AHIP FINAL EXAM TEST BANK QUESTIONS AND
ANSWERS 2024-2025 (5 DIFFERENT VERSIONS 500+
QUESTIONS ANDVERIFIED ANSWERS) COMPLETE AHIP
FINAL EXAM|ALREADY GRADED A+
Agent Harriet Walker has recently begun marketing Medicare Advantage and
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related products aimed at meeting the needs of senior citizens. Client Mildred
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Jones has expressed interest in a Medicare Advantage plan. It is now the
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beginning of September. If you were in Agent Walker's position, what would you
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do? Correct Answer: Inquire whether the client qualifies for a special enrollment
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period, andif not, solicit an enrollment application once the annual open
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enrollment election period begins on October 15th.
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Mrs. Fields wants to know whether applying for the Part D low income subsidy
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will be worth the time to fill out the paperwork. What could you tell her? Correct
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Answer: The Part D low income subsidy could substantially lower her overall
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costs. She can apply by contacting her state Medicaid office, or calling theSocial
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Security Administration
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Mr. Wendt suffers from diabetes which has gotten progressively worse during the
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last year. He is currently enrolled in Original Medicare (Parts A and B) and a PartD
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Fprescription drug plan and did not enroll in a Medicare Advantage (MA) plan
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Fduring the last annual open enrollment period (AEP) which hasjust closed. Mr.
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Wendt has heard certain MA plans might provide him with more specialized
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Fcoverage for his diabetes and wants to know if he must wait until the next annual
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open enrollment period (AEP) before enrolling in such a plan. What should you
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Ftell him? Correct Answer: If there is a special needs plan (SNP) in Mr. Wendt's
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Farea that specializes in caring for individuals with diabetes, he may enroll in the
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FSNP at any time under a special election period (SEP)
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Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent
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Fhealth and will have considerable income when she retires. She is concerned that
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Fher income will make it impossible for herto qualify for Medicare. What could you
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tell her to address her concern? Correct Answer: Medicare is aprogram for people
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Fage 65 or older and those under age 65 with certain disabilities, end stage renal
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Fdisease or Lou Gehrig's disease, so she will be eligible for Medicare
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Mr. Schmidt would like to plan for retirement and has asked you what is covered
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under Original Fee-for- Service (FFS) Medicare? What could you tell him?
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Correct Answer: Part A, which covers hospital, skilled nursing facility,
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hospice
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,and home health services and Part B, which covers professional services such
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asthose provided by a doctor are covered under Original Medicare.
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Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the
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health plan may, at some time in the future, reduce his benefits below what is
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available in Original Medicare. What should you tell him about his concern?
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Correct Answer: Medicare health plans must cover all benefits availableunder
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Medicare Part A and Part B. Many also cover Part D prescription drugs.
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Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
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weeks. She concernedabout having prescription drug coverage. Which of the
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following statements provides the best advice?
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Correct Answer: Prescription drug coverage can be obtained by enrolling in a
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Medicare Advantage planthat includes Part D coverage.
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Mrs. Willard wants to know generally how the benefits under Original Medicare
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might compare to the benefit package of a Medicare Health Plan before she starts
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looking at specific plans. What could you tellher? Correct Answer: Medicare Health
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Plans may offer extra benefits that Original Medicare does not
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offer such as vision, hearing, and dental services and must include a maximum out-
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of-pocket limit onPart A and Part B services.
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Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what
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coverage Medicare Supplemental Insurance provides since his health care needs
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are different from his wife's needs. What could you tell Mr.Meoni? Correct
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Answer: Medicare Supplemental Insurance would help cover his Part Aand Part B
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cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
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services that Medicare does not cover.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed
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full time, and paid taxes during that entire period. She is concerned that she will
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not qualify for coverage under part A because she was not born in the United
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States. What should you tell her? Correct Answer: Most individuals who are
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citizens and over age 65 are covered under Part A by virtue of having paid
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Medicaretaxes while working, though some may be covered as a result of paying
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monthly premiums.
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Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
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Social Security Administration and has been receiving disability payments. He is
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wondering whether he can obtain coverage under Medicare. What should you tell
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him? Correct Answer: After receiving such disabilitypayments for 24 months, he
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will be automatically enrolled in Medicare, regardless of age.
