AHIP STUDY GUIDE 2022 Completed Wit Accurate Answers.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will
... [Show More] 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?
Choose one answer.
a. Medicare is a program for people who have incomes and assets below specific limits, so you will have to find out her exact financial situation before telling her whether she can obtain Medicare coverage.
b. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end stage renal disease or Lou Gehrig’s disease, so she will be eligible for Medicare.
c. Medicare is a program for people of all ages with specific mental
health disabilities. Since she is in excellent health, she would not
qualify, but should instead look into her state’s Medicaid program if she wants further coverage.
d. Eligibility for Medicare is based on whether or not a person has
ever been employed by the federal government. If she or her
husband were ever employed by the federal government, she can enroll in Medicare.
Source: Medicare Program Basics
Question2
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?
Choose one answer.
a. Part D, which covers prescription drug services, is covered under Original Medicare.
b. Part A, which covers long term custodial care services, is covered under Original Medicare.
c. Part C, which always covers dental and vision services, is covered under Original Medicare.
Source: Different Ways to Get Medicare
Question3
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. What should you tell him about his concern?
Choose one answer.
a. Medicare health plans have the option of deciding, each year, what services they will cover. He is correct that the health plan could eliminate some benefits covered by Medicare and he should think carefully before enrolling in a Medicare health plan.
b. He should not be concerned because Medicare health plans
must cover all IRS-approved health care expenses, which means
that all of them provide substantially greater benefits than are available under Medicare Part A and Part B.
c. Medicare health plans must cover all benefits available under Medicare Part A and Part B. Many also cover Part D prescription drugs.
d. Medicare health plans offer a menu of benefits, from which he
may choose, so if he ever wants to increase his coverage, he need
only contact the plan and select other options.
Source: Different Ways to Get Medicare, continued
Question4
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few weeks. She concerned about having prescription drug coverage. Which of the following statements provides the best advice?
Choose one answer.
a. Prescription drug coverage can be obtained by purchasing a Medicare Supplement (Medigap) Plan F policy.
b. Comprehensive prescription drug coverage is now included under Part B of Medicare.
c. Prescription drug coverage can be obtained by enrolling in a Medicare Advantage plan that includes Part D coverage.
d. Comprehensive prescription drug coverage is offered by all Medicare Advantage Plans (Part C).
Source: Overview of Different Ways to Get Medicare
Question5
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific
plans. What could you tell her?
Choose one answer.
a. Medicare Health Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services.
b. Medicare Health Plans are not permitted to offer any benefits
beyond those available under the Original Medicare program and
must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare.
c. All Medicare Health Plans offer cost-sharing that is lower than
Original Medicare for all Part A and Part B covered services, but the
maximum out-of-pocket limit is higher than in Original Medicare.
d. Medicare Health Plans do not necessarily have to cover all of the
Original Medicare Part A and Part B services, but must include a
maximum out-of-pocket limit.
Source: Part C Medicare Health Plans
Question6
Mr. Meoni’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.Meoni?
Choose one answer.
a. Medicare Supplemental Insurance would cover his long-term care services.
b. Medicare Supplemental Insurance would cover his dental, vision and hearing services only.
c. Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee- for-Service (FFS) Medicare.
d. Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
Source: Medigap (Medicare Supplement Insurance)
1
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?
Choose one answer.
a. All individuals who are citizens and over age 65 will be covered under Part A.
b. Most individuals who are citizens and over age 65 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.
c. Most individuals who are citizens and over age 65 and are
covered under Part A must pay a monthly premium for that
coverage.
d. Most individuals who are citizens and over age 65 and wish to be
covered under Part A must enroll in a Medicare Health Plan.
Source: Medicare Entitlement – Part A; Medicare Program Basics (provides reference to citizenship).
Question2
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?
Choose one answer.
a. He became eligible for Medicare when his disability eligibility determination was first made.
b. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
c. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare.
d. Individuals receiving such disability payments from the Social Security Administration continue to receive those payments, but only become eligible for Medicare upon reaching age 65.
Source: Medicare Entitlement-Part B
Question3
Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug policy?
Choose one answer.
a. No, he cannot purchase a Medicare Advantage or Part D policy because he has not received Social Security or Railroad Retirement disability benefits for 24 months.
b. No, he cannot purchase a Medicare Advantage or Part D policy
until he is 65 years of age.
c. Yes, he can purchase such a policy, as long as it is through his
employer’s retiree group plan.
d. Yes, he can purchase such a policy because he is receiving
disability payments from his employer.
Source: Medicare Entitlement-Part B; Medicare Eligibility-Part C/D
Question4
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?
Choose one answer.
a. She is correct because she will be covered under Part A, without paying premiums and she has worked for 40 years so she will not have to pay Part B premiums.
b. She is correct that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries.
c. Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Health Plan.
d. In order to obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes.
Source: Medicare Premiums for Part B.
Question5
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?
