AHIP 2023 Final Exam Questions and Answers
(Verified Answers)
- Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicareprescription drug plan you represent and simply give you a check to cover hispremiums for the entire year. What should you tell him ANS He will need tomail inhis payment with his enrollment form.
- Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area
that does not include drug coverage. She wants to enroll in the plan and enrollin a stand-alone prescription drug plan. What should you tell her ANS She
couldenroll in a PFFS plan and a stand-alone Medicare prescription drug plan. - Mrs. Roswell is a new Medicare beneficiary who has just retired from retailwork. She is interested in selecting a Medicare Part D prescription drug plan.She takes a number of medications and is concerned that she has not been
able to identify a plan that covers all of her medications. She does not want
to make an abrupt change to new drugs that would be covered and asks whatshe should do. What should you tell her ANS Every Part D drug plan is
required tocover a single one-month fill of her existing medications sometime
during a 90-daytransition period. - Mr. Robinson was quite ill recently and forgot to pay his monthly premium
for his MA-PD plan. He is worried that he will lose his coverage now when
he needs it the most. He is certain his plan will disenroll him because that is
what happened to a friend of his in a similar type of plan. What can you tell
Mr. Robinson about his situation ANS Plan sponsors have the option to do
nothingwhen a plan member does not pay their premiums or disenroll the
member after agrace period and notice. - Mrs. Allen has a rare condition for which two different brand name drugs
are the only available treatment. She is concerned that since no generic
prescription drug is available and these drugs are very high cost, she will notbe able to find a Medicare Part D prescription drug plan that covers either
one of them. What should you tell her ANS Medicare prescription drug plans
are required to cover drugs in each therapeutic category. She should be able to
enroll in a Medicare prescription drug plan that covers the medications she needs.6. One of your clients, Lauren Nichols, has heard about a Medicare concept
from one of her neighbors called TrOOP. She asks you to explain it. What
do you say ANS TrOOP stands for true out-of-pocket expenses that count
toward the Medicare Part D catastrophic limit and include not only expenses
paid by a beneficiary but also in some instances drug manufacturer discounts. - Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits (FEHB) plan that includes creditable drug coverage. She is
ready to turn 65 and become Medicare eligible for the first time. What issues
might she consider about whether to enroll in a Medicare prescription drug
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AHIP Module 3
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- Mr. Carlini has heard that Medicare prescription drug plans are only offered
through private companies under a program known as Medicare Advantage
(MA), not by the government. He likes Original Medicare and does not want
to sign up for an MA product, but he also wants prescription drug coverage.
What should you tell him?: b. Mr. Carlini can stay with Original Medicare and
also enroll in a Medicare prescription drug plan through a private company that
has contracted with the government to provide only such drug coverage to eligible
Medicare beneficiaries. Correct - Mrs. Mulcahy is concerned that she may not qualify for enrollment in a
Medicare prescription drug plan because, although she is entitled to Part
A, she is not enrolled under Medicare Part B. What should you tell her?: d.
Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a
Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
Correct - Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has recently
lost creditable coverage previously available through her husband’s employer. She is interested in enrolling in a Medicare Part D prescription drug plan
(PDP).What should you tell her?: a. If a Part D benefit is offered through her plan
she may choose in enroll in that plan or a standalone PDP. Correct - Which of the following statements about Medicare Part D are correct?
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I. Part D plans must enroll any eligible beneficiary who applies regardless of
health status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy
network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may
only obtain Part D benefits through a standalone PDP.
IV.Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan.: b. I, II, and III only Correct
- All plans must cover at least the standard Part D coverage or its actuarial
equivalent. What costs would a beneficiary incur for prescription drugs in
2019 under the standard coverage?: c. Standard Part D coverage would require
payment of an annual deductible, 25% cost-sharing up to the coverage gap, a
portion of costs for both generics and brand-name drugs in the coverage gap, and
co-pays or co-insurance after the coverage gap. Correct
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AHIP module 1
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- 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 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.
b. Most individuals who are citizens and over age 65 and wish to be
covered under Part A must enroll in a Medicare Health Plan.
