AHIP Study Guide
, AHIP Study Guide
Module 1
1. 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 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.
2. 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?
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.
3. 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?
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
coinsurance 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.
4. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance?
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.
5. 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?
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.
6. 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 will -cover these
items and services. What should you tell her?
Medicare does not cover massage therapy, or, in general, glasses or dentures.
, AHIP Study Guide
7. 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?
He generally would pay a monthly premium, annual deductible, and per-
prescription cost- sharing.
8. Mrs. Peña 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?
She 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.
9. 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?
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.
10. 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?
He may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start.
11. 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?
To obtain Part B coverage, she must pay a standard monthly premium, though it
is higher for individuals with higher incomes.
12. 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?
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.
13. 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?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey’s entire lifetime.
, AHIP Study Guide
Module 1
1. 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 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.
2. 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?
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.
3. 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?
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
coinsurance 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.
4. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance?
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.
5. 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?
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.
6. 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 will -cover these
items and services. What should you tell her?
Medicare does not cover massage therapy, or, in general, glasses or dentures.
, AHIP Study Guide
7. 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?
He generally would pay a monthly premium, annual deductible, and per-
prescription cost- sharing.
8. Mrs. Peña 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?
She 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.
9. 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?
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.
10. 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?
He may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start.
11. 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?
To obtain Part B coverage, she must pay a standard monthly premium, though it
is higher for individuals with higher incomes.
12. 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?
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.
13. 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?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey’s entire lifetime.