Choose one answer.
a. The penalty will be a permanent 10% increase in his Part B premium for every 12 month period that passed during which he could have enrolled and did not.
b. Mr. Diaz will pay a penalty, which will be a flat amount each year,
paid during the first month of coverage.
c. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer’s plan.
d. During the first year he is covered under Part B, his premiums will
be 10% higher than they otherwise would be, after which point they
will return to normal.
Source: Medicare Premium for Part B, continued
Question6
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?
Choose one answer.
a. She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period that differs from the standard general enrollment period, during which she may enroll in Medicare Part B.
b. She may not enroll in Part B while covered under an employer group health plan and must wait until the standard general enrollment period after she retires.
c. She may only enroll in Part B during the general enrollment period whether she is retired or not.
d. She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B.
Source: Medicare Premium for Part B, continued
Question7
Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering enrollment in a Medicare health plan. What should you advise her to do before she will be able to enroll into a Medicare health plan?
Choose one answer.
a. To enroll in a Medicare health plan, she need only be entitled to Part A, so she does not need to take any further steps.
b. Since she is age 65 she may enroll in any Medicare health plan,
regardless of whether she is entitled to Part A or Part B
coverage.
c. In order to join a Medicare health plan, she must be enrolled in
Parts A, B and D.
d. In order to join a Medicare health plan, she also must enroll in Part B.
Source: Medicare Eligibility –Part C/D.
1
Mrs. Park has a low, fixed income. What could you tell her that might be of assistance? Choose one answer.
a. She should not sign up for a Medigap or Medicare Advantage plan.
b. 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.
c. She can apply to the Medicare agency for lower premiums and cost-
sharing.
d. She should only seek help from private organizations to cover her
Medicare costs.
Source: Help for Individuals with Limited Income/Resources - Apply to State Medicaid Office.
Question2
Mr. Yu has limited income and resources so you have encouraged him to see if he qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble to apply and wants to know what the assistance could do for him if he qualifies. What could you tell him?
Choose one answer.
a. He might qualify for Medicaid, which will cover all IRS-approved health services.
b. He might qualify for help with Part D prescription drug costs and help paying Part A and/or Part B premiums, deductibles, and/or cost sharing.
c. He might qualify for the Health Freedom program, which covers 80
percent of certain medical costs incurred by low-income individuals
living within the counties that have adopted this program
d. He might qualify for the Supplemental Security Income program,
which provides one-time cash grants to help low-income
beneficiaries.
Source: Help for Individuals with Limited Income/Resources - Apply to State Office; Help for Individuals with Limited Income/Resources, Continued
1
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?
Choose one answer.
would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs
d. Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases until day 90. After 90 days he would pay the full amount of all costs.
Source: Medicare Part A Benefits.
Question2
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare’s coverage of care in a skilled nursing facility?
Choose one answer.
a. Medicare will cover an unlimited number of days in a skilled- nursing facility, as long as a physician certifies that such care is needed.
b. Medicare will cover Mrs. Schmidt’s skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100
days.
c. Mrs. Schmidt will have to apply for Medicaid to have her skilled
nursing services covered because Medicare does not provide such
a benefit.
d. Once she has expended her liquid assets, Medicare will cover
80% of Mrs. Schmidt’s long-term care costs.
Source: Medicare Part A Benefits, Continued
Question3
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?
Choose one answer.
b. Inpatient psychiatric services are not covered under Original Medicare.
c. Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey’s entire lifetime.
d. Medicare will cover, at its allowable amount, as many stays as are needed throughout Mr. Rainey’s life, as long as no single stay exceeds 190 days.
Source: Medicare Part A Benefits, Continued
Question4
Mrs. Quinn has just turned 65 and received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn?
Choose one answer.
a. Part B will cover her dental and vision needs.
b. She will need to pay no premiums for Part B as she qualifies for
premium free coverage due to the number of quarters she has
worked.
c. She should disenroll if she does not want to pay the monthly
premiums. There is no disadvantage to doing so.
d. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible.
Source: Medicare Part B Benefits.
Question5
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?
Choose one answer.
b. Medicare covers treatments for existing disease, injury and malformed limbs or body parts. As such, it does not cover any screening tests and these must be paid for by the beneficiary out of pocket.
c. Medicare covers some screening tests that must be performed within the first year after enrollment. Beyond that point expenses for screening tests are the responsibility of the beneficiary.
d. Medicare covers all screening tests that have been approved by the FDA on a frequency determined by the treating physician.
Source: Medicare Part B Benefits - Preventive Services and Screenings
Question6
Mrs. Turner is comparing her employer’s retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her?
Choose one answer.
a. Original Medicare covers cosmetic surgery.
b. Original Medicare covers ambulance services.
c. Original Medicare covers orthopedic shoes.
d. Original Medicare covers therapeutic massage.
Source: Other Part B Items and Services (Parts 1 and 2). See also, Part 1
Question7
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her?
Choose one answer.
Source: Not Covered by Medicare Part A&B.