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. All individuals who are citizens and over age 65 will be covered under
Part A.: a. 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.
2.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?: d. After receiving such
disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
3.Mr. Denton is 52 years old and has recently been diagnosed with endstage renal disease (ESRD) and will soon begin dialysis. He is wondering if
he can obtain coverage under Medicare. What should you tell him?: a. He
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may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start. Correct
4.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?:
a. In order to obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher
incomes. Correct
5.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?: b. Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer’s plan. Correct
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AHIP Module 2
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1.Mr. Lopez has heard that he can sign up for a product called “Medicare
Advantage” but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health
plans that are available through the Medicare Advantage program?: c.
They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Correct
2.Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct description?:
a. Medicare Advantage is a way of covering all the Original Medicare
benefits through private health insurance companies. Correct
3.Mrs. Radford asks whether there are any special eligibility requirements
for Medicare Advantage. What should you tell her?: b. Mrs. Radford must
be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage. Correct
4.Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B
but has recently stopped paying his Part B premium. Mr. Castillo is still
covered by Part A. He would like to enroll in a Medicare Advantage (MA)
plan and is still covered by Part A. What should you tell him?: a. He is not
eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B. Correct
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5.Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several
years ago. Her doctor recently confirmed a diagnosis of end-stage renal
disease (ESRD). What options does Mrs. Billings have in regard to her MA
plan during the next open enrollment season?: a. She may remain in her
ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals
suffering from ESRD if one is available in her area. Correct
6.Daniel is a middle-income Medicare beneficiary. He has chronic
bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no
problems functioning. Which type of SNP is likely to be most appropriate
for him?: a. C-SNP Correct
7.Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him?:
d. In most Medicare Advantage HMOs, Mr. Kumar must obtain his
services only from providers who have a contractual relationship
with the plan (except in an emergency). Correct
8.Mrs. Ramos is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care. What
should you tell her?: b. Mrs. Ramos can obtain care from any provider
who participates in Original Medicare, but generally will have a higher
cost-sharing amount if she sees a provider who/that is not part of the
PPO network. Correct
AHIP Final Examination Questions and Answers
(2023) (Verified Answers)
- Mr. Zachow has a condition for which three drugs are available. He has triedtwo but had an allergic reaction to them. Only the third drug works for him
and it is not on his Part D plan’s formulary.What could you tell him to do ANS
Mr.Zachow has a right to request a formulary exception to obtain coverage for his
PartD drug. He or his physician could obtain the standardized request form on the
plan’swebsite, fill it out, and submit it to his plan. - Mr. Polanski likes the cost of an HMO plan available in his area, but would
like to be able to visit one or two doctors who aren’t participating providers. Hewants to know if the Point of Service (POS) option available with some HMOswill be of any help in this situation.What should you tell him ANS The POS
optionmight be a good solution for him as it will allow him to visit out-of-network
providers,generally without prior approval. However, he should be aware that it is
likely he willhave to pay higher cost-sharing for services from out-of-network
providers. - Mr. Barker had surgery recently and expected that he would have certain
services and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However, when he receivedthe bill, he was surprised to see large charges in excess of his maximum
out-of-pocket limit that included a number of services and items he thought
would be fully covered. He called you to ask what he could do? What could
you tell him ANS You can offer to review the plans appeal process to help him asktheplan to review the coverage decision.
- Ms.Stuart has heard about a special needs plan (SNP) that one of her friendsis enrolled in and is interested in that product. She wants to be sure she
also has coverage for prescription drugs.Would she be able to obtain drug
coverage if she enrolled in the SNP ANS a. Yes. All SNPs are required to
providePart D coverage for prescription drugs.
b.Yes, but only if she qualifies for Part D prescription drug coverage under her stateMedicaid program.
c. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug
coverage through a stand-alone Part D Medicare prescription drug plan that they
sign up for independent of their enrollment in the SNP.
d. Maybe.Some SNPs offer Part D coverage for prescription drugs and some do not.= ????? - Phiona works in the IT Department of BestCare Health Plan. Phiona is
placed in charge of BestCare’s efforts to facilitate electronic enrollment in
its Medicare Advantage plans. In setting up the enrollment site, which of the
following must Phiona consider ANS II. All data elements required to complete anenrollment request must be captured.
