AHIP OVERVIEW of MEDICARE PROGRAM BASICS: CHOICE, ELIGIBILTY, AND
BENEFITS
MODULE 1
1. 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?
a. Medicare is a program for people of all ages with specific mental health disabilities. Since she is in
excellent health, she would not qualify, but should instead look into her state’s Medicaid program if she
wants further coverage. Incorrect
b. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal
government. If she or her husband were ever employed by the federal government, she can enroll in
Medicare. Incorrect
c. 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. Correct
d. Medicare is a program for people who have incomes and assets below specific limits, so you will have
to find out her exact financial situation before telling her whether she can obtain Medicare coverage.
Incorrect
2. Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs. Park that
might be of assistance?
a. She should not sign up for a Medigap or Medicare Advantage plan. Incorrect
b. She should only seek help from private organizations to cover her Medicare costs. Incorrect
c. She can apply to the Medicare agency for lower premiums and cost-sharing. Incorrect
d. 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. Correct
3. 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?
a. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging.
Incorrect
b. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his
state’s Medicaid program. Incorrect
c. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program. Correct
d. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical
Assistance Program. Incorrect
, 4. 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?
a. 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. Correct
b. Part C, which always covers dental and vision services, is covered under Original Medicare. Incorrect
c. Part A, which covers long term custodial care services, is covered under Original Medicare. Incorrect
d. Part D, which covers prescription drug services, is covered under Original Medicare. Incorrect
5. 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?
a. 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. Correct
b. Medicare covers all screening tests that have been approved by the FDA on a frequency determined
by the treating physician. Incorrect
c. Medicare covers some screening tests that must be performed within the first year after enrollment.
Beyond that point expenses for screening tests is the responsibility of the beneficiary. Incorrect
d. Medicare covers treatments for existing disease, injury and malformed limbs or body parts. As such, it
does not cover any screening tests and these must be paid for by the beneficiary out of pocket.
Incorrect
6. 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?
a. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the
same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases
until day 90. After 90 days he would pay the full amount of all costs. Incorrect
b. 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 Correct
c. Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The
percentage increases after 60 days and again after 90 days. Incorrect
,d. Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare
provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive
care from a non-participating provider. Incorrect
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?
a. Individuals who become eligible for such disability payments only have to wait 12 months before they
can apply for coverage under Medicare. Incorrect
b. He became eligible for Medicare when his disability eligibility determination was first made. Incorrect
c. After receiving such disability payments for 24 months he will be automatically enrolled in Medicare,
regardless of age. Correct
d. Individuals receiving such disability payments from the Social Security Administration continue to
receive those payments, but only become eligible for Medicare upon reaching age 65. Incorrect
8. Mrs. Roberts has just received a new Medicare identity card in the mail. She is concerned that
it is a forgery since it does not have her Social Security number on it. What should you tell her?
a. The card is indeed a forgery since all identity cards are being phased out in favor of a new electronic
identity system developed by the Social Security Administration. Incorrect
b. The card she received is valid but she should keep her old card for at least two years and present it
whenever she receives health care. Incorrect
c. The card she received is valid, the change has been made to protect Medicare beneficiaries from
identity theft, and she should now destroy her old card. Correct
d. The card is indeed a forgery since newly issued Medicare cards will have both a beneficiary’s Social
Security number and date of birth imprinted on them. Incorrect
9. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrollment in a Medicare health plan (Part C). What should you advise her to do before she will be able
to enroll in a Medicare health plan?
a. To enroll in a Medicare health plan, she need only be entitled to Part A, so she does not need to take
any further steps. Incorrect
b. In order to join a Medicare health plan, she must be enrolled in Parts A, B, and D. Incorrect
c. Since she is age 65 she may enroll in any Medicare health plan, regardless of whether she is entitled to
Part A or Part B coverage. Incorrect
d. In order to join a Medicare health plan, she also must enroll in Part B. Correct
, 10. 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?
a. Medicare Supplemental Insurance would cover his dental, vision and hearing services only. Incorrect
b. Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not
covered under Original Fee-for-Service (FFS) Medicare. Incorrect
c. Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-
for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. Correct
d. Medicare Supplemental Insurance would cover his long-term care services. Incorrect
MEDICARE HEALTH PLANS
PART 2
1. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him?
a. Mr. Kumar will be able to obtain routine care outside of the plan’s service area, but will pay a higher
co-payment (except in an emergency). Incorrect
b. In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers
who have a contractual relationship with the plan (except in an emergency or where care is unavailable
within the network). Correct
c. In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%,
but those of specialists are covered at 80%. Incorrect
d. With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as
that provider participates in Original Medicare. Incorrect
2. Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
a. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
Correct
b. Even if Mrs. Radford has end-stage renal disease, she will be able to enroll in any Medicare Advantage
plan in her service area. Incorrect
c. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to
being accepted and enrolled. Incorrect
d. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States.
Incorrect
