AHIP Modules 1-5 Questions and Answers
1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and
a Medigap plan to pick up costs not covered by that plan. What should you tell
him?
Answer It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap
only works with Original Medicare.
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is
currently 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.
3. 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. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
4. Mr. Vasquez 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
,because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare?
Answer 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 coinsurance 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.
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr.
Moy's wife has a Medicare Advantage plan, but he wants to understand what
cover- age 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 deductible and Part B coinsurance
or copayments in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not
cover.
6. Juan Perez, who is turning age 65 next month, intends to work for several
more years at Smallcap, Incorporated. Smallcap has a workforce of 15
employ- ees and offers employer-sponsored healthcare coverage. Juan is a
naturalized citizen and has contributed to the Medicare system for over 20
years. Juan asks
you if he will be entitled to Medicare and if he enrolls how that will impact his
employer- sponsored healthcare coverage. How would you respond?
Answer Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls, Medicare would
become the primary payor of his healthcare claims and Smallcap does not have to continue to otter him coverage
comparable to those under age 65 under its employer-sponsored group health plan. Juan is likely to be eligible for
Medicare once he turns age 65 and if he enrolls, Medicare would become the primary payor of his healthcare claims
,but Smallcap must continue to otter him coverage under its employer-sponsored group health plan and would become
a secondary payor.
7. Ms. Kumar 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.
8. Mrs. Ellis recently turned 66 and decided after many years of work to
re- tire and begin receiving Social Security benefits. Shortly thereafter
Mrs. Ellis received a letter informing her that she had been automatically
enrolled in Medicare Part B. She wants to understand what this means. What
should you
tell Mrs. Ellis?
Answer Part B primarily covers physician services. She will be paying a monthly premium and, except for many
preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
9. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
Answer Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part
A and Part B services through Original Fee-for-Service Medicare.
, 10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What
could
you tell Mrs. Cook that might be of assistance?
Answer 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.
11. 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?
Answer To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
12. Mr. Bauer is 49 years old, but eighteen months ago he was declared
dis- abled 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.
13. 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.
1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and
a Medigap plan to pick up costs not covered by that plan. What should you tell
him?
Answer It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap
only works with Original Medicare.
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is
currently 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.
3. 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. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
4. Mr. Vasquez 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
,because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare?
Answer 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 coinsurance 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.
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr.
Moy's wife has a Medicare Advantage plan, but he wants to understand what
cover- age 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 deductible and Part B coinsurance
or copayments in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not
cover.
6. Juan Perez, who is turning age 65 next month, intends to work for several
more years at Smallcap, Incorporated. Smallcap has a workforce of 15
employ- ees and offers employer-sponsored healthcare coverage. Juan is a
naturalized citizen and has contributed to the Medicare system for over 20
years. Juan asks
you if he will be entitled to Medicare and if he enrolls how that will impact his
employer- sponsored healthcare coverage. How would you respond?
Answer Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls, Medicare would
become the primary payor of his healthcare claims and Smallcap does not have to continue to otter him coverage
comparable to those under age 65 under its employer-sponsored group health plan. Juan is likely to be eligible for
Medicare once he turns age 65 and if he enrolls, Medicare would become the primary payor of his healthcare claims
,but Smallcap must continue to otter him coverage under its employer-sponsored group health plan and would become
a secondary payor.
7. Ms. Kumar 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.
8. Mrs. Ellis recently turned 66 and decided after many years of work to
re- tire and begin receiving Social Security benefits. Shortly thereafter
Mrs. Ellis received a letter informing her that she had been automatically
enrolled in Medicare Part B. She wants to understand what this means. What
should you
tell Mrs. Ellis?
Answer Part B primarily covers physician services. She will be paying a monthly premium and, except for many
preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
9. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
Answer Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part
A and Part B services through Original Fee-for-Service Medicare.
, 10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What
could
you tell Mrs. Cook that might be of assistance?
Answer 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.
11. 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?
Answer To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
12. Mr. Bauer is 49 years old, but eighteen months ago he was declared
dis- abled 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.
13. 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.