III. The process must include a clear and distinct step that requires the applicant toactivate an “Enroll Now” or “I Agree” type of button or tool.
- Ms. Lewis understands that Medicare prescription drug plans may use
various methods to control the use of specific drugs. She has heard about
a technique called “step therapy” and is wondering if you can explain what
that is.What should you tell her ANS Step therapy involves using one or more
lowerpriced drugs before trying a more expensive drug when all are used to treat
the same condition. - Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his
area has an attractive premium. He wants to know if he must use doctors
in a network as his current HMO plan requires him to do. What should you
tell him ANS He may receive health care services from ANY doctor allowed to billMedicare, as long as he shows the doctor the plan’s identification card and the
doctor agrees to accept the PFFS plan’s payment terms and conditions, which couldinclude balance billing. - Mr.Wu is eligible for Medicare. He has limited financial resources but failedto qualify for the Part D low-income subsidy.Where might he turn for help withhis prescription drug costs ANS Mr. Wu may still qualify for help in paying Part
D costs through his State Pharmaceutical Assistance Program.
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AHIP 2022 Module Quizzes
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1.Mr. Bauer is 49 years old, but eighteen months ago he was declared
disabled by the Social Security Administration and has been receiving
dis- ability 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
2.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 ANSWER Part D covers prescription drugs & she should look
at her premiums, formulary, & cost sharing among other factors to
see if they have changed
3.Mr. Davis is 52 years old and has recently been diagnosed with endstage renal diease (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
- 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?-
: Beneficiaries under Original Medicare have no cost-sharing for most
preventive services which inc. immunizations such as annual flu shots - Madeline Martinez was widowed several years ago. Her husband
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worked for many years and contributed into the Medicare system. He also
left a substantial estate which provides Madeline w/ an annual income of
approx.
$130,000. Madeline, who has only worked part-time for the last 3 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 w/out paying
monthly premiums due to her husband’s long work record &
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 to her substantial income
6.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 & those
under age 65 w/ certain disabili-
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ties, end-stage renal disease, & Lou Gehrig’s disease so she will be
eligible for Medicare
7.Mrs. Quinn recently turned 66 and decided after Social Security benefits. Shortly thereafter, Mrs. Quinn received a letter informing her
she has been automatically enrolled in Medicare Part B. She wants to
understand what this means. What should you tell her ANSWER Part B
primarily covers physician services. She will be paying a monthly
premium &, with the exception of many preventive and screening
tests, generally will have 20% coinsurance for these services, in
addition to an annual deductible
8.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 w/ his prescription drug costs ANSWER He may still qualify for help
in paying Part D costs through his State Pharmaceutical Assistance
Program
9.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 him ANSWER – Medicare Supplemental Insurance would help
cover his Part A & B cost sharing in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not
cover
10.Anita Magri will turn 65 in August 2020. Anita intends to enroll in
Original Medicare Part A & B. She would also like to enroll in a Medicare
Supplement (Medigap) plan. Anita’s older neighbor Mel had told her about
Medigap Part F plan in which he is enrolled. It not only provides foreign
travel emergency benefits, but also covers his Medicare Part B deductible.
Anita comes to you for advice. What should you tell her ANSWER You are
sorry to disappoint her but a Medigap Part F plan is no longer available
to those who turn 65 after Jan. 1, 2020. Anita might instead consider
other Medigap plans that offer foreign travel benefits but do not cover
the Part B deductible
11.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.
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Singh can enroll in a stand alone prescription drug plan & continue to
be covered for Part A & B services through Original Fee-for-Service
Medicare
12.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 ANSWER Original Medicare covers ambulance services
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AHIP Module 5
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1.Mrs. Walters is entitled to Part A and has medical coverage without drug
coverage through an employer retiree plan. She is not enrolled in Part B.
