AHIP Final Exam (Actual Test) Graded A+: Complete
Study Guide for Passing on Your First Attempt 2025
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? - Answer-Mr. Wu may still qualify for help in paying Part
D costs through his State Pharmaceutical Assistance Program.
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.
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? - Answer-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.
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? - Answer-He may sign-up for
Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
,Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be the correct description? - Answer-Medicare
Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - Answer-In most Medicare
Advantage HMOs, Mr. Kumar must generally obtain his services only from
providers within the plan's network (except in an emergency or where care is
unavailable within the network).
Mrs. Quinn has just turned 65, is in excellent health and has a relatively high
income. She uses no medications and sees no reason to spend money on a
Medicare prescription drug plan if she does not need the coverage. She currently
does not have creditable coverage. What could you tell her about the implications
of such a decision? - Answer-If she does not sign up for a Medicare prescription
drug plan as soon as she is eligible to do so, and if she does sign up at a later date,
her premium will be permanently increased by 1% of the national average
premium for every month that she was not covered.
Mrs. Walters is entitled to Part A and has medical coverage without drug
coverage through an employer retiree plan. She is not enrolled in Part B. Since the
employer plan does not cover prescription drugs, she wants to enroll in a
Medicare prescription drug plan. Will she be able to? - Answer-Yes. Mrs. Walters
must be entitled to Part A and/or enrolled in Part B to be eligible for coverage
under the Medicare prescription drug program.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy
will be worth the time to fill out the paperwork. What could you tell her? -
Answer-The Part D low-income subsidy could substantially lower her overall costs.
, She can apply by contacting her state Medicaid office or calling the Social Security
Administration.
Mr. Torres has a small savings account. He would like to pay for his monthly Part
D premiums with an automatic monthly withdrawal from his savings account until
it is exhausted, and then have his premiums withheld from his Social Security
check. What should you tell him? - Answer-In general, he must select a single Part
D premium payment mechanism that will be used throughout the year.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any
other option he has for obtaining help with his considerable drug costs. What
should you tell him? - Answer-He could check with the manufacturers of his
medications to see if they offer an assistance program to help people with limited
means to obtain the medications they need. Alternatively, he could check to see
whether his state has a pharmacy assistance program to help him with his
expenses.
Charles McCarthy is a Medicare beneficiary who suffers from diabetes. Mr.
McCarthy is considering enrollment in a MA-PD plan that you represent. He asks
you whether his insulin costs will be covered. What should you say? - Answer-Mr.
McCarthy's insulin costs for a one-month supply cannot be more than $35 in any
coverage phase under the prescription drug plan beginning in 2023.
Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan? - Answer-Jose, a grandfather who was granted asylum and has worked in
the United States for many years.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently
lost creditable coverage previously available through her husband's employer.
Study Guide for Passing on Your First Attempt 2025
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? - Answer-Mr. Wu may still qualify for help in paying Part
D costs through his State Pharmaceutical Assistance Program.
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.
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? - Answer-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.
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? - Answer-He may sign-up for
Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
,Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be the correct description? - Answer-Medicare
Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - Answer-In most Medicare
Advantage HMOs, Mr. Kumar must generally obtain his services only from
providers within the plan's network (except in an emergency or where care is
unavailable within the network).
Mrs. Quinn has just turned 65, is in excellent health and has a relatively high
income. She uses no medications and sees no reason to spend money on a
Medicare prescription drug plan if she does not need the coverage. She currently
does not have creditable coverage. What could you tell her about the implications
of such a decision? - Answer-If she does not sign up for a Medicare prescription
drug plan as soon as she is eligible to do so, and if she does sign up at a later date,
her premium will be permanently increased by 1% of the national average
premium for every month that she was not covered.
Mrs. Walters is entitled to Part A and has medical coverage without drug
coverage through an employer retiree plan. She is not enrolled in Part B. Since the
employer plan does not cover prescription drugs, she wants to enroll in a
Medicare prescription drug plan. Will she be able to? - Answer-Yes. Mrs. Walters
must be entitled to Part A and/or enrolled in Part B to be eligible for coverage
under the Medicare prescription drug program.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy
will be worth the time to fill out the paperwork. What could you tell her? -
Answer-The Part D low-income subsidy could substantially lower her overall costs.
, She can apply by contacting her state Medicaid office or calling the Social Security
Administration.
Mr. Torres has a small savings account. He would like to pay for his monthly Part
D premiums with an automatic monthly withdrawal from his savings account until
it is exhausted, and then have his premiums withheld from his Social Security
check. What should you tell him? - Answer-In general, he must select a single Part
D premium payment mechanism that will be used throughout the year.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any
other option he has for obtaining help with his considerable drug costs. What
should you tell him? - Answer-He could check with the manufacturers of his
medications to see if they offer an assistance program to help people with limited
means to obtain the medications they need. Alternatively, he could check to see
whether his state has a pharmacy assistance program to help him with his
expenses.
Charles McCarthy is a Medicare beneficiary who suffers from diabetes. Mr.
McCarthy is considering enrollment in a MA-PD plan that you represent. He asks
you whether his insulin costs will be covered. What should you say? - Answer-Mr.
McCarthy's insulin costs for a one-month supply cannot be more than $35 in any
coverage phase under the prescription drug plan beginning in 2023.
Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan? - Answer-Jose, a grandfather who was granted asylum and has worked in
the United States for many years.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently
lost creditable coverage previously available through her husband's employer.
