AHIP 2022 EXAM (ACTUAL TEST)
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) andwill soon
begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? - He
may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis
treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored healthcarecoverage.
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? - Juan is likely to be eligible forMedicare 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 offer him coverage comparable to those under age 65 under its employer-sponsored group health
plan.
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? - Medicare Supplemental Insurance would help cover his Part A andPart B
deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services
that Medicare does not cover.
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? - She may
enroll at any time while she is covered under her employer plan, but she will have a special eight-month
enrollment period after the last month on her employer plan that differsfrom the standard general
enrollment period, during which she may enroll in Medicare Part B.
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? - Most individuals who arecitizens and age 65 or
over 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.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug
coverage. She would like to keep the coverage she has but replace her existing Medigap plan
,with one that provides drug coverage. What should you tell her? - Mrs. Gonzalez cannot purchase aMedigap
plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
massage therapy. She is concerned about whether or not Medicare will cover these items and services.
What should you tell her? - Medicare does not cover massage therapy, or, in general,glasses or dentures.
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? - Under Original Medicare, there is a single deductible amount due for thefirst 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.
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? -
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with
higher incomes.
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer'sretiree
coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would
generally expect to encounter when enrolling into a standard MedicarePart D prescription drug plan.
What should you tell him? - He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
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? - 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.
, Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided underOriginal
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare
beneficiaries? - Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary
Notice (MSN) and disagrees with a determination that partially denied one of her claims for services. What
advice would you give her? - Mrs. Duarte should file an appeal of this initial determination within 120 days
of the date she received the MSN in the mail.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pickup costs
not covered by that plan.
What should you tell him? - 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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be
of assistance? - 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. 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? - Medicare will cover a total of 190days of inpatient psychiatric
care during Mr. Rainey's entire lifetime.
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? - Part A, which covers hospital, skilled nursing facility,
hospice, and home health services and Part B, which covers professional servicessuch as those provided
by a doctor are covered under Original Medicare.
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 adviseAgent John Miller to proceed? - Tell
prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to
his present coverage.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) andwill soon
begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? - He
may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis
treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored healthcarecoverage.
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? - Juan is likely to be eligible forMedicare 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 offer him coverage comparable to those under age 65 under its employer-sponsored group health
plan.
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? - Medicare Supplemental Insurance would help cover his Part A andPart B
deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services
that Medicare does not cover.
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? - She may
enroll at any time while she is covered under her employer plan, but she will have a special eight-month
enrollment period after the last month on her employer plan that differsfrom the standard general
enrollment period, during which she may enroll in Medicare Part B.
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? - Most individuals who arecitizens and age 65 or
over 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.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug
coverage. She would like to keep the coverage she has but replace her existing Medigap plan
,with one that provides drug coverage. What should you tell her? - Mrs. Gonzalez cannot purchase aMedigap
plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
massage therapy. She is concerned about whether or not Medicare will cover these items and services.
What should you tell her? - Medicare does not cover massage therapy, or, in general,glasses or dentures.
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? - Under Original Medicare, there is a single deductible amount due for thefirst 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.
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? -
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with
higher incomes.
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer'sretiree
coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would
generally expect to encounter when enrolling into a standard MedicarePart D prescription drug plan.
What should you tell him? - He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
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? - 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.
, Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided underOriginal
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare
beneficiaries? - Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary
Notice (MSN) and disagrees with a determination that partially denied one of her claims for services. What
advice would you give her? - Mrs. Duarte should file an appeal of this initial determination within 120 days
of the date she received the MSN in the mail.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pickup costs
not covered by that plan.
What should you tell him? - 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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be
of assistance? - 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. 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? - Medicare will cover a total of 190days of inpatient psychiatric
care during Mr. Rainey's entire lifetime.
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? - Part A, which covers hospital, skilled nursing facility,
hospice, and home health services and Part B, which covers professional servicessuch as those provided
by a doctor are covered under Original Medicare.
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 adviseAgent John Miller to proceed? - Tell
prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to
his present coverage.
