AHIP 2021/2022 Exam bank (answered) explained.
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. Correct Answer: 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?
Original Medicare covers ambulance services. Correct Answer: 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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's
plan. Correct Answer: 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?
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. Correct Answer: 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?
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. Correct Answer: 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?
After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age. Correct Answer: 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?
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. Correct Answer: 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?
,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. Correct
Answer: 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 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.
Correct Answer: 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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which
include immunizations such as annual flu shots. Correct Answer: 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?
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. Correct Answer: 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?
The Part B deductible will no longer be covered for individuals newly eligible for Medicare
starting January 1, 2020. Correct Answer: What impact, if any, will recent regulatory changes
have upon Medigap plans?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program. Correct Answer: 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?
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. Correct Answer:
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?
, Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage. Correct Answer: 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?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for
medically necessary services Correct Answer: 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?
He may sign-up for Medicare at any time however coverage usually begins on the fourth month
after dialysis treatments start. Correct Answer: 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?
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. Correct Answer: 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?
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 Answer: Mr. Singh
would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What
should you tell him?
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
offer him coverage comparable to those under age 65 under its employer-sponsored group health
plan. Correct Answer: 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 employees 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?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
Correct Answer: Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
He is not eligible to enroll in a Medicare Advantage plan until he reenrolls in Medicare Part B.
Correct Answer: Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but
has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
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. Correct Answer: 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?
Original Medicare covers ambulance services. Correct Answer: 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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's
plan. Correct Answer: 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?
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. Correct Answer: 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?
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. Correct Answer: 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?
After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age. Correct Answer: 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?
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. Correct Answer: 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?
,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. Correct
Answer: 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 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.
Correct Answer: 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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which
include immunizations such as annual flu shots. Correct Answer: 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?
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. Correct Answer: 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?
The Part B deductible will no longer be covered for individuals newly eligible for Medicare
starting January 1, 2020. Correct Answer: What impact, if any, will recent regulatory changes
have upon Medigap plans?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program. Correct Answer: 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?
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. Correct Answer:
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?
, Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage. Correct Answer: 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?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for
medically necessary services Correct Answer: 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?
He may sign-up for Medicare at any time however coverage usually begins on the fourth month
after dialysis treatments start. Correct Answer: 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?
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. Correct Answer: 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?
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 Answer: Mr. Singh
would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What
should you tell him?
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
offer him coverage comparable to those under age 65 under its employer-sponsored group health
plan. Correct Answer: 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 employees 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?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
Correct Answer: Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
He is not eligible to enroll in a Medicare Advantage plan until he reenrolls in Medicare Part B.
Correct Answer: Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but
has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
