UPDATED 2024/2025 AHIP FINAL EXAM TEST QUESTIONS AND ANSWERS GRADED A+ (VERY RESOURCEFUL MATERIAL)
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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?correct answersHe may sign-up for Medicare at any
time however coverage usually begins o...
,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?correct answersHe 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?correct answersJuan is likely to be eligible for
Medicare once he turns age 65 and if he enrolls Medicare would become theprimary
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?correct answersMedicare
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?correct answersShe 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 qualifyfor
coverage under part A because she was not born in the United States. What should you tell
her?correct answersMost 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?correct answersMrs. 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
willcover these items and services. What should you tell her?correct answersMedicare
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
tounder 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?correct answersUnder 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 paya daily amount
up to 60 days over his lifetime, after which he would be responsiblefor 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?correct answersTo 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?correct
answersHe 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 healthand
will have considerable income when she retires. She is concerned that her incomewill
make it impossible for her to qualify for Medicare. What could you tell her to addressher
concern?correct answersMedicare 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?correct answersBeneficiaries 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?correct answersMrs. Duarte
should file an appeal of this initial determination within 120 days ofthe date she received
the MSN in the mail.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigapplan to pick up costs not covered by that plan.
What should you tell him?correct answersIt is illegal for you to sell Mr. Capadona a
Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works
withOriginal Medicare.
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