AHIP 2022 Test Answers
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. 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.
3. Juan Perez, who is turning age 65 next month, intends to work for several more years
at Smallcap, 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?: Juan is likely
to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would
become the primary 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.
4. 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?: 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.
,5. 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 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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?: He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
12 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?: Beneficiaries
under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
13. 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?: Mrs. Duarte should file an appeal of this initial determination within 120
days of the date she received the MSN in the mail.
14. 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.
, 15. 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.
16. 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.
17. 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.
18. 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?: Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
19. 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?: After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
20. Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell
him?: Medicare covers the periodic performance of a 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 be covered.
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. 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.
3. Juan Perez, who is turning age 65 next month, intends to work for several more years
at Smallcap, 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?: Juan is likely
to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would
become the primary 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.
4. 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?: 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.
,5. 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 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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?: He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
12 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?: Beneficiaries
under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
13. 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?: Mrs. Duarte should file an appeal of this initial determination within 120
days of the date she received the MSN in the mail.
14. 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.
, 15. 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.
16. 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.
17. 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.
18. 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?: Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
19. 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?: After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
20. Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell
him?: Medicare covers the periodic performance of a 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 be covered.
