AHIP Final Exam |LATEST VERSION
|NEW UPDATE |GUARANTEED
PASS|2024-2025 |BEST STUDYING
MATERIAL WITH 100+ QUESTIONS
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 years and paying Medicare taxes.
What should you tell her?
- CORRECT ANS-To obtain Part B coverage, she must pay a standard monthly premium, though
it is higher for individuals with higher incomes.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance?
- CORRECT ANS-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.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This
coverage has recently been terminated due to the end of the PHE. While Shirley was enrolled in
Medicaid, she missed an opportunity to enroll in Medicare and now wants Part B. Which of the
following statements best describes Shirley's ability to now enroll in Medicare Part B? -
CORRECT ANS-Shirley is eligible for a Special Enrollment Period (SEP) for up to six months after
the termination of her Medicaid coverage. Under this SEP, Shirley can choose retroactive
coverage back to the date of termination from Medicaid or coverage beginning the month after
the month of enrollment.
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? -
CORRECT ANS-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.
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?
- CORRECT ANS-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. 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? -
CORRECT ANS-Most individuals who are citizens and age 65 or over are covered under Part A by
virtue of having paid Medicare taxes while working, though some may be covered as a result of
paying monthly premiums.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
under Original Medicare. What should you tell Mr. Xi that best describes the health coverage
provided to Medicare beneficiaries?
- CORRECT ANS-Beneficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
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?
- CORRECT ANS-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.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage
and is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
, Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say?
- CORRECT ANS-Anthony is eligible for a special enrollment period (SEP) because he missed an
enrollment period due to the impact of the Federally declared disaster. This SEP will allow
Anthony to enroll in Part B up to six months after the end of the emergency declaration.
Anthony may enroll in premium-free Part A at any time and his Part A coverage will be
retroactive for up to 6 months.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that
he would have certain services and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However, when he received the bill, he was
surprised to see large charges in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called you to ask what he could do?
What could you tell him?
- CORRECT ANS-You can offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree
group health plan that includes drug coverage with nominal copays. He heard about a
neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs,
he is considering signing up for it. What should you tell him?
- CORRECT ANS-He should compare the benefits in his employer-sponsored retiree group
health plan with the benefits in his neighbor's MA-PD plan to determine which one will provide
sufficient coverage for his prescription needs.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at
severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is
likely to be most appropriate for him?
- CORRECT ANS-C-SNP
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to
enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed several expensive medications.
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