Since the employer plan does not cover prescription drugs, she wants to
enroll in a Medicare prescription drug plan. Will she be able to?: c. Yes.
Mrs. Walters must be entitled to Part A or enrolled in Part B to be
eligible for coverage under the Medicare prescription drug program.
Correct
2.Mr. Sanchez is entitled to Part A, but has not enrolled in Part B because
he has coverage through an employer plan. If he wants to enroll in a
Medicare Advantage plan, what will he have to do?: c. He will have to
enroll in Part B. Correct
- Mr. Kelly wants to know whether he is eligible to sign up for a Private
fee-for-service (PFFS) plan. What questions would you need to ask to
deter- mine his eligibility?: a. You would need to ask Mr. Kelly if he is
enrolled in Part A and Part B and if he lives in the PFFS plan’s service
area. Correct
4.Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he
wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he have
to do?: d. He will have to enroll in Part B prior to enrolling in the PFFS
plan. Correct
5.Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does
not include drug coverage and also enroll in a stand-alone Medicare
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prescription drug plan. Under what circumstances can she do this?: c. If
the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan
that does not offer drug coverage or a Medical Savings Account, Mrs.
Berkowitz can do this. Correct
6.Mrs. Roberts has Original Medicare and would like to enroll in a Private
Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her
area. Which options could Mrs. Roberts consider before selecting a PFFS
plan?: d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan
that combines medical benefits and Part D prescription drug coverage,
a PFFS plan offering only medical benefits, or a PFFS plan in
combination with a stand-alone prescription drug plan. Correct
7.Which of the following individuals is most likely to be eligible to enroll in
a Medicare Advantage or Part D Plan?: d. Jose, a grandfather who was
granted asylum and has worked in the United States for many years.
Correct
8.Mr. and Mrs. Nunez attended one of your sales presentations. They’ve
asked you to come to their home to clear up a few questions. During the
presentation, Mrs. Nunez feels tired and tells you that her husband can
finish things up. She goes to bed. At the end of your discussion, Mr. Nunez
says that he wants to enroll both himself and his wife. What should you
do?: d. As
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long as she is able to do so, only Mrs. Nunez can sign her enrollment
form. Mrs. Nunez will have to wake up to sign her form or do so at
another time. Correct
9.You are visiting with Mr. Tully and his daughter at her request. He has
advanced Alzheimer’s and is incapable of understanding the implications
of choosing a Medicare Advantage or prescription drug plan. Can his
daughter fill out the enrollment form and sign it for him?: c. Mr. Tully’s
daughter can do so only, if she is authorized under state law as a
court-appointed legal guardian, has durable power of attorney for
health care decisions, or is authorized under state surrogate consent
laws to make health decisions. Correct
10.You are meeting with Ms. Berlin and she has completed an enrollment
form for a MA-PD plan you represent. You notice that her handwriting is
illegible and as a result, the spelling of her street looks incorrect. She
asks you to fill in the corrected street name. What should you do?: c. You
may correct this information as long as you add your initials and date
next to the correction Correct
- Phiona works in the IT Department of BestCare Health Plan. Phiona is
placed in charge of BestCare’s efforts to facilitate electronic enrollment in
its Medicare Advantage plans. In setting up the enrollment site, which of
the following must Phiona consider?
I. If a legal representative is completing an electronic enrollment request,
he or she must first upload proof of his or her authority.
II. All data elements required to complete an enrollment request must
be captured.
III.The process must include a clear and distinct step that requires the
applicant to activate an “Enroll Now” or “I Agree” type of button or
tool.
