AHIP ACTUAL EXAM 2023-2024 COMPLETE REAL 250 EXAM QUESTIO
AND CORRECT DETAILED ANSWERS
Study online at https://quizlet.com/_fyz27m
1. Mr. Davis is 52 years old and He may sign-up for Medicare at any
has recently been diagnosed with time however coverage usually be-
end-stage renal disease (ESRD) and gins on the fourth month after dialysis
will soon begin dialysis. He is won- treatments start.
dering if he can obtain coverage un-
der Medicare. What should you tell
him?
2. Juan Perez, who is turning age 65 Juan is likely to be eligible for
next month, intends to work for sev- Medicare once he turns age 65 and
eral more years at Smallcap, Incor- if he enrolls Medicare would become
porated. Smallcap has a workforce the primary payor of his healthcare
of15 employees and offers employ- claims and Smallcap does not have
er-sponsored healthcare coverage. to continue to offer him coverage
Juan is a naturalized citizen and has comparable to those under age 65
contributed to the Medicare system under its employer-sponsored group
for over 20 years. Juan asks you if health plan.
he will be entitled to Medicare and
if he enrolls how that will impact
his employer-sponsored healthcare
coverage. How would you respond?
3. Mr. Moy's wife has a Medicare Ad- Medicare Supplemental Insurance
vantage plan, but he wants to under- would help cover his Part A and Part
stand what coverage Medicare Sup- B deductibles or coinsurance in Orig-
plemental Insurance provides since inal Fee-for-Service (FFS) Medicare
his health care needs are different as well as possibly some services
from his wife's needs. What could that Medicare does not cover.
you tell Mr. Moy?
4. Mrs. PeHa is 66 years old, has cov- She may enroll at any time while
erage under an employer plan, and she is covered under her employ-
will retire next year. She heard she er plan, but she will have a special
must enroll in Part B at the begin- eight-month enrollment period after
ning of the year to ensure no gap in the last month on her employer plan
coverage. What can you tell her? that differs from the standard general
enrollment period, during which she
may enroll in Medicare Part B.
, AHIP ACTUAL EXAM 2023-2024 COMPLETE REAL 250 EXAM QUESTIO
AND CORRECT DETAILED ANSWERS
Study online at https://quizlet.com/_fyz27m
5. Mrs. Chen will be 65 soon, has been Most individuals who are citizens
a citizen for twelve years, has been and age 65 or over are covered
employed full time, and paid taxes under Part A by virtue of having
during that entire period. She is con- paid Medicare taxes while working,
cerned that she will not qualify for though some may be covered as a
coverage under part A because she result of paying monthly premiums.
was not born in the United States.
What should you tell her?
6. Mrs. Gonzalez is enrolled in Original Mrs. Gonzalez cannot purchase a
Medicare and has a Medigap poli- Medigap plan that covers drugs, but
cy as well, but it provides no drug she could keep her Medigap policy
coverage. She would like to keep and enroll in a Part D prescription
the coverage she has but replace drug plan.
her existing Medigap plan with one
that provides drug coverage. What
should you tell her?
7. Mrs. West wears glasses and den- Medicare does not cover massage
tures and has enjoyed considerable therapy, or, in general, glasses or
pain relief from arthritis through dentures.
massage therapy. She is concerned
about whether or not Medicare will
cover these items and services.
What should you tell her?
8. Mr. Patel is in good health and is Under Original Medicare, there is a
preparing a budget in anticipation single deductible amount due for the
of his retirement when he turns 66. first 60 days of any inpatient hospi-
He wants to understand the health tal stay, after which it converts into a
care costs he might be exposed to per-day coinsurance amount through
under Medicare if he were to require day 90. After day 90, he would pay
hospitalization as a result of an ill- a daily amount up to 60 days over
ness. In general terms, what could his lifetime, after which he would be
you tell him about his costs for in- responsible for all costs.
patient hospital services
under Original Medicare?
9.
, AHIP ACTUAL EXAM 2023-2024 COMPLETE REAL 250 EXAM QUESTIO
AND CORRECT DETAILED ANSWERS
Study online at https://quizlet.com/_fyz27m
Ms. Henderson believes that she To obtain Part B coverage, she must
will qualify for Medicare Coverage pay a standard monthly premium,
when she turns 65, without pay- though it is higher for individuals with
ing any premiums, because she has higher incomes.
been working for 40 years and pay-
ing Medicare taxes. What should
you tell her?
10. Mr. Alonso receives some help pay- He generally would pay a month-
ing for his two generic prescrip- ly premium, annual deductible, and
tion drugs from his employer's re- per-prescription cost-sharing.
tiree coverage, but he wants to
compare it to a Part D prescrip-
tion drug plan. He asks you what
costs he would generally expect
to encounter when enrolling into a
standard MedicarePart D prescrip-
tion drug plan. What should you tell
him?
11. Ms. Moore plans to retire when she Medicare is a program for people age
turns 65 in a few months. She is 65 or older and those under age 65
in excellent health and will have with certain disabilities, end-stage re-
considerable income when she re- nal disease, and Lou Gehrig's dis-
tires. She is concerned that her in- ease so she will be eligible for
come will make it impossible for her Medicare.
to qualify for Medicare. What could
you tell her to address her concern?