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,Mr. Davis is 49 years old and has been receiving disability benefits from the Social
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Security Administration for 12 months. Can you sell him a Medicare Advantage or
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Part D Prescription Drug policy? Correct Answer: No, he cannot purchase a
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Medicare Advantage or Part D policy because he has not received Social Security
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or Railroad Retirement disability benefits for 24 months.
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Ms. Henderson believes that she will qualify for Medicare coverage when she
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turns 65, without paying any premiums, because she has been working for 40 years
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and paying Medicare taxes. What should youtell her? Correct Answer: In order to
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obtain Part B coverage, she must pay a standard monthly premium, though it is
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higher for individuals with higher incomes.
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Mr. Diaz continued working with his company and was insured under his
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employer's group plan until hereached age 68. He has heard that there is a
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premium penalty for those who did not sign up for Part B when first eligible and
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wants to know how much he will have to pay. What should you tell him? Correct
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Answer: Mr. Diaz will not pay any penalty because he had continuous coverage
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under his employer's plan.
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Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next
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year. She heard she must enroll in Part B at the beginning of the year to ensure no
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gap in coverage. What can you tell her? Correct Answer: She may enroll at any time
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while she is covered under her employer plan, but she will have a special eight-
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month enrollment period that differs from the standard general enrollment period,
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during which she may enroll in Medicare Part B.
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Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering
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enrollment in a Medicare health plan. What should you advise her to do before she
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will be able to enroll into a Medicarehealth plan? Correct Answer: In order to join a
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Medicare health plan, she also must enroll in Part B.
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Mrs. Park has a low, fixed income. What could you tell her that might be of
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assistance? Correct Answer: She should contact her state Medicaid agency to see if
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she qualifies for one of several programs that canhelp with Medicare costs for which
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she is responsible.
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Mr. Yu has limited income and resources so you have encouraged him to see if he
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qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the
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trouble to apply and wants to know what the assistance could do for him if he
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qualifies. What could you tell him? Correct Answer: He might qualify forhelp with
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Part D prescription drug costs and help paying Part A and/or Part B premiums,
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deductibles, and/or cost sharing.
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Mr. Patel is in good health and is preparing a budget in anticipation of his
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retirement when he turns 66. He wants to understand the health care costs he might
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, be exposed to under Medicare if he were to require hospitalization as a result of an
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illness. In general terms, what could you tell him about his costs for inpatient
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Fhospital services under Original Medicare? Correct Answer: Under Original
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FMedicare, thereis a single deductible amount due for the first 60 days of any
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Finpatient hospital stay, after which it converts into a per-day amount through day
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90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after
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which he would be responsible for all costs
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Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
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Fbeing successfully treated for that condition. However, she and her physicians feel
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that after her lengthy hospital stay shewill need a month or two of nursing and
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Frehabilitative care. What should you tell them about Original Medicare's coverage
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of care in a skilled nursing facility? Correct Answer: Medicare will cover Mrs.
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Schmidt's skilled nursing services provided during the first 20 days of her stay,
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Fafter which she wouldhave a coinsurance until she has been in the facility for 100
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days
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Mr. Rainey is experiencing paranoid delusions and his physician feels that he
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should be hospitalized.What should you tell Mr. Rainey (or his representative)
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about the length of an inpatient psychiatrichospital stay that Medicare will cover?
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Correct Answer: Medicare will cover a total of 190 days of inpatient psychiatric
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care during Mr. Rainey's entire lifetime.
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Mrs. Quinn has just turned 65 and received a letter informing her that she has
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been automatically enrolled in Medicare Part B. She wants to understand what this
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means. What should you tell Mrs. Quinn? Correct Answer: Part B primarily
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covers physician services. She will be paying a monthly premium and, with the
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exception of many preventive and screening tests, generally will have 20% co-
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payments for these services, in addition to an annual deductible.
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Mr. Buck has several family members who died from different cancers. He wants to
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know if Medicare covers cancer screening. What should you tell him? Correct
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Answer: Medicare covers periodic performance of a range of screening tests that are
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meant to provide early detection of disease. Mr. Buckwill need to check specific
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tests before obtaining them to see if they will be covered.
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Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
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would like to knowwhich of the following services Original Medicare will cover if
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the appropriate criteria are met? What could you tell her? Correct Answer: Original
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Medicare covers ambulance services.
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Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from
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arthritis through acupuncture. She is concerned about whether or not Medicare will
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cover these items and services. What
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