IV. The mechanism must capture an accurate time and date stamp at the
time the applicant enters the online site.: b. II and III only Correct
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AHIP module 4
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1.Mr. Prentice has many clients who are Medicare beneficiaries. He should
review the Centers for Medicare & Medicaid Services’ Marketing Guidelines
to ensure he is compliant for which type of products?: c. Medicare
Advantage (MA) and Prescription Drug (PDP) plans Correct
2.Another agent working for your agency claims that because you are not
employed by the Medicare Advantage plans that you represent, you are not
subject to the same requirements as the plans themselves. How should
you respond to such a statement?: c. Your coworker is not correct.
Marketing on behalf of a plan is considered marketing by the plan and
requires that all contracted and employed agents comply with all
Medicare marketing rules. Correct
3.You work for a company that has marketed Medigap products for many
years. The company has added Medicare Advantage and Part D plans and
you will begin marketing those plans this fall. You are planning what
materials to use to easily show the differences in benefits, premiums and
cost sharing for each of the products. What do you need to do with your
materials before using them for marketing purposes?: b. You must submit
your materials to the plan you represent, so CMS can review and
approve the materials to ensure they are accurate. Correct
4.Which of the following is a correct statement about state laws as they
per- tain to marketing representatives?: d. Medicare health plans must
comply with requests for information from state insurance departments
investigating complaints about a marketing representative. Correct
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5.You are seeking to represent an individual Medicare Advantage plan and
an individual Part D plan in your state. You have completed the required
training for each plan, but you did not achieve a passing score on the tests
that came after the training. What can you do in this situation?: a. You will
not be able to represent any Medicare Advantage or Part D plan until
you complete the training and achieve an adequate score, although
you will not have to take a test if you exclusively market
employer/union group plans and the companies do not require testing.
Correct
6.Your colleague works at a third party marketing organization (TMO) and
she said she did not need to take the Medicare training for brokers and
agents or pass a test to market Medicare plans since her contract is with
the TMO, not the plans that have the products she sells. What could you
say to her?: d.You could tell her she is wrong, and that only agents
selling employer/union group plans are permitted an exemption from
testing, but some employer/union
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group plans may require testing to promote agent compliance with
CMS marketing requirements. Correct
7.Agent Armstrong is employed by XYZ Agency, which is under contract
with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in
multiple states. XYZ Agency maintains a website marketing the MA plans
with which it has contracts. Agent Armstrong follows up with individuals
who request more information about ABC MA plans via the website and
tries to persuade them to enroll in ABC plans. What statement best
describes the marketing and compliance rules that apply to Agent
Armstrong?: c. Agent Armstrong needs to be licensed and appointed in
every state in which beneficiaries to whom he markets ABC MA plans
are located. Correct
8.You are mailing invitations to new Medicare beneficiaries for a
marketing event. You want an idea of how many people to expect, so you
would like to request RSVPs. What should you keep in mind?: d. You may
request RSVPs, but you are not permitted to require contact
information. Correct
9.Agent Antonio is preparing for a presentation on Medicare and Medicare
Advantage before a local senior citizen civic group where he hopes to
enroll some attendees. Which of the following steps should he take in
order to be in compliance with Medicare marketing rules?: a. Antonio
should include on the invitation a statement that a salesperson will be
present with information and applications. Correct
10.You have set up an appointment for an in-home sales presentation with
Mrs. Fernandez, who expressed interest in the Medicare plans you
represent. In preparation for the sales presentation, what must you do?: c.
Prior to con- ducting the presentation, obtain, and document having
obtained her permission to visit, along with her interest in the specific
products you will present. Correct
AHIP 2023 Final Exam Test Questions and Answers
(Verified Answers)
- 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 ANS He may signup for Medicare at any time however coverage usually begins on the fourth month
afterdialysis 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 naturalizedcitizen 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 impacthis employer-sponsored healthcare coverage. How would you respond ANS
Juanis likely to be eligible for Medicare once he turns age 65 and if he enrolls
Medicarewould become the primary payor of his healthcare claims and Smallcap
does not have to continue to offer him coverage comparable to those under age 65under itsemployer-sponsored group health plan. - Mr. Moy’s wife has a Medicare Advantage plan, but he wants to under-
stand what coverage Medicare Supplemental Insurance provides since his
health care needs are different from his wife’s needs.What could you tell Mr.