12. Mr. Xi will soon turn age 65 and has Beneficiaries under Original
come to you for advice as to what Medicare have no cost-sharing for
services are provided under Origi- most preventive services which in-
nal Medicare. What should you tell clude immunizations such as annual
Mr. Xi that best describes the health flu shots.
coverage provided to Medicare ben-
eficiaries?
13. Mrs. Duarte is enrolled in Original Mrs. Duarte should file an appeal of
Medicare Parts A and B. She has re- this initial determination within 120
, AHIP ACTUAL EXAM 2023-2024 COMPLETE REAL 250 EXAM QUESTIO
AND CORRECT DETAILED ANSWERS
Study online at https://quizlet.com/_fyz27m
cently reviewed her Medicare Sum- days of the date she received the
mary Notice (MSN) and disagrees MSN in the mail.
with a determination that partially
denied one of her claims for ser-
vices. What advice would you give
her?
14. Mr. Capadona would like to pur- It is illegal for you to sell Mr. Ca-
chase a Medicare Advantage (MA) padona a Medigap plan if he is en-
plan and a Medigap plan to pick up rolled in an MA plan, and besides,
costs not covered by that plan. Medigap only works with Original
What should you tell him? Medicare.
15. Mrs. Park is an elderly retiree. Mrs. She should contact her state Medic-
Park has a low fixed income. What aid agency to see if she qualifies for
could you tell Mrs. Park that might one of several programs that can help
be of assistance? with Medicare costs for which she is
responsible.
16. Mr. Rainey is experiencing para- Medicare will cover a total of 190
noid delusions and his physician days of inpatient psychiatric care dur-
feels that he should be hospitalized. ing Mr. Rainey's entire lifetime.
What should you tell Mr. Rainey (or
his representative) about the length
of an inpatient psychiatric hospital
stay that Medicare will cover?
17. Mr. Schmidt would like to plan for re- Part A, which covers hospital, skilled
tirement and has asked you what is nursing facility, hospice, and home
covered under Original Fee-for-Ser- health services and Part B, which
vice (FFS) Medicare? What could covers professional services such as
you tell him? those provided by a doctor are cov-
ered under Original Medicare.
18. Agent John Miller is meeting with Tell prospect Jerry Smith that he
Jerry Smith, a new prospect. Jerry is should consider adding a standalone
currently enrolled in Medicare Parts Part D prescription drug coverage
A and B. Jerry has also purchased policy to his present coverage.
a Medicare Supplement (Medigap)
AND CORRECT DETAILED ANSWERS
Study online at https://quizlet.com/_fyz27m
1. Mr. Davis is 52 years old and He may sign-up for Medicare at any
has recently been diagnosed with time however coverage usually be-
end-stage renal disease (ESRD) and gins on the fourth month after dialysis
will soon begin dialysis. He is won- treatments start.
dering if he can obtain coverage un-
der Medicare. What should you tell
him?
2. Juan Perez, who is turning age 65 Juan is likely to be eligible for
next month, intends to work for sev- Medicare once he turns age 65 and
eral more years at Smallcap, Incor- if he enrolls Medicare would become
porated. Smallcap has a workforce the primary payor of his healthcare
of15 employees and offers employ- claims and Smallcap does not have
er-sponsored healthcare coverage. to continue to offer him coverage
Juan is a naturalized citizen and has comparable to those under age 65
contributed to the Medicare system under its employer-sponsored group
for over 20 years. Juan asks you if health plan.
he will be entitled to Medicare and
if he enrolls how that will impact
his employer-sponsored healthcare
coverage. How would you respond?
3. Mr. Moy's wife has a Medicare Ad- Medicare Supplemental Insurance
vantage plan, but he wants to under- would help cover his Part A and Part
stand what coverage Medicare Sup- B deductibles or coinsurance in Orig-
plemental Insurance provides since inal Fee-for-Service (FFS) Medicare
his health care needs are different as well as possibly some services
from his wife's needs. What could that Medicare does not cover.
you tell Mr. Moy?
4. Mrs. PeHa is 66 years old, has cov- She may enroll at any time while
erage under an employer plan, and she is covered under her employ-
will retire next year. She heard she er plan, but she will have a special
must enroll in Part B at the begin- eight-month enrollment period after
ning of the year to ensure no gap in the last month on her employer plan
coverage. What can you tell her? that differs from the standard general
enrollment period, during which she
may enroll in Medicare Part B.
, AHIP ACTUAL EXAM 2023-2024 COMPLETE REAL 250 EXAM QUESTIO
AND CORRECT DETAILED ANSWERS
Study online at https://quizlet.com/_fyz27m
5. Mrs. Chen will be 65 soon, has been Most individuals who are citizens
a citizen for twelve years, has been and age 65 or over are covered
employed full time, and paid taxes under Part A by virtue of having
during that entire period. She is con- paid Medicare taxes while working,
cerned that she will not qualify for though some may be covered as a
coverage under part A because she result of paying monthly premiums.
was not born in the United States.
