2023 AHIP FINAL EXAM TEST h h h h
(With Verified Answers 100% h h h h
Correct) UPDATED APRIL 2 h h h
023
Mr. Davis is 52 years old and has recently been diagnosed with end-
h h h h h h h h h h h h
stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
h h h h h h h h h h h h h h h
obtain coverage under Medicare. What should you tell him? ✓He may sign-
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up for Medicare at any time however coverage usually begins on the fourth month a
h h h h h h h h h h h h h h
fter dialysis treatments start.
h h h
Juan Perez, who is turning age 65 next month, intends to work for several more yea
h h h h h h h h h h h h h h h
rs at Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers
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employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to t
h h h h h h h h h h h h
he Medicare system for over 20 years. Juan asks you if he will be entitled to Medica
h h h h h h h h h h h h h h h h
re and if he enrolls how that will impact his employer-
h h h h h h h h h h
hsponsored healthcare coverage. How would you respond? h h h h h h
h✓Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls M
h h h h h h h h h h h h h h h h h
edicare would become the primary payor of his healthcare claims and Smallcap do
h h h h h h h h h h h h
es not have to continue to offer him coverage comparable to those under age 65 und
h h h h h h h h h h h h h h h
er its employer-sponsored group health plan.
h h h h h
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what c
h h h h h h h h h h h h h h
overage Medicare Supplemental Insurance provides since his health care needs are
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different from his wife's needs. What could you tell Mr. Moy?
h h h h h h h h h h
h✓Medicare Supplemental Insurance would help cover his Part A and Part B deduc
h h h h h h h h h h h h
tibles or coinsurance in Original Fee-for-
h h h h h
Service (FFS) Medicare as well as possibly some services that Medicare does not c
h h h h h h h h h h h h h
,over.
,Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next y
h h h h h h h h h h h h h h h h
ear. She heard she must enroll in Part B at the beginning of the year to ensure no gap i
h h h h h h h h h h h h h h h h h h h
n coverage. What can you tell her?
h h h h h h
✓She may enroll at any time while she is covered under her employer plan, but she
h h h h h h h h h h h h h h h h h
will have a special eight-
h h h h
month enrollment period after the last month on her employer plan that differs from t
h h h h h h h h h h h h h h
he standard general enrollment period, during which she may enroll in Medicare Part
h h h h h h h h h h h h
B.
h
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed f
h h h h h h h h h h h h h h h h
ull time, and paid taxes during that entire period. She is concerned that she will not q
h h h h h h h h h h h h h h h h
ualify for coverage under part A because she was not born in the United States. Wha
h h h h h h h h h h h h h h h
t should you tell her? ✓Most individuals who are citizens and age 65
h h h h h h h h h h h h
, or over are covered under Part A by virtue of having paid Medicare taxes while w
h h h h h h h h h h h h h h h
orking, though some may be covered as a result of paying monthly premiums.
h h h h h h h h h h h h
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, b
h h h h h h h h h h h h h h
ut it provides no drug coverage. She would like to keep the coverage she has but repl
h h h h h h h h h h h h h h h h
ace her existing Medigap plan with one that provides drug coverage. What should y
h h h h h h h h h h h h h
ou tell her?h h
✓✓Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she coul
h h h h h h h h h h h h h
d keep her Medigap policy and enroll in a Part D prescription drug plan.
h h h h h h h h h h h h h
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief f
h h h h h h h h h h h h
rom arthritis through massage therapy. She is concerned about whether or not M
h h h h h h h h h h h h
edicare will cover these items and services. What should you tell her?
h h h h h h h h h h h
✓✓Medicare does not cover massage therapy, or, in general, glasses or dentures.
h h h h h h h h h h h
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
h h h h h h h h h h h h h h h h
when he turns 66. He wants to understand the health care costs he might be exposed t
h h h h h h h h h h h h h h h h
o under Medicare if he were to require hospitalization as a result of an illness. In gene
h h h h h h h h h h h h h h h h
ral terms, what could you tell him about his costs for inpatient hospital services
h h h h h h h h h h h h h
under Original Medicare? h h
h✓✓Under Original Medicare, there is a single deductible amount due for the first
h h h h h h h h h h h h h
60 days of any inpatient hospital stay, after
h h h h h h h
which it converts into a per- h h h h h
day coinsurance amount through day 90. After day 90, he would pay a daily amount
h h h h h h h h h h h h h h h
up to 60 days over his lifetime, after which he would be responsible for all costs.
h h h h h h h h h h h h h h h
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns
h h h h h h h h h h h h h
65, without paying any premiums, because she has been working for 40 years and pa
h h h h h h h h h h h h h h
ying Medicare taxes. What should you tell her?
h h h h h h h
h✓✓To obtain Part B coverage, she must pay a standard monthly premium, though it
h h h h h h h h h h h h h h
is higher for individuals with higher incomes.
h h h h h h
Mr. Alonso receives some help paying for his two generic prescription drugs from h
h h h h h h h h h h h h h
is employer's retiree coverage, but he wants to compare it to a Part D prescription dr
h h h h h h h h h h h h h h h
ug plan. He asks you what costs he would generally expect to encounter when enroll
h h h h h h h h h h h h h h
ing into a standard MedicarePart D prescription drug plan. What should you tell him
h h h h h h h h h h h h h
? ✓✓He generally would pay a monthly premium, annual deductible, and per-
h h h h h h h h h h h
prescription cost-sharing. h
(With Verified Answers 100% h h h h
Correct) UPDATED APRIL 2 h h h
023
Mr. Davis is 52 years old and has recently been diagnosed with end-
h h h h h h h h h h h h
stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
h h h h h h h h h h h h h h h
obtain coverage under Medicare. What should you tell him? ✓He may sign-
h h h h h h h h h h h
up for Medicare at any time however coverage usually begins on the fourth month a
h h h h h h h h h h h h h h
fter dialysis treatments start.
