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AHIP EXAM QUESTIONS AND ANSWERS
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AHIP EXAM QUESTIONS AND ANSWERS
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AHIP EXAMQUESTIONS
AND ANSWERS
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.
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.
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.
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.
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. 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.
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. 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. 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.
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.
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 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.
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.
We have an expert-written solution to this problem!
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.
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.
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. 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. 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.
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.
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.
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