AHIP 2021
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?
a. Medicare Part B generally provides prescription drug coverage.
b. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
c. Medicare Part A generally covers medically necessary physician and other health care professional
services.
d. Benefits covered by Medicare Parts A and B include routine dental care, hearing aids, and routine eye
care. correct answerb. Beneficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
(Beneficiaries enrolled in both Original Medicare (Parts A and B) have no cost-sharing for most
preventive services. These services include immunizations such as annual flu shots.)
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him?
a. Mr. Singh must leave Original Medicare to receive drug coverage.
b. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Advantage plan
that also covers Part A and Part B services.
c. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through
some means other than a Medicare Advantage plan.
d. 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. correct answerd. 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.
,(Prescription drug coverage is available to those who enroll in a stand-alone Part D prescription drug
plan and continue coverage under Original Medicare Part A and Part B.)
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?
a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically
necessary services.
b. Medigap plans are not sold by private companies and are a government insurance product.
c. All costs not covered by Medicare are covered by some Medigap plans.
d. If Mrs. Paterson applies during the Medigap open enrollment period, she will have to undergo a
medical review to determine if she has a pre-existing condition that would increase the premium for a
Medigap policy. correct answera. Medigap plans help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services.
(Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles when Original
Medicare determines that a benefit is medically necessary.)
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?
a. 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.
b. Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of
coverage.
c. During the first year, he is covered under Part B, his premiums will be 10% higher than they otherwise
would be, after which point they will return to normal.
d. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
correct answerd. Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
,(Individuals with coverage based on their own current employment are not subject to the late
enrollment penalty.)
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?
a. 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.
b. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal
government. If she or her husband were ever employed by the federal government, she can enroll in
Medicare.
c. Medicare is a program for people who have incomes and assets below specific limits, so you will have
to find out her exact financial situation before telling her whether she can obtain Medicare coverage.
d. Medicare is a program for people of all ages with specific mental health disabilities. Since she is in
excellent health, she would not qualify, but should instead look into her state's Medicaid program if she
wants further coverage. correct answera. 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.
(Individuals that meet these criteria may be eligible to participate in Medicare. It is not based on
income.)
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?
a. 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 the highest rate because her income over the last
several years has exceeded $100,000.
b. You should tell Madeline that she will need to pay premiums for Part A because of her short work
history. You should also tell Madeline that she will pay Part B premiums at the highest rate because her
income over the last several years has exceeded $100,000.
c. 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.
d. You should tell Madeline that she will be able to enroll in both Medicare Part A and Part B without
paying monthly premiums due to her husband's long work record and participation in the Medicare
system. correct answerc. 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.
(Madeline will be able to enroll in premium-free Part A due to her husband's work record. She will pay a
premium for Part B coverage based on her income level (her income-related monthly adjustment
amount [IRMMA]). An income level of $100,00 would mean Mrs. Martinez would pay a premium more
than the standard (lowest) amount but not at the highest level which looks at incomes above $500,000
for those filing individual income tax returns.)
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?
a. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social
Security benefits.
b. He may sign-up for Medicare at any time and coverage usually begins immediately.
c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
d. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after
dialysis treatments start. correct answerc. He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
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?
a. Medicare Part B generally provides prescription drug coverage.
b. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
c. Medicare Part A generally covers medically necessary physician and other health care professional
services.
d. Benefits covered by Medicare Parts A and B include routine dental care, hearing aids, and routine eye
care. correct answerb. Beneficiaries under Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
(Beneficiaries enrolled in both Original Medicare (Parts A and B) have no cost-sharing for most
preventive services. These services include immunizations such as annual flu shots.)
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him?
a. Mr. Singh must leave Original Medicare to receive drug coverage.
b. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Advantage plan
that also covers Part A and Part B services.
c. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through
some means other than a Medicare Advantage plan.
d. 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. correct answerd. 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.
,(Prescription drug coverage is available to those who enroll in a stand-alone Part D prescription drug
plan and continue coverage under Original Medicare Part A and Part B.)
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?
a. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically
necessary services.
b. Medigap plans are not sold by private companies and are a government insurance product.
c. All costs not covered by Medicare are covered by some Medigap plans.
d. If Mrs. Paterson applies during the Medigap open enrollment period, she will have to undergo a
medical review to determine if she has a pre-existing condition that would increase the premium for a
Medigap policy. correct answera. Medigap plans help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services.
(Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles when Original
Medicare determines that a benefit is medically necessary.)
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?
a. 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.
b. Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of
coverage.
c. During the first year, he is covered under Part B, his premiums will be 10% higher than they otherwise
would be, after which point they will return to normal.
d. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
correct answerd. Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
,(Individuals with coverage based on their own current employment are not subject to the late
enrollment penalty.)
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?
a. 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.
b. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal
government. If she or her husband were ever employed by the federal government, she can enroll in
Medicare.
c. Medicare is a program for people who have incomes and assets below specific limits, so you will have
to find out her exact financial situation before telling her whether she can obtain Medicare coverage.
d. Medicare is a program for people of all ages with specific mental health disabilities. Since she is in
excellent health, she would not qualify, but should instead look into her state's Medicaid program if she
wants further coverage. correct answera. 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.
(Individuals that meet these criteria may be eligible to participate in Medicare. It is not based on
income.)
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?
a. 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 the highest rate because her income over the last
several years has exceeded $100,000.
b. You should tell Madeline that she will need to pay premiums for Part A because of her short work
history. You should also tell Madeline that she will pay Part B premiums at the highest rate because her
income over the last several years has exceeded $100,000.
c. 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.
d. You should tell Madeline that she will be able to enroll in both Medicare Part A and Part B without
paying monthly premiums due to her husband's long work record and participation in the Medicare
system. correct answerc. 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.
(Madeline will be able to enroll in premium-free Part A due to her husband's work record. She will pay a
premium for Part B coverage based on her income level (her income-related monthly adjustment
amount [IRMMA]). An income level of $100,00 would mean Mrs. Martinez would pay a premium more
than the standard (lowest) amount but not at the highest level which looks at incomes above $500,000
for those filing individual income tax returns.)
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?
a. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social
Security benefits.
b. He may sign-up for Medicare at any time and coverage usually begins immediately.
c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
d. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after
dialysis treatments start. correct answerc. He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
