AHIP Certification Test 2025 –
Complete Study Guide for Medicare
Agents | Verified Questions, Correct
Answers & Proven Success Plan
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? - ANSW✔ -Medicare is a
program for people age 65 or older and those under age 65 with certain disabilities, end stage renal
disease or Lou Gehrig's disease, so she will be eligible for Medicare
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? - ANSW✔ -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.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at
some time in the future, reduce his benefits below what is available in Original Medicare. What should
you tell him about his concern? - ANSW✔ -Medicare health plans must cover all benefits available
under Medicare Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few weeks. She
concerned about having prescription drug coverage. Which of the following statements provides the
best advice? - ANSW✔ -Prescription drug coverage can be obtained by enrolling in a Medicare
Advantage plan that includes Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to
the benefit package of a Medicare Health Plan before she starts looking at specific plans. What could
you tell her? - ANSW✔ -Medicare Health Plans may offer extra benefits that Original Medicare does
not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit
on Part A and Part B services.
,Mr. Meoni'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.Meoni? - ANSW✔ -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.
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? - ANSW✔ -Most 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.
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? - ANSW✔ -After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
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? - ANSW✔ -No, 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.
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? - ANSW✔ -In order to obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
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? -
ANSW✔ -Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's
plan.
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? -
ANSW✔ -She 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.
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? - ANSW✔ -In 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? - ANSW✔ -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.
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? - ANSW✔ -He 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.
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? - ANSW✔ -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 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
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? - ANSW✔ -Medicare will cover Mrs. Schmidt's
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
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? - ANSW✔ -Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
Complete Study Guide for Medicare
Agents | Verified Questions, Correct
Answers & Proven Success Plan
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? - ANSW✔ -Medicare is a
program for people age 65 or older and those under age 65 with certain disabilities, end stage renal
disease or Lou Gehrig's disease, so she will be eligible for Medicare
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? - ANSW✔ -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.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at
some time in the future, reduce his benefits below what is available in Original Medicare. What should
you tell him about his concern? - ANSW✔ -Medicare health plans must cover all benefits available
under Medicare Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few weeks. She
concerned about having prescription drug coverage. Which of the following statements provides the
best advice? - ANSW✔ -Prescription drug coverage can be obtained by enrolling in a Medicare
Advantage plan that includes Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to
the benefit package of a Medicare Health Plan before she starts looking at specific plans. What could
you tell her? - ANSW✔ -Medicare Health Plans may offer extra benefits that Original Medicare does
not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit
on Part A and Part B services.
,Mr. Meoni'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.Meoni? - ANSW✔ -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.
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? - ANSW✔ -Most 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.
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? - ANSW✔ -After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
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? - ANSW✔ -No, 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.
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? - ANSW✔ -In order to obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
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? -
ANSW✔ -Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's
plan.
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? -
ANSW✔ -She 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.
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? - ANSW✔ -In 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? - ANSW✔ -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.
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? - ANSW✔ -He 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.
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? - ANSW✔ -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 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
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? - ANSW✔ -Medicare will cover Mrs. Schmidt's
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
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? - ANSW✔ -Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