What should you tell her?
6. Mrs. Gonzalez is enrolled in Original Mrs. Gonzalez cannot purchase a
Medicare and has a Medigap poli- Medigap plan that covers drugs, but
cy as well, but it provides no drug she could keep her Medigap policy
coverage. She would like to keep and enroll in a Part D prescription
the coverage she has but replace drug plan.
her existing Medigap plan with one
that provides drug coverage. What
should you tell her?
7. Mrs. West wears glasses and den- Medicare does not cover massage
tures and has enjoyed considerable therapy, or, in general, glasses or
pain relief from arthritis through dentures.
massage therapy. She is concerned
about whether or not Medicare will
cover these items and services.
What should you tell her?
8. Mr. Patel is in good health and is Under Original Medicare, there is a
preparing a budget in anticipation single deductible amount due for the
of his retirement when he turns 66. first 60 days of any inpatient hospi-
He wants to understand the health tal stay, after which it converts into a
care costs he might be exposed to per-day coinsurance amount through
under Medicare if he were to require day 90. After day 90, he would pay
hospitalization as a result of an ill- a daily amount up to 60 days over
ness. In general terms, what could his lifetime, after which he would be
you tell him about his costs for in- responsible for all costs.
patient hospital services
under Original Medicare?
9.
, AHIP ACTUAL EXAM 2023-2024 COMPLETE REAL 250 EXAM QUESTIO
AND CORRECT DETAILED ANSWERS
Study online at https://quizlet.com/_fyz27m
Ms. Henderson believes that she To obtain Part B coverage, she must
will qualify for Medicare Coverage pay a standard monthly premium,
when she turns 65, without pay- though it is higher for individuals with
ing any premiums, because she has higher incomes.
been working for 40 years and pay-
ing Medicare taxes. What should
you tell her?
10. Mr. Alonso receives some help pay- He generally would pay a month-
ing for his two generic prescrip- ly premium, annual deductible, and
tion drugs from his employer's re- per-prescription cost-sharing.
tiree coverage, but he wants to
compare it to a Part D prescrip-
tion drug plan. He asks you what
costs he would generally expect
to encounter when enrolling into a
standard MedicarePart D prescrip-
tion drug plan. What should you tell
him?
11. Ms. Moore plans to retire when she Medicare is a program for people age
turns 65 in a few months. She is 65 or older and those under age 65
in excellent health and will have with certain disabilities, end-stage re-
considerable income when she re- nal disease, and Lou Gehrig's dis-
tires. She is concerned that her in- ease so she will be eligible for
come will make it impossible for her Medicare.
to qualify for Medicare. What could
you tell her to address her concern?
12. Mr. Xi will soon turn age 65 and has Beneficiaries under Original
come to you for advice as to what Medicare have no cost-sharing for
services are provided under Origi- most preventive services which in-
nal Medicare. What should you tell clude immunizations such as annual
Mr. Xi that best describes the health flu shots.
coverage provided to Medicare ben-
eficiaries?
13. Mrs. Duarte is enrolled in Original Mrs. Duarte should file an appeal of
Medicare Parts A and B. She has re- this initial determination within 120
, AHIP ACTUAL EXAM 2023-2024 COMPLETE REAL 250 EXAM QUESTIO
AND CORRECT DETAILED ANSWERS
Study online at https://quizlet.com/_fyz27m
cently reviewed her Medicare Sum- days of the date she received the
mary Notice (MSN) and disagrees MSN in the mail.
with a determination that partially
denied one of her claims for ser-
vices. What advice would you give
her?
14. Mr. Capadona would like to pur- It is illegal for you to sell Mr. Ca-
chase a Medicare Advantage (MA) padona a Medigap plan if he is en-
plan and a Medigap plan to pick up rolled in an MA plan, and besides,
costs not covered by that plan. Medigap only works with Original
What should you tell him? Medicare.
15. Mrs. Park is an elderly retiree. Mrs. She should contact her state Medic-
Park has a low fixed income. What aid agency to see if she qualifies for
could you tell Mrs. Park that might one of several programs that can help
be of assistance? with Medicare costs for which she is
responsible.
16. Mr. Rainey is experiencing para- Medicare will cover a total of 190
noid delusions and his physician days of inpatient psychiatric care dur-
feels that he should be hospitalized. ing Mr. Rainey's entire lifetime.
What should you tell Mr. Rainey (or
his representative) about the length
of an inpatient psychiatric hospital
stay that Medicare will cover?
17. Mr. Schmidt would like to plan for re- Part A, which covers hospital, skilled
tirement and has asked you what is nursing facility, hospice, and home
covered under Original Fee-for-Ser- health services and Part B, which
vice (FFS) Medicare? What could covers professional services such as
you tell him? those provided by a doctor are cov-
ered under Original Medicare.
18. Agent John Miller is meeting with Tell prospect Jerry Smith that he
Jerry Smith, a new prospect. Jerry is should consider adding a standalone
currently enrolled in Medicare Parts Part D prescription drug coverage
A and B. Jerry has also purchased policy to his present coverage.
a Medicare Supplement (Medigap)
