AHIP 2022 - Questions And Answers
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? Correct Ans -
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? Correct Ans - 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? Correct Ans - 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? Correct Ans -
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? Correct
Ans - 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?
Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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?
Correct Ans - 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? Correct Ans
- 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? Correct
Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans -
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? Correct Ans
- 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? Correct Ans - Medicare will cover a total of 190 days
of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Quinn has just turned 65 and received a letter informing her that she has
been automatically enrolled in Medicare Part B. She wants to understand what
this means. What should you tell Mrs. Quinn? Correct Ans - Part B primarily
covers physician services. She will be paying a monthly premium and, with the
exception of many preventive and screening tests, generally will have 20% co-
payments for these services, in addition to an
annual deductible.
Mr. Buck has several family members who died from different cancers. He
wants to know if Medicare covers cancer screening. What should you tell him?
Correct Ans - Medicare covers periodic performance of a range of screening
tests that are meant to provide early detection of disease. Mr. Buck will need
to check specific tests before obtaining them to see if they will be covered.
Mrs. Turner is comparing her employer's retiree insurance to Original
Medicare and would like to know which of the following services Original
Medicare will cover if the appropriate criteria are met? What could you tell
her? Correct Ans - Original Medicare covers ambulance services.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through acupuncture. She is concerned about whether or
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? Correct Ans -
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? Correct Ans - 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? Correct Ans - 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? Correct Ans -
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? Correct
Ans - 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?
Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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?
Correct Ans - 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? Correct Ans
- 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? Correct
Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans -
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? Correct Ans
- 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? Correct Ans - Medicare will cover a total of 190 days
of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Quinn has just turned 65 and received a letter informing her that she has
been automatically enrolled in Medicare Part B. She wants to understand what
this means. What should you tell Mrs. Quinn? Correct Ans - Part B primarily
covers physician services. She will be paying a monthly premium and, with the
exception of many preventive and screening tests, generally will have 20% co-
payments for these services, in addition to an
annual deductible.
Mr. Buck has several family members who died from different cancers. He
wants to know if Medicare covers cancer screening. What should you tell him?
Correct Ans - Medicare covers periodic performance of a range of screening
tests that are meant to provide early detection of disease. Mr. Buck will need
to check specific tests before obtaining them to see if they will be covered.
Mrs. Turner is comparing her employer's retiree insurance to Original
Medicare and would like to know which of the following services Original
Medicare will cover if the appropriate criteria are met? What could you tell
her? Correct Ans - Original Medicare covers ambulance services.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through acupuncture. She is concerned about whether or
