AHIP EXAM REVIEW FULL SOLUTION
SOLVED QUESTIONS
◉ 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? ANSWER: Tell prospect
Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
◉ 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? ANSWER: Mr. Wu may
still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
◉ Mr. Vasquez 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 because of an illness. In general terms, what
could you tell him about his costs for inpatient hospital services under
Original Medicare? ANSWER: 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.
,◉ Mr. Moy will soon turn age 65. He is slightly younger than his wife.
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? ANSWER: Medicare Supplemental Insurance
would help cover his Part A deductible and Part B coinsurance or
copayments in Original Fee-for-Service (FFS) Medicare as well as
possibly some services that Medicare does not cover.
◉ Juan Perez, who is turning age 65 next month, intends to work for
several more years at Smallcap, Incorporated. Smallcap has a workforce
of 15 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? ANSWER: 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. 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 but
Smallcap must continue to offer him coverage under its employer-
sponsored group health plan and would become a secondary payor.
◉ Ms. Kumar 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?
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.
◉ Mrs. Ellis recently turned 66 and decided after many years of work to
retire and begin receiving Social Security benefits. Shortly thereafter
Mrs. Ellis received a letter informing her that she had been automatically
enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis? ANSWER: Part B primarily covers
physician services. She will be paying a monthly premium and, except
for many preventive and screening tests, generally will have 20% co-
payments for these services, in addition to an annual deductible.
◉ Mr. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him? ANSWER:
Mr. Singh can enroll in a stand-alone prescription drug plan and
continue to be covered for Part A and Part B services through Original
Fee-for-Service Medicare.
◉ Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income.
What could you tell Mrs. Cook that might be of assistance? 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.
◉ 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? ANSWER: To obtain Part B coverage, she must pay a standard
, monthly premium, though it is higher for individuals with higher
incomes.
◉ 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? ANSWER: After receiving
such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
◉ 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? 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.
◉ Anthony Boniface turned 65 in 2024. 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? 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-
SOLVED QUESTIONS
◉ 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? ANSWER: Tell prospect
Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
◉ 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? ANSWER: Mr. Wu may
still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
◉ Mr. Vasquez 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 because of an illness. In general terms, what
could you tell him about his costs for inpatient hospital services under
Original Medicare? ANSWER: 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.
,◉ Mr. Moy will soon turn age 65. He is slightly younger than his wife.
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? ANSWER: Medicare Supplemental Insurance
would help cover his Part A deductible and Part B coinsurance or
copayments in Original Fee-for-Service (FFS) Medicare as well as
possibly some services that Medicare does not cover.
◉ Juan Perez, who is turning age 65 next month, intends to work for
several more years at Smallcap, Incorporated. Smallcap has a workforce
of 15 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? ANSWER: 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. 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 but
Smallcap must continue to offer him coverage under its employer-
sponsored group health plan and would become a secondary payor.
◉ Ms. Kumar 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?
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.
◉ Mrs. Ellis recently turned 66 and decided after many years of work to
retire and begin receiving Social Security benefits. Shortly thereafter
Mrs. Ellis received a letter informing her that she had been automatically
enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis? ANSWER: Part B primarily covers
physician services. She will be paying a monthly premium and, except
for many preventive and screening tests, generally will have 20% co-
payments for these services, in addition to an annual deductible.
◉ Mr. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him? ANSWER:
Mr. Singh can enroll in a stand-alone prescription drug plan and
continue to be covered for Part A and Part B services through Original
Fee-for-Service Medicare.
◉ Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income.
What could you tell Mrs. Cook that might be of assistance? 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.
◉ 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? ANSWER: To obtain Part B coverage, she must pay a standard
, monthly premium, though it is higher for individuals with higher
incomes.
◉ 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? ANSWER: After receiving
such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
◉ 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? 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.
◉ Anthony Boniface turned 65 in 2024. 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? 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-
