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AHIP Medicare Training Module 1 Final Review 2024/2025 already graded A+
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AHIP Medicare Training Module 1 Final Review 2024/2025 already graded A+
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AHIP1. Mrs. Burton is a retiree with substantial income. She is enrolled in an
MA-PD plan and was disappointed with the service she received from her
primary care physician because she was told she would have to wait five
weeks to get an appointment when she was feeling ill. She called you to
ask what she could do so she would not have to put up with such poor
access to care. What could you tell her?: She could file a grievance with her
plan to complain about the lack of timeliness in getting an appointment.
2. Edward IP suffered from serious kidney disease. As a result. Edward
became eligible for Medicare coverage due to end-stage renal disease
(ESRD). A close relative donated their kidney and Edward successfully
underwent transplant surgery 12 months ago. Edward is now age 50 and
asks you if his Medicare coverage will continue, what should you say?:
Individuals eligible for Medicare based on ESRD generally lose eligibility 36
months after the month in which the individual receives a kidney transplant
unless they are eligible for Medicare on another basis such as age or disability.
Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would
cover the drugs.
3. 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?: 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.
4. Mr. Diaz continued working with his company and was insured under
his employer's group plan until he reached age 68. He has heard that there
is a premium penalty for those who did not sign up for Part B when first
eligible and wants to know how much he will have to pay. What should
you tell him?: Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
5. 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.
,6. 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.
7. 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.
8. 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.
9. Mrs. PeHa 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.
10.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.
11.Madeline Martinez was widowed several years ago. Her husband
worked for many years and contributed into the Medicare system. He also
left a substantial estate which provides Madeline with an annual income of
approximately $130,000. Madeline, who has only worked part-time for the
last three years, will soon turn age 65 and hopes to enroll in Original
Medicare. She comes to you for advice. What should you tell her?: You
should tell Madeline that she will be able to enroll in Medicare Part A without
paying monthly premiums due to her husband's long work record and
, AHIP
participation in the Medicare system. You should also tell Madeline that she will
pay Part B premiums at more than the standard lowest rate but less than the
highest rate due her substantial income.
12.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.
13.To obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.: 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.
14.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.
15.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.
16.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.
17.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.
18.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.
19.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?: Mr. Wu may still qualify for help in
paying Part D costs through his State Pharmaceutical Assistance Program.
20.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?: 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.
21.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?: 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.
22.Mrs. Lyons is in good health, uses a single prescription, and lives
independently in her own home. She is attracted by the idea of
maintaining control over a Medical Savings Account (MSA) but is not sure
if the plan associated with the account will fit her needs. What specific
piece of information about a Medicare MSA plan would it be important for
her to know, prior to enrolling in such a plan?: All MSAs cover Part A and
Part B benefits, but not Part D prescription drug benefits, which could be
obtained by also enrolling in a separate prescription drug plan.
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