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AHIP questions 2024/2025 already graded A+
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AHIP questions 2024/2025 already graded A+
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AHIP questionsMr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is
not sure about what type of plan designs are available through this program. What should
you tell him about the types of health plans that are available through the Medicare
Advantage program? - ANSThey are Medicare health plans such as HMOs, PPOs, PFFS,
SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - ANSMedicare Advantage is a way of
covering all of the Original Medicare benefits through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a
type of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if
this would be available to her. What should you tell her about PFFS plans? - ANSA PFFS
plan is one of various types of Medicare Advantage plans offered by private entities and she
may enroll in one if it is available in her area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - ANSMrs. Radford must be entitled to Part A and
enrolled in Part B to enroll in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. 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
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her
doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options
does Mrs. Billings have in regard to her MA plan during the next open enrollment season? -
ANSShe may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for
individuals suffering from ESRD if one is available in her area
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him? - ANSIn most Medicare Advantage HMOs, Mr.
Kumar must obtain his services only from providers who have a contractual relationship with
the plan (except in an emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - ANSMrs. Ramos can
obtain care from any provider who participates in Original Medicare, but generally will be
charged a lower co-payment if she goes to one of the plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has
received under Original Medicare, but he would like to know more about Medicare
,Advantage Special Needs Plans (SNPs). What could you tell him? - ANSSNPs have special
programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription
drug coverage that could be very helpful as well
(W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from
his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan
(SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and
Mr. Greco would like to join that plan. What should you tell him? - ANSSNPs limit enrollment
to certain sub-populations of beneficiaries. Given his current situation, he is unlikely to
qualify and would not be able to enroll in the SNP.
(W) 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? - ANSMost individuals who are citizens and over age 65 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.
(W) 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.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social
Security Administration for 12 months. Can you sell him a Medicare Advantage or Part D
Prescription Drug policy? - ANSNo, he cannot purchase a Medicare Advantage or Part D
policy because he has not received Social Security or Railroad Retirement disability benefits
for 24 months.
(W) 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? - ANSIn order to obtain Part B coverage, she
must pay a standard monthly premium, though it is higher for individuals with higher incomes
(W) 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? - ANSMr. Diaz will not pay any penalty because he had
continuous coverage under his employer's plan.
(W) 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
, (W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering
enrollment in a Medicare health plan. What should you advise her to do before she will be
able to enroll into a Medicare health plan? - ANSIn order to join a Medicare health plan, she
also must enroll in Part B
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance? -
ANSShe 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
(W) Mr. Yu has limited income and resources so you have encouraged him to see if he
qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble to
apply and wants to know what the assistance could do for him if he qualifies. What could you
tell him? - ANSHe might qualify for help with Part D prescription drug costs and help paying
Part A and/or Part B premiums, deductibles, and/or cost sharing.
(W) 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? - ANSUnder 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 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
(W) Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover? - ANSMedicare will cover a total
of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -
ANSMedicare will cover Mrs. Shields' skilled nursing services provided during the first 20
days of her stay, after which she would have a coinsurance until she has been in the facility
for 100 days.
Mrs. Quinn has just turned 65 and received a letter informing her that she has been
automatically enrolled in Medicare Part B. She wants to understand what this means. What
should you tell Mrs. Quinn? - ANSPart B primarily covers physician services. She will be
paying a monthly premium and, with the exception of many preventive and screening tests,
generally will have 20% co-payments for these services, in addition to an annual deductible.
(W) 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? - ANSMedicare covers
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.
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