would you
advise Agent John Miller to proceed?
a.Tell prospect Jerry Smith that he should consider
adding a standalone Part D prescription drug cover-
age policy to his present coverage.
b.Tell prospect Jerry Smith that he should drop his
Medigap coverage and put those premium dollars
toward the purchase of a standalone Part D prescrip-
tion drug plan because he can always reactivate his
Medigap policy on a guaranteed issue basis. Fur-
thermore, because he has had Medigap Jerry will not
incur a Part D late enrollment penalty.
c.Tell prospect Jerry Smith that Medigap is simply
, AHIP 2026 - Modules 1-5
Study online at https://quizlet.com/_hiuu5b
a variation of a Medicare Advantage plan and the
companies John r
4. MOD 1 - Review - Mildred Savage enrolled in All- c.Mildred may remain en-
care Medicare Advantage plan several years ago. rolled in Allcare and make
Mildred recently learned that she is suffering from a hospice election. Hospice
inoperable cancer and has just a few months to live. benefits will be paid for by
She would like to spend these final months in hos- Original Medicare under Part
pice care. Mildred's family asks you whether hospice A and Allcare will continue to
benefits will be paid for under the Allcare Medicare pay for any non-hospice ser-
Advantage plan. What should you say? vices
a.Hospice benefits will be available to Mildred but
they will be paid for by Original Medicare under Part
B.
b.Hospice benefits will be paid for under Mildred's
Allcare Medicare Advantage plan which must cover
all Medicare Part A and Part B benefits.
c.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
.d.Hospice benefits are not covered under Medicare
and must be paid for using private f
5. MOD 1 - Review - Mr. Vasquez is in good health and c.Under Original Medicare,
is preparing a budget in anticipation of his retire- there is a single deductible
ment when he turns 66. He wants to understand amount due for the first 60
the health care costs he might be exposed to un- days of any inpatient hospi-
der Medicare if he were to require hospitalization tal stay, after which it con-
because of an illness. In general terms, what could verts into a per-day coinsur-
you tell him about his costs for inpatient hospital ance amount through day 90.
services under Original Medicare? After day 90, he would pay a
, AHIP 2026 - Modules 1-5
Study online at https://quizlet.com/_hiuu5b
a.Under Original Medicare, if the inpatient hospi- daily amount up to 60 days
tal service is provided by a participating Medicare over his lifetime, after which
provider, the co-payment is waived. Co-payments he would be responsible for
are only charged when a beneficiary opts to receive all costs.
care from a non-participating provider.
b.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.
c.Under Original Medicare, there is a single de-
ductible amount due for the first 60 days of any
inpatient hospital stay, after which it converts
6. MOD 1. - Review - Edward suffered from serious kid- a.Individuals eligible for
ney disease. As a result, Edward became eligible for Medicare based on ESRD
Medicare coverage due to end-stage renal disease generally lose eligibility 36
(ESRD). A close relative donated their kidney and months after the month in
Edward successfully underwent transplant surgery which the individual receives a
12 months ago. Edward is now age 50 and asks you kidney transplant unless they
if his Medicare coverage will continue, what should are eligible for Medicare on
you say? another basis such as age or
disability. Edward may, how-
a.Individuals eligible for Medicare based on ESRD ever, remain enrolled in Part
generally lose eligibility 36 months after the month B but solely for coverage of
in which the individual receives a kidney transplant immunosuppressive drugs if
unless they are eligible for Medicare on another ba- he has no other health care
sis such as age or disability. Edward may, however, coverage that would cover the
remain enrolled in Part B but solely for coverage of drugs.
immunosuppressive drugs if he has no other health
care coverage that would cover the drugs.
b.Individuals eligible for Medicare based on ESRD
generally lose eligibility 24 months after the month
Study online at https://quizlet.com/_hiuu5b
1. MOD ! - Review - Mrs. Ellis recently turned 66 and c.Part B primarily covers
decided after many years of work to retire and begin physician services. She will be
receiving Social Security benefits. Shortly thereafter paying a monthly premium
Mrs. Ellis received a letter informing her that she had and, except for many preven-
been automatically enrolled in Medicare Part B. She tive and screening tests, gen-
wants to understand what this means. erally will have 20% co-pay-
What should you tell Mrs. Ellis? ments for these services, in
addition to an annual de-
a.She should disenroll if she does not want to pay ductible.
the monthly premiums. There is no disadvantage in
doing so.
b.She will need to pay no premiums for Part B as
she qualifies for premium-free coverage due to the
number of quarters she has worked.
c.Part B primarily covers physician services. She will
be paying a monthly premium and, except for many
preventive and screening tests, generally will have
20% co-payments for these services, in addition to
an annual deductible.
d.Part B will cover her routine dental and vision
needs.
