AHIP Final Exam Questions and Answers
1. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park 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.
2. 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.
3. 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.
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,4. 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.
5. 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 that differs from the
standard general enrollment period, during which she may enroll in Medicare Part B.
6. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur-
rently 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.
7. 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?
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, 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.
8. 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 con- cerned 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.
9. 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.
10. 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
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1. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park 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.
2. 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.
3. 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.
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17
,4. 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.
5. 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 that differs from the
standard general enrollment period, during which she may enroll in Medicare Part B.
6. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur-
rently 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.
7. 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?
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17
, 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.
8. 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 con- cerned 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.
9. 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.
10. 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
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