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Voorbeeld van de inhoud
AHIP 2024 final examMrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance? - ANSShe should contact her state Medicaid agency to see if she
qualifies forprograms that can help with Medicare costs for which she is responsible.
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? - ANSYou 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.
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 - ANSAfter receiving such
disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of
age.
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? - ANSPart 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.
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? - ANSShe may enroll at any time while she is covered under her employer
plan, but she will have a special eight month enrollment period that differs from the standard
general enrollment period, during which she may enroll in Medicare Part B.
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? - ANSTell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his present coverage.
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? - ANSThe penalty will be a permanent 10% increase in his Part B premium
for every 12-month period that passed during which he could have enrolled and did not.
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? -
ANSMedicare 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.
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? - ANSMildred 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. 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? - ANSHe 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. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? - ANSYou would need
to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's service
area.
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to
the benefits package of a Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? - ANSMedicare Advantage Plans may offer extra benefits that Original
Medicare does not offer such as vision, hearing, and dental services. It must include a maximum
out-of-pocket limit on Part A and Part B services.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll
in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? -
ANSHe is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part
B.
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
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