AHIP EXAM 2024 AND PRACTICE EXAM TEST BANK WITH
A STUDY GUIDE | ACCURATE REAL EXAM QUESTIONS
WITH DETAILED ANSWERS | LATEST UPDATE FOR
GUARANTEED PASS | GRADED A
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 ANSWER Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present
coverage.
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, and Lou Gehrig's disease so she will be eligible
for Medicare.
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.
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 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. 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. 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 ANSWER Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This
coverage has recently been terminated due to the end of the PHE. While Shirley was enrolled in
Medicaid, she missed an opportunity to enroll in Medicare and now wants Part B. Which of the
following statements best describes Shirley's ability to now enroll in Medicare Part B? -
CORRECT ANSWER Shirley is eligible for a Special Enrollment Period (SEP) for up to six
months after the termination of her Medicaid coverage. Under this SEP, Shirley can choose
retroactive coverage back to the date of termination from Medicaid or coverage beginning the
month after the month of enrollment.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - CORRECT ANSWER Anthony is eligible for a special
enrollment period (SEP) because he missed an enrollment period due to the impact of the
Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months
after the end of the emergency declaration. Anthony may enroll in premium-free Part A at any
time and his Part A coverage will be retroactive for up to 6 months.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA) but is not sure if the plan associated with the account will fit her needs. What specific
piece of information about a Medicare MSA plan would it be important for her to know, prior to
enrolling in such a plan? - CORRECT ANSWER All MSAs cover Part A and Part B benefits,
but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate
prescription drug plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers
she can go to for her health care. What should you tell her? - CORRECT ANSWER Mrs. 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 ANSWER He should
compare the benefits in his employer-sponsored retiree group health plan with the benefits in his
neighbor's MA-PD plan to determine which one will provide sufficient coverage for his
prescription needs.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received
under Original Medicare, but he would like to know more about Medicare Advantage Special
Needs Plans (SNPs). What could you tell him? - CORRECT ANSWER SNPs have special
programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription
drug coverage that could be very helpful as well.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms
and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr.
Brennan charge? - CORRECT ANSWER Dr. 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.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his current HMO
plan requires him to do. What should you tell him? - CORRECT ANSWER He may receive
health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the
plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and
conditions, which could include balance billing.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty
years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap
Incorporated and contributed to the Medicare system. Juan suffers from diabetes. He will soon
retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How would
you respond? - CORRECT ANSWER Juan is eligible to enroll in a Medicare Advantage as long
as he is entitled to Part A and enrolled in Part B. Juan should go to the Social Security website to
enroll in Medicare Part A and B if he has not done so already. Once he is enrolled, he can choose
a Medicare Advantage plan.
, Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - CORRECT ANSWER Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney
and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50
and asks you if his Medicare coverage will continue, what should you say? - CORRECT
ANSWER Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months
after the month in which the individual receives a kidney transplant unless they are eligible for
Medicare on another basis such as age or disability. Edward may, however, remain enrolled in
Part B but solely for coverage of immunosuppressive drugs if he has no other health care
coverage that would cover the drugs.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suffering from inoperable cancer and has just a few months to live.
She would like to spend these final months in hospice care. Mildred's family asks you whether
hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you
say? - CORRECT ANSWER Mildred may remain enrolled in Allcare and make a hospice
election. Hospice benefits will be paid for by Original Medicare under Part A and Allcare will
continue to pay for any non-hospice 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 ANSWER Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer's 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 are different from his
wife's needs. What could you tell Mr. Moy? - CORRECT ANSWER Medicare Supplemental
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. 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 age 65 or over are covered under Part A by
A STUDY GUIDE | ACCURATE REAL EXAM QUESTIONS
WITH DETAILED ANSWERS | LATEST UPDATE FOR
GUARANTEED PASS | GRADED A
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 ANSWER Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present
coverage.
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, and Lou Gehrig's disease so she will be eligible
for Medicare.
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.
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 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. 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. 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 ANSWER Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This
coverage has recently been terminated due to the end of the PHE. While Shirley was enrolled in
Medicaid, she missed an opportunity to enroll in Medicare and now wants Part B. Which of the
following statements best describes Shirley's ability to now enroll in Medicare Part B? -
CORRECT ANSWER Shirley is eligible for a Special Enrollment Period (SEP) for up to six
months after the termination of her Medicaid coverage. Under this SEP, Shirley can choose
retroactive coverage back to the date of termination from Medicaid or coverage beginning the
month after the month of enrollment.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - CORRECT ANSWER Anthony is eligible for a special
enrollment period (SEP) because he missed an enrollment period due to the impact of the
Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months
after the end of the emergency declaration. Anthony may enroll in premium-free Part A at any
time and his Part A coverage will be retroactive for up to 6 months.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA) but is not sure if the plan associated with the account will fit her needs. What specific
piece of information about a Medicare MSA plan would it be important for her to know, prior to
enrolling in such a plan? - CORRECT ANSWER All MSAs cover Part A and Part B benefits,
but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate
prescription drug plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers
she can go to for her health care. What should you tell her? - CORRECT ANSWER Mrs. 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 ANSWER He should
compare the benefits in his employer-sponsored retiree group health plan with the benefits in his
neighbor's MA-PD plan to determine which one will provide sufficient coverage for his
prescription needs.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received
under Original Medicare, but he would like to know more about Medicare Advantage Special
Needs Plans (SNPs). What could you tell him? - CORRECT ANSWER SNPs have special
programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription
drug coverage that could be very helpful as well.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms
and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr.
Brennan charge? - CORRECT ANSWER Dr. 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.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his current HMO
plan requires him to do. What should you tell him? - CORRECT ANSWER He may receive
health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the
plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and
conditions, which could include balance billing.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty
years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap
Incorporated and contributed to the Medicare system. Juan suffers from diabetes. He will soon
retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How would
you respond? - CORRECT ANSWER Juan is eligible to enroll in a Medicare Advantage as long
as he is entitled to Part A and enrolled in Part B. Juan should go to the Social Security website to
enroll in Medicare Part A and B if he has not done so already. Once he is enrolled, he can choose
a Medicare Advantage plan.
, Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - CORRECT ANSWER Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney
and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50
and asks you if his Medicare coverage will continue, what should you say? - CORRECT
ANSWER Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months
after the month in which the individual receives a kidney transplant unless they are eligible for
Medicare on another basis such as age or disability. Edward may, however, remain enrolled in
Part B but solely for coverage of immunosuppressive drugs if he has no other health care
coverage that would cover the drugs.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suffering from inoperable cancer and has just a few months to live.
She would like to spend these final months in hospice care. Mildred's family asks you whether
hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you
say? - CORRECT ANSWER Mildred may remain enrolled in Allcare and make a hospice
election. Hospice benefits will be paid for by Original Medicare under Part A and Allcare will
continue to pay for any non-hospice 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 ANSWER Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer's 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 are different from his
wife's needs. What could you tell Mr. Moy? - CORRECT ANSWER Medicare Supplemental
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. 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 age 65 or over are covered under Part A by
