AHIP 2024 Final Exam Test Questions and Answers
Updated (Verified Answers)
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? -
Answer- Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
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? - Answer- After receiving such
disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of
age.
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? - Answer- 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. 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? - Answer- 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? - Answer- Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his present coverage.
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? - Answer- 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.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms
and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr.
Brennan charge? - Answer- Dr. Brennan can charge Mary Rogers no more than the cost sharing
specified in the PFFS plan's terms and condition of payment which may include balance billing
up to 15%of the Medicare rate.
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? - Answer- SNPs limit enrollment to certain
subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would
not be able to enroll in the SNP.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty
years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap
Incorporated and contributed to the Medicare system. Juan suffers from diabetes. He will soon
retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How would
you respond? - Answer- Juan is eligible to enroll in a Medicare Advantage as long as he is
entitled to Part A and enrolled in Part B. Juan should go to the Social Security website to enroll
in Medicare Part A and B if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA) but is not sure if the plan associated with the account will fit her needs. What specific
piece of information about a Medicare MSA plan would it be important for her to know, prior to
enrolling in such a plan? - Answer- All MSAs cover Part A and Part B benefits, but not Part D
prescription drug benefits, which could be obtained by also enrolling in a separate prescription
drug plan.
,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? - Answer- He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
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? - Answer- 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? - Answer- 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? - Answer- 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. 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? - Answer- 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? - Answer- 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? - Answer- 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? - Answer- 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.
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? - Answer- Mrs. Ramos can obtain
care from any provider who participates in Original Medicare, but generally will have a higher
cost-sharing amount if she sees a provider who/that is not a part of the PPO network.
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
because his MA-PD coverage has been very good. However, when he received the bill, he was
surprised to see large charges in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called you to ask what he could do?
What could you tell him? - Answer- You can offer to review the plans appeal process to help him
ask the plan to review the coverage decision.
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? - Answer- He 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.