Moy ANS Medicare Supplemental Insurance would help cover his Part A and PartB deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well
as possibly some services that Medicare does not cover.
- Mrs. PeHa is 66 years old, has coverage under an employer plan, and will retirnext year. She heard she must enroll in Part B at the beginning of the year toensure no gap in coverage. What can you tell her ANS She may enroll at any
time while she is covered under her employer plan, but she will have a special eightmonth enrollment period after the last month on her employer plan that differs fromthe 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 concernedthat she will not qualify for coverage under part A because she was not born inthe United States. What should you tell her ANS 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 aswell, 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 ANS 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 whetheror not Medicare will cover these items and services. What should you tell
her ANS 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 hemight be exposed to under Medicare if he were to require hospitalization as aresult of an illness. In general terms, what could you tell him about his costsfor inpatient hospital services
under Original Medicare ANS Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient hospital stay, after
which it convertsinto 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 forall 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 ANS To
obtain Part B coverage, she must pay a standard monthly premium, though it is
higher forindividuals with higher incomes.
AHIP Final Exam Practice Test
(200 Questions and Answers 100% Correct)
Latest (2023 / 2024) (Verified Answers)
1.Mr. Lopez has heard that he can sign up for a product called “Medicare
Advantage” but is not sure about what type of plan designs are available
through this program. What should you tell him about the types of health
plans that are available through the Medicare Advantage program ANS
They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and
MSAs
- (W) Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct
description?-
: Medicare Advantage is a way of covering all of the Original
Medicare benefits through private health insurance companies.
3.During a sales presentation in Ms. Sullivan’s home, she tells you that she
has heard about a type of Medicare health plan known as Private Fee-forSer- vice (PFFS). She wants to know if this would be available to her. What
should you tell her about PFFS plans ANS A PFFS plan is one of various
types of Medicare Advantage plans offered by private entities and she
may enroll in one if it is available in her area.
4.(W) Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her ANS Mrs.
Radford must be entitled to Part A and enrolled in Part B to enroll in
Medicare Advantage
5.Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B
but has recently stopped paying his Part B premium. He would like to enroll
in a Medicare Advantage (MA) plan and is still covered by Part A. What
should you tell him ANS He is not eligible to enroll in a Medicare
Advantage plan until he re-enrolls in Medicare Part B
6.(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan
several years ago. Her doctor recently confirmed a diagnosis of end-stage
renal disease (ESRD). What options does Mrs. Billings have in regard to her
MA plan during the next open enrollment season ANS She may remain in
her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals
suffering from ESRD if one is available in her area
7.Mr. Kumar is considering a Medicare Advantage HMO and has questions
about his ability to access providers. What should you tell him ANS In most
Medicare Advantage HMOs, Mr. Kumar must obtain his services only
from providers who have a contractual relationship with the plan
(except in an emergency).
8.Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should you
tell her ANS Mrs. Ramos can obtain care from any provider who
participates in Original Medicare, but generally will be charged a lower
co-payment if she goes to one of the plan’s preferred providers.
9.Mr. Sinclair has diabetes and heart trouble and is generally satisfied with
the care he has received under Original Medicare, but he would like to know
more about Medicare Advantage Special Needs Plans (SNPs). What could
you tell him ANS SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coveragethat could be very helpful as well
10.(W) Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has mentioned
that the SNP charges very low cost-sharing amounts and Mr. Greco would
like to join that plan. What should you tell him ANS SNPs limit enrollment
to certain sub-populations of beneficiaries. Given his current situation,
he is unlikely to qualify and would not be able to enroll in the SNP.
11.(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, hasbeen employed full time, and paid taxes during that entire period. She isconcerned that she will not qualify for coverage under part A because shewas not born in the United States. What should you tell her ANS Mostindividuals who are citizens and over age 65 are covered under Part Aby virtue of having paid Medicare taxes while working, though somemay be covered as a result of paying monthly premiums.
