AHIP Final Exam with Questions and Answers New Update

AHIP Final Exam with Questions and Answers New Update

**Question 1:** Mrs. Burton is a retiree with substantial income. She is enrolled in an MAPD plan and was disappointed with the service she received from her primary care physician
because she was told she would have to wait five weeks to get an appointment when she was
feeling ill. She called you to ask what she could do so she would not have to put up with such
poor access to care. What could you tell her?
**Answer 1:** She could file a grievance with her plan to complain about the lack of
timeliness in getting an appointment.
---
**Question 2:** 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 2:** 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.
---
**Question 3:** 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 3:** 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.
---
**Question 4:** 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 4:** Mr. Diaz will not pay any penalty because he had continuous coverage under
his employer's plan.
---
**Question 5:** 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 5:** 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.
---
**Question 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?
**Answer 6:** 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.
---
**Question 7:** 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 7:** After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.

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