h h h
Juan Perez, who is turning age 65 next month, intends to work for several more yea
h h h h h h h h h h h h h h h
rs at Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers
h h h h h h h h h h h h
employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to t
h h h h h h h h h h h h
he Medicare system for over 20 years. Juan asks you if he will be entitled to Medica
h h h h h h h h h h h h h h h h
re and if he enrolls how that will impact his employer-
h h h h h h h h h h
hsponsored healthcare coverage. How would you respond? h h h h h h
h✓Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls M
h h h h h h h h h h h h h h h h h
edicare would become the primary payor of his healthcare claims and Smallcap do
h h h h h h h h h h h h
es not have to continue to offer him coverage comparable to those under age 65 und
h h h h h h h h h h h h h h h
er its employer-sponsored group health plan.
h h h h h
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what c
h h h h h h h h h h h h h h
overage Medicare Supplemental Insurance provides since his health care needs are
h h h h h h h h h h h
different from his wife's needs. What could you tell Mr. Moy?
h h h h h h h h h h
h✓Medicare Supplemental Insurance would help cover his Part A and Part B deduc
h h h h h h h h h h h h
tibles or coinsurance in Original Fee-for-
h h h h h
Service (FFS) Medicare as well as possibly some services that Medicare does not c
h h h h h h h h h h h h h
,over.
,Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next y
h h h h h h h h h h h h h h h h
ear. She heard she must enroll in Part B at the beginning of the year to ensure no gap i
h h h h h h h h h h h h h h h h h h h
n coverage. What can you tell her?
h h h h h h
✓She may enroll at any time while she is covered under her employer plan, but she
h h h h h h h h h h h h h h h h h
will have a special eight-
h h h h
month enrollment period after the last month on her employer plan that differs from t
h h h h h h h h h h h h h h
he standard general enrollment period, during which she may enroll in Medicare Part
h h h h h h h h h h h h
B.
h
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed f
h h h h h h h h h h h h h h h h
ull time, and paid taxes during that entire period. She is concerned that she will not q
h h h h h h h h h h h h h h h h
ualify for coverage under part A because she was not born in the United States. Wha
h h h h h h h h h h h h h h h
t should you tell her? ✓Most individuals who are citizens and age 65
h h h h h h h h h h h h
, or over are covered under Part A by virtue of having paid Medicare taxes while w
h h h h h h h h h h h h h h h
orking, though some may be covered as a result of paying monthly premiums.
h h h h h h h h h h h h
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, b
h h h h h h h h h h h h h h
ut it provides no drug coverage. She would like to keep the coverage she has but repl
h h h h h h h h h h h h h h h h
ace her existing Medigap plan with one that provides drug coverage. What should y
h h h h h h h h h h h h h
ou tell her?h h
✓✓Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she coul
h h h h h h h h h h h h h
d keep her Medigap policy and enroll in a Part D prescription drug plan.
h h h h h h h h h h h h h
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief f
h h h h h h h h h h h h
rom arthritis through massage therapy. She is concerned about whether or not M
h h h h h h h h h h h h
edicare will cover these items and services. What should you tell her?
h h h h h h h h h h h
✓✓Medicare does not cover massage therapy, or, in general, glasses or dentures.
h h h h h h h h h h h
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
h h h h h h h h h h h h h h h h
when he turns 66. He wants to understand the health care costs he might be exposed t
h h h h h h h h h h h h h h h h
o under Medicare if he were to require hospitalization as a result of an illness. In gene
h h h h h h h h h h h h h h h h
ral terms, what could you tell him about his costs for inpatient hospital services
h h h h h h h h h h h h h
under Original Medicare? h h
h✓✓Under Original Medicare, there is a single deductible amount due for the first
h h h h h h h h h h h h h
60 days of any inpatient hospital stay, after
h h h h h h h
which it converts into a per- h h h h h
day coinsurance amount through day 90. After day 90, he would pay a daily amount
h h h h h h h h h h h h h h h
up to 60 days over his lifetime, after which he would be responsible for all costs.
h h h h h h h h h h h h h h h
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns
h h h h h h h h h h h h h
65, without paying any premiums, because she has been working for 40 years and pa
h h h h h h h h h h h h h h
ying Medicare taxes. What should you tell her?
h h h h h h h
h✓✓To obtain Part B coverage, she must pay a standard monthly premium, though it
h h h h h h h h h h h h h h
is higher for individuals with higher incomes.
h h h h h h
Mr. Alonso receives some help paying for his two generic prescription drugs from h
h h h h h h h h h h h h h
is employer's retiree coverage, but he wants to compare it to a Part D prescription dr
h h h h h h h h h h h h h h h
ug plan. He asks you what costs he would generally expect to encounter when enroll
h h h h h h h h h h h h h h
ing into a standard MedicarePart D prescription drug plan. What should you tell him
h h h h h h h h h h h h h
? ✓✓He generally would pay a monthly premium, annual deductible, and per-
h h h h h h h h h h h
prescription cost-sharing. h
