2023/2024 AHIP Module 1, 2, 3, 4, 5 (ACTUAL
TEST) Questions and Answers GRADED A ALL
COREECT.
• Mr. Moy's wife has a Medicare Advantage plan, but he wants to
understand what coverage Medicare Supplemental Insurance
provides since his health care needs are different from his wife's
needs. What could you tell Mr. Moy? ✓Medicare Supplemental
Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-for-Service (FFS) Medicare as well as
possibly some services that Medicare does not cover.
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? ✓She may enroll at any time while she is covered under her
employer plan, but she will have a special eight-month enrollment
period after the last month on her employer plan that differs from the
standard general enrollment period, during which she may enroll in
Medicare Part B.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has
been employed full time, and paid taxes during that entire period.
She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell
her? ✓Most individuals who are citizens and age 65
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? ✓He may sign-
up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for
several more years at Smallcap, Incorporated. Smallcap has a
, workforce of15 employees and offers employersponsored healthcare
coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he willbe entitled
to Medicare and if he enrolls how that will impact his employer-
sponsored healthcare coverage. How would you respond? ✓Juan is
likely to be eligible for Medicare once he turns age 65 and if he
enrolls Medicare would become the primary payor of his healthcare
claims and Smallcap does not have to continue to offer him coverage
comparable to those under age 65 under its employer-sponsored
group health plan.
or over are covered under Part A by virtue of having paid Medicare taxes
whileworking, though some may be covered as a result of paying monthly
premiums.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap
policy as well, but it provides no drug coverage. She would like to
keep the coverage she has but replace her existing Medigap plan
with one that provides drug coverage. What should you tell her? ✓
✓Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs,
but she could keep her Medigap policy and enroll in a Part D
prescription drug plan.
Mrs. West wears glasses and dentures and has enjoyed
considerable pain relief from arthritis through massage therapy.
She is concerned about whether or not Medicare will cover these
items and services. What should you tell her?
✓✓Medicare does not cover massage therapy, or, in general, glasses or
dentures.
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? ✓✓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 wouldbe responsible for all
costs.
Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 yearsand paying Medicare taxes. What should you tell her? ✓✓To
obtain Part B coverage, she must pay a standard monthly premium, though
it is higher for individuals with higher incomes.
Mr. Alonso receives some help paying for his two generic prescription
drugs from his employer's retiree coverage, but he wants to compare it to a
Part D prescription drug plan. He asks you what costs he would generally
expect to encounter when enrolling into a standard MedicarePart D
prescription drug plan. What should you tell him? ✓✓He generally would
pay a monthly premium, annual deductible, and per-prescription
costsharing.
Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellenthealth 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? ✓✓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.
Mr. Xi will soon turn age 65 and has come to you for advice as to what
services areprovided under Original Medicare. What should you tell Mr. Xi
that best describes the health coverage provided to Medicare
beneficiaries? ✓✓Beneficiaries under Original Medicare have no cost-
sharing for most preventive services which include immunizations such as
annual flu shots.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with
a determination that partially denied one of her claims for services. What
advice would you give her? ✓✓Mrs. Duarte should file an appeal of this
initial determination within 120 days of the date she received the MSN in
the mail.
, Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and
a Medigap plan to pick up costs not covered by that plan.
What should you tell him? ✓✓It is illegal for you to sell Mr. Capadona a
Medigap plan if he is enrolled in an MA plan, and besides, Medigap only
works with Original Medicare.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance? ✓✓She should
contact her state Medicaid agency to see if she qualifies for one of several
programs that can help with Medicare costs for which she is responsible.
Mr. Rainey is experiencing paranoid delusions and his physician feels that
he should be hospitalized. What should you tell Mr. Rainey (or his
representative) about the length of an inpatient psychiatric hospital stay
that Medicare will cover?
✓✓Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr.Rainey's entire lifetime.
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? ✓✓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.
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? ✓✓Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to
his present coverage.
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? ✓✓After receiving such
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