AHIP Testing 2023| 685 QUESTIONS| GRADED A
Agent Harriet Walker has recently begun marketing Medicare Advantage and related products
aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a
Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's
position, what would you do? Correct Answer: Inquire whether the client qualifies for a special
enrollment period, and if not, solicit an enrollment application once the annual open enrollment
election period begins on October 15th.
Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the
time to fill out the paperwork. What could you tell her? Correct Answer: The Part D low income
subsidy could substantially lower her overall costs. She can apply by contacting her state
Medicaid office, or calling the Social Security Administration
Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is
currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did
not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP)
which has just closed. Mr. Wendt has heard certain MA plans might provide him with more
specialized coverage for his diabetes and wants to know if he must wait until the next annual open
enrollment period (AEP) before enrolling in such a plan. What should you tell him? Correct Answer:
If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals
with diabetes, he may enroll in the SNP at any time under a special election period (SEP)
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
Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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
Answer: 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
Answer: 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 Answer: 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 Answer:
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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 not Medicare will cover these items and services. What
, should you tell her? Correct Answer: Medicare does not cover acupuncture, or, in general,
glasses or dentures.
Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should
you tell him? Correct Answer: 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.
Mr. Alonso receives some help paying for his two generic prescription drugs from his
employer's retiree 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
Medicare Part D prescription drug plan. What should you tell him? Correct Answer: He
generally would pay a monthly premium, annual deductible, and per-prescription cost sharing.
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 Answer: 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.
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
Answer: Medigap plans help beneficiaries cover coinsurance, co-payments, and/or
deductibles for medically necessary services.
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? Correct
Answer: Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep
her Medigap policy and enroll in a Part D prescription drug plan.
Mr. Kelly has substantial financial means. He enrolled in Original Medicare and purchased a Medigap
policy many years ago that offered prescription drug coverage. The prescription drug coverage has not
been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly
took no action. Which of the following statements best describes what will occur if Mr. Kelly now decides
to enroll in Medicare Part D? Correct Answer: He will incur a late enrollment penalty.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to
pick up costs not covered by that plan. What should you tell him? Correct Answer: 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.
What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
have upon Medigap plans? Correct Answer: The Part B deductible will no longer be covered
for individuals newly eligible for Medicare starting January 1, 2020.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about
what type of plan designs are available through this program. What should you tell him about the types
Agent Harriet Walker has recently begun marketing Medicare Advantage and related products
aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a
Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's
position, what would you do? Correct Answer: Inquire whether the client qualifies for a special
enrollment period, and if not, solicit an enrollment application once the annual open enrollment
election period begins on October 15th.
Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the
time to fill out the paperwork. What could you tell her? Correct Answer: The Part D low income
subsidy could substantially lower her overall costs. She can apply by contacting her state
Medicaid office, or calling the Social Security Administration
Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is
currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did
not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP)
which has just closed. Mr. Wendt has heard certain MA plans might provide him with more
specialized coverage for his diabetes and wants to know if he must wait until the next annual open
enrollment period (AEP) before enrolling in such a plan. What should you tell him? Correct Answer:
If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals
with diabetes, he may enroll in the SNP at any time under a special election period (SEP)
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
Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 Answer: 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
Answer: 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
Answer: 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 Answer: 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 Answer:
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 Answer: 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 Answer: 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 Answer: 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 Answer: 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 not Medicare will cover these items and services. What
, should you tell her? Correct Answer: Medicare does not cover acupuncture, or, in general,
glasses or dentures.
Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should
you tell him? Correct Answer: 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.
Mr. Alonso receives some help paying for his two generic prescription drugs from his
employer's retiree 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
Medicare Part D prescription drug plan. What should you tell him? Correct Answer: He
generally would pay a monthly premium, annual deductible, and per-prescription cost sharing.
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 Answer: 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.
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
Answer: Medigap plans help beneficiaries cover coinsurance, co-payments, and/or
deductibles for medically necessary services.
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? Correct
Answer: Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep
her Medigap policy and enroll in a Part D prescription drug plan.
Mr. Kelly has substantial financial means. He enrolled in Original Medicare and purchased a Medigap
policy many years ago that offered prescription drug coverage. The prescription drug coverage has not
been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly
took no action. Which of the following statements best describes what will occur if Mr. Kelly now decides
to enroll in Medicare Part D? Correct Answer: He will incur a late enrollment penalty.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to
pick up costs not covered by that plan. What should you tell him? Correct Answer: 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.
What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
have upon Medigap plans? Correct Answer: The Part B deductible will no longer be covered
for individuals newly eligible for Medicare starting January 1, 2020.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about
what type of plan designs are available through this program. What should you tell him about the types