2. MOD 1 - Review -Juan Perez, who is turning age 65 d.Juan is likely to be eligi-
next month, intends to work for several more years ble for Medicare once he
at Smallcap, Incorporated. Smallcap has a workforce turns age 65 and if he en-
of 15 employees and offers employer-sponsored rolls, Medicare would be-
healthcare coverage. Juan is a naturalized citizen and come the primary payor of his
has contributed to the Medicare system for over 20 healthcare claims and Small-
years. Juan asks you if he will be entitled to Medicare cap does not have to contin-
and if he enrolls how that will impact his employer- ue to offer him coverage com-
sponsored healthcare coverage. How would you re- parable to those under age
spond? 65 under its employer-spon-
, AHIP 2026 - Modules 1-5
Study online at https://quizlet.com/_hiuu5b
sored group health plan and
a.Juan is likely to be ineligible for Medicare since he would become a secondary
was born outside the United States and has only payor.
contributed to the Medicare system for 20 years.
b.Juan is likely to be eligible for Medicare once he
turns age 65 and if he enrolls his employer-spon-
sored coverage would continue to be the primary
payor while Medicare would be considered a sec-
ondary payor of his healthcare claims.
c.Juan is likely to be eligible for Medicare once he
turns age 65 and if h
3. MOD 1 - Review - Agent John Miller is meeting with a.Tell prospect Jerry Smith that
Jerry Smith, a new prospect. Jerry is currently en- he should consider adding a
rolled in Medicare Parts A and B. Jerry has also standalone Part D prescrip-
purchased a Medicare Supplement (Medigap) plan tion drug coverage policy to
which he has had for several years. However, the his present coverage.
plan does not provide drug benefits. How would you
advise Agent John Miller to proceed?
a.Tell prospect Jerry Smith that he should consider
adding a standalone Part D prescription drug cover-
age policy to his present coverage.
b.Tell prospect Jerry Smith that he should drop his
Medigap coverage and put those premium dollars
toward the purchase of a standalone Part D prescrip-
tion drug plan because he can always reactivate his
Medigap policy on a guaranteed issue basis. Fur-
thermore, because he has had Medigap Jerry will not
incur a Part D late enrollment penalty.
c.Tell prospect Jerry Smith that Medigap is simply
, AHIP 2026 - Modules 1-5
Study online at https://quizlet.com/_hiuu5b
a variation of a Medicare Advantage plan and the
companies John r
4. MOD 1 - Review - Mildred Savage enrolled in All- c.Mildred may remain en-
care Medicare Advantage plan several years ago. rolled in Allcare and make
Mildred recently learned that she is suffering from a hospice election. Hospice
inoperable cancer and has just a few months to live. benefits will be paid for by
She would like to spend these final months in hos- Original Medicare under Part
pice care. Mildred's family asks you whether hospice A and Allcare will continue to
benefits will be paid for under the Allcare Medicare pay for any non-hospice ser-
Advantage plan. What should you say? vices
a.Hospice benefits will be available to Mildred but
they will be paid for by Original Medicare under Part
B.
b.Hospice benefits will be paid for under Mildred's
Allcare Medicare Advantage plan which must cover
all Medicare Part A and Part B benefits.
c.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
.d.Hospice benefits are not covered under Medicare
and must be paid for using private f
5. MOD 1 - Review - Mr. Vasquez is in good health and c.Under Original Medicare,
is preparing a budget in anticipation of his retire- there is a single deductible
ment when he turns 66. He wants to understand amount due for the first 60
the health care costs he might be exposed to un- days of any inpatient hospi-
der Medicare if he were to require hospitalization tal stay, after which it con-
because of an illness. In general terms, what could verts into a per-day coinsur-
you tell him about his costs for inpatient hospital ance amount through day 90.
services under Original Medicare? After day 90, he would pay a
, AHIP 2026 - Modules 1-5
Study online at https://quizlet.com/_hiuu5b
a.Under Original Medicare, if the inpatient hospi- daily amount up to 60 days
tal service is provided by a participating Medicare over his lifetime, after which
provider, the co-payment is waived. Co-payments he would be responsible for
are only charged when a beneficiary opts to receive all costs.
care from a non-participating provider.
b.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.
c.Under Original Medicare, there is a single de-
ductible amount due for the first 60 days of any
inpatient hospital stay, after which it converts
6. MOD 1. - Review - Edward suffered from serious kid- a.Individuals eligible for
ney disease. As a result, Edward became eligible for Medicare based on ESRD
Medicare coverage due to end-stage renal disease generally lose eligibility 36
(ESRD). A close relative donated their kidney and months after the month in
Edward successfully underwent transplant surgery which the individual receives a
12 months ago. Edward is now age 50 and asks you kidney transplant unless they
if his Medicare coverage will continue, what should are eligible for Medicare on
you say? another basis such as age or
disability. Edward may, how-
a.Individuals eligible for Medicare based on ESRD ever, remain enrolled in Part
generally lose eligibility 36 months after the month B but solely for coverage of
in which the individual receives a kidney transplant immunosuppressive drugs if
unless they are eligible for Medicare on another ba- he has no other health care
sis such as age or disability. Edward may, however, coverage that would cover the
remain enrolled in Part B but solely for coverage of drugs.
immunosuppressive drugs if he has no other health
care coverage that would cover the drugs.
b.Individuals eligible for Medicare based on ESRD
generally lose eligibility 24 months after the month
