America's Health Insurance Plan (AHIP) Exam 2022 Questions & Answers Bank
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America's Health Insurance Plan (AHIP) Exam 2022 Questions & Answers-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...
americas health insurance plan ahip exam 2022 questions amp answers bank
mr davis is 52 years old and has recently been diagnosed with end stage renal disease esrd and will soon begin dialy
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America's Health Insurance Plan (AHIP) Exam
2022 Questions & Answers
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 employer-sponsored healthcare
coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years.
Juan asks you if he will be 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.
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 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.
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 would be
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 years and 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 cost-sharing.
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?
- 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 are provided 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 disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
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?
- 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.
Which of the following statement is/are correct about a Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500
indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as
payment in full. - I, II, and IV only
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of
three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not
include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not
include drug coverage and intends to obtain his drug coverage through a stand-alone Medicare
prescription drug plan. What should you tell him about this situation?
, - He could enroll either in one of the MA plans that include prescription drug coverage or Original
Medicare with a Medigap plan and standalone Part D prescription drug coverage, but he cannot
enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she
can go to for her health care. What should you tell her?
- Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but
generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the
PPO network.
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?
- 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.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and
conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan
charge?
- Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan's
terms and condition of payment which may include balance billing up to 15% of the Medicare rate.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network as his current HMO plan requires
him to do. What should you tell him?
- He may receive health care services from any doctor allowed to bill Medicare, as long as he shows
the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment
terms and conditions, which could include balance billing.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be the correct description?
- Medicare Advantage is a way of covering all the Original Medicare benefits through private health
insurance companies.
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.
Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise
Mrs. Chi?
- Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D prescription
drug plan.
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? - .
C-SNP
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