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AHIP Questions and Correct Answers.docx
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2023 AHIP Questions and CorrectAnswers
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? -
correct answers:He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored healthcare
coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years.
Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-
sponsored healthcare coverage. How would you respond? - correct answers:Juan is likely to be eligible
for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his
healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those
under age 65 under its employer-sponsored group health plan.
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? - correct answers: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.
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? -
correct answers: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.
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? - correct answers: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.
,Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug
coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one
that provides drug coverage. What should you tell her? - correct answers: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.
West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
massage therapy. She is concerned about whether or not Medicare will cover these items and services.
What should you tell her? - correct answers:Medicare does not cover massage therapy, or, in general,
glasses or dentures.
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? - correct answers: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.
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? - correct answers:To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.
Alonso receives some help paying for his two generic prescription drugs from his employer's retiree
coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he
would generally expect to encounter when enrolling into a standard MedicarePart D prescription drug
plan. What should you tell him? - correct answers:He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
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? - correct answers: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.
, 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? - correct answers:Beneficiaries under Original Medicare have no cost-sharing for most
preventive services which include immunizations such as annual flu shots.
Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary
Notice (MSN) and disagrees with a determination that partially denied one of her claims for services.
What advice would you give her? - correct answers:Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
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? - correct answers: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.
Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be
of assistance? - correct answers: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.
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? - correct answers:Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
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? - correct answers: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.
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? - correct answers:Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present coverage.
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