12.(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared
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AHIP STUDY GUIDE Questions and Answers
(2022/2023)
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111
Module 1
- 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?
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. 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?
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. - 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?
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 - 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. - Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance?
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. Schmidt would like to plan for retirement and has asked you what is covered under Original
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Fee-for-Service (FFS) Medicare? What could you tell him?
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.
- 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?
Medicare does not cover massage therapy, or, in general, glasses or dentures.
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- 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?
He generally would pay a monthly premium, annual deductible, and perprescription cost- sharing. - Mrs. Peña 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?
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. 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?
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. - 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?
He may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start. - 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?
To obtain Part B coverage, she must pay a standard monthly premium, though it
is higher for individuals with higher incomes. - 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?
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. - 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?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey’s entire lifetime.
AHIP Final Exam Test Review Questions and Answers
(2022/2023)
111111111111111111111111111111111111111111111111111111111
2022 Ahip Review
Question 1
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?
a. Medicare covers all screening tests that have been approved by the FDA on a frequency
determined by the treating physician.
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 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.
Source: Module 1, Slide – Medicare Part B Benefits – Preventive Services and Screenings
Question 2
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-forService (FFS) Medicare? What could you tell him?
a.Part C, which always covers dental and vision services, is covered under Original Medicare.
b.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.
c.Part A, which covers long-term custodial care services, is covered under Original Medicare.
d.Part D, which covers prescription drug services, is covered under Original Medicare.
Source: Module 1, Slide – Overview of Medicare Benefits and Coverage – Parts A, B, C, and Slide –
Overview of Different Ways to Get Medicare
Question 3
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 employersponsored healthcare coverage. How would you respond?
a.Juan is likely to be ineligible for Medicare since he was born outside the United States and has only
contributed to the Medicare system for 20 years.
b. 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.
c.Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employersponsored coverage would continue to be the primary payor while Medicare would be considered a
secondary payor of his healthcare claims.
Incorrect: Medicare is the primary payor for individuals who have group health coverage due to
their continued employment with a small employer. A small group health plan is one offered by a
company with fewer than 20 employees.
d. 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.
Source: Module 1, Slide – Eligibility for Part A and Part B Benefits and Slide – Medicare for Individuals
Who Are Still Working – Small GHPs and Slide – Medicare Coordination with Employer Group Health
Plans
Question 4
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?
a.After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
b.Individuals who become eligible for such disability payments only have to wait 12 months before they
can apply for coverage under Medicare.
c.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.
d.He became eligible for Medicare when his disability eligibility determination was first
made. Source: Module 1, Slide – Medicare Enrollment Part A & B
Question 5
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?
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.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.
b.Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or coinsurance
in
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.Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, endstage renal disease, and Lou Gehrig’s disease so she will be eligible for Medicare.
Source: Module 1, Slide – Eligibility for Part A and Part B Benefits
Question 6
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?
a. Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received
the MSN in the mail.
b.Mrs. Duarte has no right to appeal this determination since her claim has been partially paid.
c. Mrs. Duarte should file an appeal of this initial determination within 90 days of the date she received
the MSN in the mail. If she still disagrees with Medicare Administrative Contractor’s (MAC’s) further
decision she should request a reconsideration by a qualified independent party within 10 days.
Incorrect: Beneficiaries must file an appeal related to Part A or B services within 120 days of the date
they get the MSN in the mail. If a beneficiary disagrees with the Medicare Administrative Contractor’s
decision, he/she has 180 days after getting the decision notice to request a reconsideration by a
Qualified Independent Contractor.
d.Mrs. Duarte should request a reconsideration of the decision by a qualified independent party within
60 days of the date she received the MSN in the mail.
Source: Module 1, Slide – Appeals related to Part A and Part B Coverage and Payment Determinations.
Question 7
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?
a.Medicare Supplemental Insurance would cover his dental, vision and hearing services only.
Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
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 cover his long-term care services.
Source: Module 1, Slide – Medigap (Medicare Supplement Insurance)