1
Mr. Singh would like drug coverage, but does not want to be enrolled into a health plan. What should you tell him?
Choose one answer.
a. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Health Plan.
b. Mr. Singh must leave Original Medicare to receive drug
coverage.
c. 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.
d. Part D prescription drug coverage can only be obtained by
enrollment into a Medicare Health Plan that also covers Part A and
Part B services.
Source: Original Medicare and Part D Prescription Drug Coverage
Question2
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 Medicare Part D prescription drug plan. What should you tell him?
Choose one answer.
Source: Original Medicare and Part D Prescription Drug Coverage, continued
Question3
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her?
Choose one answer.
a. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up.
b. Part D covers long-term care services and she shouldn’t worry
because there has been no change in coverage.
c. Part D covers prescription drugs and she should look at her premiums, formulary, and cost sharing among other factors to see if they have changed.
d. Part D covers hospital and home health services and the cost
sharing has changed this year.
Source: Original Medicare and Part D Prescription Drug Coverage
1
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What can you tell her about Medigap as an option to address this concern?
Choose one answer.
a. Medigap plans are not sold by private companies and are a government insurance product.
b. If Mrs. Paterson applies during the Medigap open enrollment
period, she will have to undergo a medical review to determine if
she has a pre-existing condition that would increase the premium for a Medigap policy.
c. All costs not covered by Medicare are covered by some Medigap
plans.
d. Medigap plans help beneficiaries cover coinsurance, co- payments, and/or deductibles for medically necessary services.
Source: Further Information on Medigap (Medicare Supplement Insurance)
Question2
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?
Choose one answer.
a. Medigap is a replacement for Original Medicare and she has been paying for double coverage. She should simply drop her Medigap policy.
b. Mrs. Gonzalez can purchase a Medigap plan that covers drugs,
but it likely won’t offer coverage that is equivalent to that provided
under Part D.
c. Mrs. Gonzalez should purchase a K or L Medigap plan.
d. 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.
Source: Beneficiaries in Original Medicare with Medigap Drug Coverage
Question3
Mr. Kelly has substantial financial means. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D?
Choose one answer.
Source: Beneficiaries in Original Medicare with Medigap Drug Coverage; Beneficiaries in Orginal Medciare with Medigap Drug Coverage, continued
Question4
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?
Choose one answer.
a. Medigap plans that cover costs not paid for by a MA plan are available only in Massachusetts, Minnesota, and Wisconsin.
b. Medigap plans are a form of Medicare Advantage, so purchasing
both would be redundant coverage.
c. 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.
d. Medigap policies designed to cover costs not paid for by a MA plan
can be purchased, but only if the MA plan’s design is considered to be
the “defined standard benefit.”
Source: Medigap is NOT.
Question5
What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans?
Choose one answer.
Source: Changes coming to Medigap
1
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefit package of a Medicare Health Plan before she starts looking at specific
plans. What could you tell her? Choose one answer.
a. Medicare Health Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services.
b. Medicare Health Plans are not permitted to offer any benefits
beyond those available under the Original Medicare program and
must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare.
c. Medicare Health Plans do not necessarily have to cover all of the
Original Medicare Part A and Part B services, but must include a
maximum out-of-pocket limit.
d. All Medicare Health Plans offer cost-sharing that is lower than
Original Medicare for all Part A and Part B covered services, but the
maximum out-of-pocket limit is higher than in Original Medicare.
Source: Part C Medicare Health Plans
Question2
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the health plan may, at some time in the future, reduce his benefits below what is available in Original Medicare. What should you tell him about his concern?
Choose one answer.
a. Medicare health plans have the option of deciding, each year, what services they will cover. He is correct that the health plan could eliminate some benefits covered by Medicare and he should think carefully before enrolling in a Medicare health plan.
b. Medicare health plans offer a menu of benefits, from which he
may choose, so if he ever wants to increase his coverage, he need
only contact the plan and select other options.
c. Medicare health plans must cover all benefits available under Medicare Part A and Part B. Many also cover Part D prescription drugs.
d. He should not be concerned because Medicare health plans
must cover all IRS-approved health care expenses, which means
that all of them provide substantially greater benefits than are available under Medicare Part A and Part B.
Source: Different Ways to Get Medicare, continued
Question3
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few weeks. She concerned about having prescription drug coverage. Which of the following statements provides the best advice?
Choose one answer.
Source: Overview of Different Ways to Get Medicare
Question4
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?
Choose one answer.
a. Most individuals who are citizens and over age 65 and wish to be covered under Part A must enroll in a Medicare Health Plan.
b. All individuals who are citizens and over age 65 will be covered
under Part A.
c. Most individuals who are citizens and over age 65 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.
d. Most individuals who are citizens and over age 65 and are
covered under Part A must pay a monthly premium for that
coverage.
Source: Medicare Entitlement – Part A; Medicare Program Basics (provides reference to citizenship).
Question5
Mr. Schmidt would like to plan for retirement and has asked you [Show Less]