AHIP COMPREHENSIVE STUDY GUIDE
SUMMARY COMPLETE QUESTIONS AND
ANSWERS
◉ This year you decide to focus your efforts on marketing to employer
and union groups. Which of the following statements best describes
what you can and cannot do in order to stay in compliance? ANSWER:
You are not required to submit communication and marketing materials
specific only to those employer plans to CMS at the time of use, but
CMS may request and review copies if employee complaints occur.
◉ Agent Suma has recently had several clients request his
assistance in completing their paper enrollment form. What advice
would you give him? ANSWER: Agent Suma is only permitted to fill
out the applicant's name and contact information. The applicant must fill
in the remaining information in order to protect his or her privacy.
◉ Mrs. Quinn recently turned 66 and decided after many years of
work to begin receiving Social Security benefits. Shortly thereafter Mrs.
Quinn 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? ANSWER: Part 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% coinsurance for these services, in addition to an annual deductible.
, ◉ Mrs. Turner is comparing her employer's retiree insurance to
Original Medicare and would like to know which of the following
services Original Medicare will cover if the appropriate criteria are met?
What could you tell her? ANSWER: Original Medicare covers
ambulance services.
◉ 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.
◉ Anita Magri will turn age 65 in August 2020. Anita intends to
enroll in Original Medicare Part A and Part B. She would also like to
enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor
Mel has told her about the Medigap Part F plan in which he is enrolled.
It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Anita comes to you for advice. What should
you tell her ANSWER: You are sorry to disappoint Anita but a Medigap
Part F plan is no longer available to those who turn age 65 after January
1,2020. Anita might instead consider other Medigap plans that offer
foreign travel benefits but do not cover the Part B deductible.
◉ 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 cost sharing in Original Fee-for-
,Service (FFS) Medicare as well as possibly some services that Medicare
does not cover.
◉ 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.
◉ 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.
◉ 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?
ANSWER: 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.
◉ 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? ANSWER: Medicare will cover Mrs. Shield's
skilled nursing services provided during the first 20 days of her stay,
after which she would have a copay until she has been in the facility for
100 days.
◉ 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. Geisler's neighbor told her she should look at her Part D
options during the annual Medicare enrollment period because features
of Part D might have changed. Mrs. Geisler can't remember what Part D
is so she called you to ask what her neighbor was talking about. What
could you tell her? ANSWER: Part D covers prescription drugs and she
should look at her premiums, formulary, and cost-sharing among other
factors to see if they have changed.
◉ What impact, if any, will recent regulatory changes have upon
Medigap plans? ANSWER: The Part B deductible will no longer be
covered for individuals newly eligible for Medicare starting January 1,
2020.
◉ 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.
SUMMARY COMPLETE QUESTIONS AND
ANSWERS
◉ This year you decide to focus your efforts on marketing to employer
and union groups. Which of the following statements best describes
what you can and cannot do in order to stay in compliance? ANSWER:
You are not required to submit communication and marketing materials
specific only to those employer plans to CMS at the time of use, but
CMS may request and review copies if employee complaints occur.
◉ Agent Suma has recently had several clients request his
assistance in completing their paper enrollment form. What advice
would you give him? ANSWER: Agent Suma is only permitted to fill
out the applicant's name and contact information. The applicant must fill
in the remaining information in order to protect his or her privacy.
◉ Mrs. Quinn recently turned 66 and decided after many years of
work to begin receiving Social Security benefits. Shortly thereafter Mrs.
Quinn 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? ANSWER: Part 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% coinsurance for these services, in addition to an annual deductible.
, ◉ Mrs. Turner is comparing her employer's retiree insurance to
Original Medicare and would like to know which of the following
services Original Medicare will cover if the appropriate criteria are met?
What could you tell her? ANSWER: Original Medicare covers
ambulance services.
◉ 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.
◉ Anita Magri will turn age 65 in August 2020. Anita intends to
enroll in Original Medicare Part A and Part B. She would also like to
enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor
Mel has told her about the Medigap Part F plan in which he is enrolled.
It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Anita comes to you for advice. What should
you tell her ANSWER: You are sorry to disappoint Anita but a Medigap
Part F plan is no longer available to those who turn age 65 after January
1,2020. Anita might instead consider other Medigap plans that offer
foreign travel benefits but do not cover the Part B deductible.
◉ 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 cost sharing in Original Fee-for-
,Service (FFS) Medicare as well as possibly some services that Medicare
does not cover.
◉ 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.
◉ 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.
◉ 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?
ANSWER: 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.
◉ 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? ANSWER: Medicare will cover Mrs. Shield's
skilled nursing services provided during the first 20 days of her stay,
after which she would have a copay until she has been in the facility for
100 days.
◉ 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. Geisler's neighbor told her she should look at her Part D
options during the annual Medicare enrollment period because features
of Part D might have changed. Mrs. Geisler can't remember what Part D
is so she called you to ask what her neighbor was talking about. What
could you tell her? ANSWER: Part D covers prescription drugs and she
should look at her premiums, formulary, and cost-sharing among other
factors to see if they have changed.
◉ What impact, if any, will recent regulatory changes have upon
Medigap plans? ANSWER: The Part B deductible will no longer be
covered for individuals newly eligible for Medicare starting January 1,
2020.
◉ 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.
