AHIP 2024 Final Exam Test Updated Questions
and Answers (Verified Answers)
1) Edward IP suffered from serious kidney disease. As a result. Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue, what should you say?
- ANSWER>>Individuals eligible for Medicare based on ESRD generally
lose eligibility 36 months after the month in which the individual receives a
kidney transplant unless they are eligible for Medicare on another basis
such as age or disability. Edward may, however, remain enrolled in Part B
but solely for coverage of immunosuppressive drugs if he has no other
health care coverage that would cover the drugs.
2) Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just
a few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the
Allcare Medicare Advantage plan. What should you say?
- ANSWER>>Mildred may remain enrolled in Allcare and make a hospice
election. Hospice benefits will be paid for by Original Medicare under Part
A and Allcare will continue to pay for any non-hospice services.
3) Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay. What should you tell him?
- ANSWER>>Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's 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?
- ANSWER>>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. 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?
- ANSWER>>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.
6) 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.
7) 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? -
ANSWER>>Beneficiaries under Original Medicare have no cost-sharing for most
preventive services which include immunizations such as annual flu shots.
8) 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? - ANSWER>>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) 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? - ANSWER>>He may sign-
up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
10) Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substantial
estate which provides Madeline with an annual income of approximately
$130,000. Madeline, who has only worked part-time for the last three years, will
soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for
advice. What should you tell her? - ANSWER>>You should tell Madeline that she
will be able to enroll in Medicare Part A without paying monthly premiums due to
her husband's long work record and participation in the Medicare system. You
should also tell Madeline that she will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due her substantial income.
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? - ANSWER>>To
obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.
, 12) To obtain Part B coverage, she must pay a standard monthly premium, though it
is higher for individuals with higher incomes. - ANSWER>>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.
13) 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.
14) 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? - 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.
15) 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? - ANSWER>>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.
16) Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park 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.
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? -
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.
18) 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.
19) Shirly Thomas was enrolled in Medicaid during the Public Health Emergency
(PHE). This coverage has recently been terminated due to the end of the PHE.
While Shirley was enrolled in Medicaid, she missed an opportunity to enroll in
and Answers (Verified Answers)
1) Edward IP suffered from serious kidney disease. As a result. Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue, what should you say?
- ANSWER>>Individuals eligible for Medicare based on ESRD generally
lose eligibility 36 months after the month in which the individual receives a
kidney transplant unless they are eligible for Medicare on another basis
such as age or disability. Edward may, however, remain enrolled in Part B
but solely for coverage of immunosuppressive drugs if he has no other
health care coverage that would cover the drugs.
2) Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just
a few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the
Allcare Medicare Advantage plan. What should you say?
- ANSWER>>Mildred may remain enrolled in Allcare and make a hospice
election. Hospice benefits will be paid for by Original Medicare under Part
A and Allcare will continue to pay for any non-hospice services.
3) Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay. What should you tell him?
- ANSWER>>Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's 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?
- ANSWER>>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. 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?
- ANSWER>>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.
6) 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.
7) 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? -
ANSWER>>Beneficiaries under Original Medicare have no cost-sharing for most
preventive services which include immunizations such as annual flu shots.
8) 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? - ANSWER>>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) 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? - ANSWER>>He may sign-
up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
10) Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substantial
estate which provides Madeline with an annual income of approximately
$130,000. Madeline, who has only worked part-time for the last three years, will
soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for
advice. What should you tell her? - ANSWER>>You should tell Madeline that she
will be able to enroll in Medicare Part A without paying monthly premiums due to
her husband's long work record and participation in the Medicare system. You
should also tell Madeline that she will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due her substantial income.
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? - ANSWER>>To
obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.
, 12) To obtain Part B coverage, she must pay a standard monthly premium, though it
is higher for individuals with higher incomes. - ANSWER>>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.
13) 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.
14) 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? - 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.
15) 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? - ANSWER>>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.
16) Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park 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.
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? -
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.
18) 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.
19) Shirly Thomas was enrolled in Medicaid during the Public Health Emergency
(PHE). This coverage has recently been terminated due to the end of the PHE.
While Shirley was enrolled in Medicaid, she missed an opportunity to enroll in
