AHIP Questions And Answers 2022

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? Correct Answer: He may sign-up for Medicare at any time however coverage usually begins

on the fourth month after dialysis treatments start.

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 employersponsored healthcare coverage. How would you respond? Correct 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.

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? Correct 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.

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? Correct 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.

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? Correct 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.

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? Correct 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.

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? Correct Answer: Medicare does not cover massage therapy, or, in

general, glasses or dentures.

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? Correct 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.

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? Correct Answer: To obtain Part B coverage, she must pay a standard monthly

premium, though it is higher for individuals with higher incomes.

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? Correct Answer: He generally would pay a monthly

premium, annual deductible, and per-prescription cost-sharing.

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? Correct 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.

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? Correct Answer: Beneficiaries under Original Medicare have no cost-sharing

for most preventive services which include immunizations such as annual flu shots.

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? Correct Answer: Mrs. Duarte should file an appeal of this

initial determination within 120 days of the date she received the MSN in the mail.

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? Correct 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.

Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that

might be of assistance? Correct 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.

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? Correct Answer: Medicare will cover a total of 190 days of

inpatient psychiatric care during Mr. Rainey's entire lifetime.

Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Feefor-Service (FFS) Medicare? What could you tell him? Correct 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.

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? Correct Answer: Tell prospect Jerry Smith that he should consider adding a

standalone Part D prescription drug coverage policy to his present coverage.

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? Correct Answer: After receiving such disability

payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.

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? Correct Answer: 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.