AHIP 2021 Questions And Correct Answers
Mrs. Quinn recently turned 66 and decided after many years of work to begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn 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% coinsurance for these services,
in addition to an annual deductible.
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.
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.
Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare
Supplement (Medigap) plan. Anita's older neighbor Mel has told her about
the Medigap Part F plan in which he is enrolled. It not only provides foreign
travel emergency benefits but also covers his Medicare Part B deductible.
Anita comes to you for advice. What should you tell her? Correct Ans -
You are sorry to disappoint Anita but a Medigap Part F plan is no longer
available to those who turn age 65 after January 1,2020. Anita might instead
consider other Medigap plans that offer foreign travel benefits but do not
cover the Part B deductible.
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?
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.
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. 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.
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, and Lou Gehrig's disease so
she will be eligible for Medicare.
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. Shield's skilled nursing services provided
during the first 20 days of her stay, after which she would have a copay until
she has been in the facility for 100 days.
Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr. Xi
that best describes the health coverage provided to Medicare beneficiaries?
Correct Ans - Beneficiaries under Original Medicare have no cost-sharing
for most preventive services which include immunizations such as annual flu
shots.
Mrs. Geisler's neighbor told her she should look at her Part D options during
the annual Medicare enrollment period because features of Part D might
have changed. Mrs. Geisler can't remember what Part D is so she called you
to ask what her neighbor was talking about. What could you tell her?
Correct Ans - Part D covers prescription drugs and she should look at her
premiums, formulary, and cost-sharing among other factors to see if they
have changed.
What impact, if any, will recent regulatory changes have upon Medigap
plans? Correct Ans - The Part B deductible will no longer be covered for
individuals newly eligible for Medicare starting January 1, 2020.
, 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? Correct Ans - Mr. Wu may still qualify for
help in paying Part D costs through his State Pharmaceutical Assistance
Program.
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? Correct
Ans - 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.
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? Correct Ans - Tell prospect Jerry Smith that
he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
Mrs. Paterson is concerned about the deductibles and co-payments
associated with Original Medicare. What can you tell her about Medigap as
an option to address this concern? Correct Ans - Medigap plans help
beneficiaries cover coinsurance, co-payments, and/or deductibles for
medically necessary services
Mr. Davis is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
obtain coverage under Medicare. What should you tell him? Correct Ans -
He may sign-up for Medicare at any time however coverage usually begins
on the fourth month after dialysis treatments start.
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 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. Quinn recently turned 66 and decided after many years of work to begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn 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% coinsurance for these services,
in addition to an annual deductible.
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.
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.
Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare
Supplement (Medigap) plan. Anita's older neighbor Mel has told her about
the Medigap Part F plan in which he is enrolled. It not only provides foreign
travel emergency benefits but also covers his Medicare Part B deductible.
Anita comes to you for advice. What should you tell her? Correct Ans -
You are sorry to disappoint Anita but a Medigap Part F plan is no longer
available to those who turn age 65 after January 1,2020. Anita might instead
consider other Medigap plans that offer foreign travel benefits but do not
cover the Part B deductible.
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?
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.
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. 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.
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, and Lou Gehrig's disease so
she will be eligible for Medicare.
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. Shield's skilled nursing services provided
during the first 20 days of her stay, after which she would have a copay until
she has been in the facility for 100 days.
Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr. Xi
that best describes the health coverage provided to Medicare beneficiaries?
Correct Ans - Beneficiaries under Original Medicare have no cost-sharing
for most preventive services which include immunizations such as annual flu
shots.
Mrs. Geisler's neighbor told her she should look at her Part D options during
the annual Medicare enrollment period because features of Part D might
have changed. Mrs. Geisler can't remember what Part D is so she called you
to ask what her neighbor was talking about. What could you tell her?
Correct Ans - Part D covers prescription drugs and she should look at her
premiums, formulary, and cost-sharing among other factors to see if they
have changed.
What impact, if any, will recent regulatory changes have upon Medigap
plans? Correct Ans - The Part B deductible will no longer be covered for
individuals newly eligible for Medicare starting January 1, 2020.
, 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? Correct Ans - Mr. Wu may still qualify for
help in paying Part D costs through his State Pharmaceutical Assistance
Program.
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? Correct
Ans - 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.
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? Correct Ans - Tell prospect Jerry Smith that
he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
Mrs. Paterson is concerned about the deductibles and co-payments
associated with Original Medicare. What can you tell her about Medigap as
an option to address this concern? Correct Ans - Medigap plans help
beneficiaries cover coinsurance, co-payments, and/or deductibles for
medically necessary services
Mr. Davis is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
obtain coverage under Medicare. What should you tell him? Correct Ans -
He may sign-up for Medicare at any time however coverage usually begins
on the fourth month after dialysis treatments start.
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 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.
