AHIP Medicare Knowledge Examination – Medicare
Advantage & Part D Certification Preparation, 50 Q&A
*
*1. Mrs. Park is an elderly retiree with a low fixed income. What could
you tell her that might be of assistance?**
**Answer:** She should contact her state Medicaid agency to see if
she qualifies for programs that can help with Medicare costs for which
she is responsible.
**Rationale:** State Medicaid agencies administer programs like
Medicare Savings Programs (MSPs) that help pay Medicare premiums
and cost-sharing for beneficiaries with limited income and resources .
**2. 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. Is he eligible for Medicare?**
**Answer:** After receiving disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
**Rationale:** Individuals under 65 who receive Social Security
Disability Insurance (SSDI) become eligible for Medicare after a 24-
month qualifying period .
**3. Mr. Schmidt would like to know 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.
**Rationale:** Original Medicare consists of Part A (Hospital Insurance)
and Part B (Medical Insurance), which together cover inpatient and
outpatient medical care .
**4. Mrs. Pea 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 that differs from the standard general enrollment period, during
which she may enroll in Medicare Part B.
**Rationale:** If a beneficiary has group health plan coverage based on
current employment, they qualify for a Special Enrollment Period (SEP)
to enroll in Part B without penalty, which lasts for eight months after
employment ends .
**5. Mr. Diaz continued working with his company and was insured
under his employer's group plan until he reached age 68. He wants to
know how much he will have to pay for the Part B late enrollment
penalty. What should you tell him?**
,**Answer:** The penalty will be a permanent 10% increase in his Part
B premium for every 12-month period that passed during which he
could have enrolled and did not.
**Rationale:** The Part B late enrollment penalty is calculated as 10%
of the standard premium for each full 12-month period that the
beneficiary was eligible but not enrolled .
**6. Ms. Moore plans to retire when she turns 65. She is concerned
that her considerable income will make it impossible for her to qualify
for Medicare. How can you 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 regardless
of income.
**Rationale:** Medicare eligibility is based on age, disability status, or
specific diseases, not on income level .
**7. Which group may qualify for Medicare before age 65 without ALS
or ESRD?**
**Answer:** Disabled SSDI recipients after 24 months.
**Rationale:** As noted above, SSDI recipients qualify after a 24-
month waiting period. ALS and ESRD patients have different rules (ALS
has no waiting period) .
**8. A U.S. resident becomes eligible for premium-free Part A at age 65
after accruing how many quarters of Social Security credits?**
, **Answer:** 40 quarters (10 years).
**Rationale:** Individuals who have paid Medicare taxes for at least 40
quarters (or are married to someone who has) qualify for premium-free
Part A .
**9. The Initial Enrollment Period (IEP) for Part A and Part B lasts how
many months?**
**Answer:** 7 months.
**Rationale:** The IEP begins three months before the month of the
65th birthday, includes the birthday month, and ends three months
after that month .
**10. Part B covers which service at 100% with no deductible?**
**Answer:** Influenza vaccine (and other recommended preventive
vaccines).
**Rationale:** Medicare Part B covers certain preventive vaccines (flu,
pneumococcal, COVID-19) at no cost to the beneficiary, with no
deductible or coinsurance .
**11. Medicare defines "medically necessary" services as:**
**Answer:** Services reasonable and necessary for diagnosis or
treatment.
**Rationale:** This is the statutory definition under Medicare law—
services must be reasonable and necessary for the diagnosis or
treatment of illness or injury .
Advantage & Part D Certification Preparation, 50 Q&A
*
*1. Mrs. Park is an elderly retiree with a low fixed income. What could
you tell her that might be of assistance?**
**Answer:** She should contact her state Medicaid agency to see if
she qualifies for programs that can help with Medicare costs for which
she is responsible.
**Rationale:** State Medicaid agencies administer programs like
Medicare Savings Programs (MSPs) that help pay Medicare premiums
and cost-sharing for beneficiaries with limited income and resources .
**2. 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. Is he eligible for Medicare?**
**Answer:** After receiving disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
**Rationale:** Individuals under 65 who receive Social Security
Disability Insurance (SSDI) become eligible for Medicare after a 24-
month qualifying period .
**3. Mr. Schmidt would like to know 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.
**Rationale:** Original Medicare consists of Part A (Hospital Insurance)
and Part B (Medical Insurance), which together cover inpatient and
outpatient medical care .
**4. Mrs. Pea 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 that differs from the standard general enrollment period, during
which she may enroll in Medicare Part B.
**Rationale:** If a beneficiary has group health plan coverage based on
current employment, they qualify for a Special Enrollment Period (SEP)
to enroll in Part B without penalty, which lasts for eight months after
employment ends .
**5. Mr. Diaz continued working with his company and was insured
under his employer's group plan until he reached age 68. He wants to
know how much he will have to pay for the Part B late enrollment
penalty. What should you tell him?**
,**Answer:** The penalty will be a permanent 10% increase in his Part
B premium for every 12-month period that passed during which he
could have enrolled and did not.
**Rationale:** The Part B late enrollment penalty is calculated as 10%
of the standard premium for each full 12-month period that the
beneficiary was eligible but not enrolled .
**6. Ms. Moore plans to retire when she turns 65. She is concerned
that her considerable income will make it impossible for her to qualify
for Medicare. How can you 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 regardless
of income.
**Rationale:** Medicare eligibility is based on age, disability status, or
specific diseases, not on income level .
**7. Which group may qualify for Medicare before age 65 without ALS
or ESRD?**
**Answer:** Disabled SSDI recipients after 24 months.
**Rationale:** As noted above, SSDI recipients qualify after a 24-
month waiting period. ALS and ESRD patients have different rules (ALS
has no waiting period) .
**8. A U.S. resident becomes eligible for premium-free Part A at age 65
after accruing how many quarters of Social Security credits?**
, **Answer:** 40 quarters (10 years).
**Rationale:** Individuals who have paid Medicare taxes for at least 40
quarters (or are married to someone who has) qualify for premium-free
Part A .
**9. The Initial Enrollment Period (IEP) for Part A and Part B lasts how
many months?**
**Answer:** 7 months.
**Rationale:** The IEP begins three months before the month of the
65th birthday, includes the birthday month, and ends three months
after that month .
**10. Part B covers which service at 100% with no deductible?**
**Answer:** Influenza vaccine (and other recommended preventive
vaccines).
**Rationale:** Medicare Part B covers certain preventive vaccines (flu,
pneumococcal, COVID-19) at no cost to the beneficiary, with no
deductible or coinsurance .
**11. Medicare defines "medically necessary" services as:**
**Answer:** Services reasonable and necessary for diagnosis or
treatment.
**Rationale:** This is the statutory definition under Medicare law—
services must be reasonable and necessary for the diagnosis or
treatment of illness or injury .
