AHIP Final Exam Latest Updated 2023 With
Well Organised Questions And Answers
{Guaranteed A+ Pass}
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 answersHe may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years atSmallcap,
Incorporated. Smallcap has a workforce of15 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?correct
answersJuan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would
become theprimary 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.
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 aredifferent from his wife's needs. What
could you tell Mr. Moy?correct answersMedicareSupplemental Insurance would help cover his Part A and
Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
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 gapin coverage. What can you tell
her?correct answersShe may enroll at any time while she is covered under her employer plan, but she will
have a special eight-month enrollment period after the last month on her employer plan that differs from
the standard general enrollment period, during which she may enroll in Medicare Part B.
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 qualifyfor coverage under part A because she
was not born in the United States. What shouldyou tell her?correct answersMost 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. 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 answersMrs. 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.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
massage therapy. She is concerned about whether or not Medicare willcover these items and services.
What should you tell her?correct answersMedicare does not cover massage therapy, or, in general,
glasses or dentures.
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 tounder 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 answersUnder 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 coinsurance amount
through day 90. After day 90, he would paya daily amount up to 60 days over his lifetime, after which he
would be responsible for all costs.
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 answersTo obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higherincomes.
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 MedicarePart D prescription drug plan. What
should you tell him?correctanswersHe generally would pay a monthly premium, annual deductible, and
per- prescription cost-sharing.
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 addressher concern?correct answersMedicare 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.
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 answersBeneficiaries underOriginal Medicare have no cost-sharing for
most preventive services which include immunizations such as annual flu shots.
,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for
services. What advice would you give her?correct answersMrs. Duarte should file an appeal of this initial
determination within 120 days ofthe date she received the MSN in the mail.
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 answersIt is illegal for you to sell Mr. Capadona a Medigap plan if
he is enrolled in an MA plan, and besides, Medigap only works withOriginal Medicare.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance?correct answersShe should contact her state Medicaid agency to see if she qualifies for
one of several programs that can help withMedicare costs for which she is responsible.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should behospitalized. What
should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay
that Medicare will cover?correct answersMedicare will cover a total of 190 days of inpatient psychiatric
care during Mr. Rainey's entire lifetime.
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 answersPartA, which covers hospital, skilled
nursing facility, hospice, and home health services andPart B, which covers professional services such as
those provided by a doctor are covered under Original Medicare.
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 providedrug benefits. How would you advise Agent John Miller to
proceed?correct answersTell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
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 answersAfter receiving such disability
payments for 24 months, he will beautomatically enrolled in Medicare, regardless of age.
Mr. Buck has several family members who died from different cancers. He wants toknow if Medicare
covers cancer screening.
, What should you tell him?correct answersMedicare covers the periodic performance ofa 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 becovered.
Which of the following statement is/are correct about a Medicare Savings Account(MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.III. An individual
who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare wouldpay them as
payment in full.correct answersI, II, and IV only
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three
plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug
coverage, but the other two plans do. Mr. Lombardilikes the PPO plan that does not include drug coverage
and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What
should you tell him about this situation?correct answersHe could enroll either in one of the MA plans that
include prescription drug coverage or Original Medicare with a Medigap plan and standalone Part D
prescription drug coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription
drug plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about whichproviders she can
go to for her health care. What should you tell her?correct answersMrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she
sees a provider who/that is not a part of the PPO network.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health
plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you
represent and because he takes numerous prescription drugs, he is considering signing up for it. What
should you tell him?correct answersHe should compare the benefits in his employer-sponsored retiree
group healthplan with the benefits in his neighbor's MA-PD plan to determine which one will provide
sufficient coverage for his prescription needs.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan'sterms and
conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan
charge?correct answersDr. Brennan can charge Mary Rogers no more than the cost sharing specified in
the PFFS plan's terms and condition of payment which may include balance billing up to 15% of the
Medicare rate.
Well Organised Questions And Answers
{Guaranteed A+ Pass}
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 answersHe may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years atSmallcap,
Incorporated. Smallcap has a workforce of15 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?correct
answersJuan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would
become theprimary 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.
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 aredifferent from his wife's needs. What
could you tell Mr. Moy?correct answersMedicareSupplemental Insurance would help cover his Part A and
Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
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 gapin coverage. What can you tell
her?correct answersShe may enroll at any time while she is covered under her employer plan, but she will
have a special eight-month enrollment period after the last month on her employer plan that differs from
the standard general enrollment period, during which she may enroll in Medicare Part B.
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 qualifyfor coverage under part A because she
was not born in the United States. What shouldyou tell her?correct answersMost 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. 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 answersMrs. 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.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
massage therapy. She is concerned about whether or not Medicare willcover these items and services.
What should you tell her?correct answersMedicare does not cover massage therapy, or, in general,
glasses or dentures.
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 tounder 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 answersUnder 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 coinsurance amount
through day 90. After day 90, he would paya daily amount up to 60 days over his lifetime, after which he
would be responsible for all costs.
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 answersTo obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higherincomes.
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 MedicarePart D prescription drug plan. What
should you tell him?correctanswersHe generally would pay a monthly premium, annual deductible, and
per- prescription cost-sharing.
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 addressher concern?correct answersMedicare 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.
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 answersBeneficiaries underOriginal Medicare have no cost-sharing for
most preventive services which include immunizations such as annual flu shots.
,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for
services. What advice would you give her?correct answersMrs. Duarte should file an appeal of this initial
determination within 120 days ofthe date she received the MSN in the mail.
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 answersIt is illegal for you to sell Mr. Capadona a Medigap plan if
he is enrolled in an MA plan, and besides, Medigap only works withOriginal Medicare.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance?correct answersShe should contact her state Medicaid agency to see if she qualifies for
one of several programs that can help withMedicare costs for which she is responsible.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should behospitalized. What
should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay
that Medicare will cover?correct answersMedicare will cover a total of 190 days of inpatient psychiatric
care during Mr. Rainey's entire lifetime.
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 answersPartA, which covers hospital, skilled
nursing facility, hospice, and home health services andPart B, which covers professional services such as
those provided by a doctor are covered under Original Medicare.
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 providedrug benefits. How would you advise Agent John Miller to
proceed?correct answersTell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
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 answersAfter receiving such disability
payments for 24 months, he will beautomatically enrolled in Medicare, regardless of age.
Mr. Buck has several family members who died from different cancers. He wants toknow if Medicare
covers cancer screening.
, What should you tell him?correct answersMedicare covers the periodic performance ofa 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 becovered.
Which of the following statement is/are correct about a Medicare Savings Account(MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.III. An individual
who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare wouldpay them as
payment in full.correct answersI, II, and IV only
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three
plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug
coverage, but the other two plans do. Mr. Lombardilikes the PPO plan that does not include drug coverage
and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What
should you tell him about this situation?correct answersHe could enroll either in one of the MA plans that
include prescription drug coverage or Original Medicare with a Medigap plan and standalone Part D
prescription drug coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription
drug plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about whichproviders she can
go to for her health care. What should you tell her?correct answersMrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she
sees a provider who/that is not a part of the PPO network.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health
plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you
represent and because he takes numerous prescription drugs, he is considering signing up for it. What
should you tell him?correct answersHe should compare the benefits in his employer-sponsored retiree
group healthplan with the benefits in his neighbor's MA-PD plan to determine which one will provide
sufficient coverage for his prescription needs.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan'sterms and
conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan
charge?correct answersDr. Brennan can charge Mary Rogers no more than the cost sharing specified in
the PFFS plan's terms and condition of payment which may include balance billing up to 15% of the
Medicare rate.
