AHIP Final Exam BUNDLE
AHIP Final Exam Latest 2024
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?
Answer:
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.
Mr. Shapiro gets by on a very small amount of fixed income. He has heard there
may be extra help paying for Part D prescription drugs for Medicare beneficiaries
with limited income. He wants to know whether he might qualify. What should you
tell him?
Answer:
The extra help is available to beneficiaries whose income and assets do not exceed
annual limits specified by the government.
Which of the following statements about Medicare Part D are correct?
Answer:
I, II, and III only
-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.
Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-forService (PFFS) plan. All types of PFFS plans are available in her area. Which
options could Mrs. Roberts consider before selecting a PFFS plan?
Answer:
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.
Mrs. Lu is turning 65 in November and called to ask for your help deciding on a
Medicare Advantage plan. She agreed to sign a scope of appointment form and meet
with you on October 15. During the appointment, what are you permitted to do?
Answer:
You may provide her with the required enrollment materials and take her
completed enrollment application.
Agent Daniel Webber has properly set up a sales appointment to meet with client
Edward Young at Agent Webber’s office. At the agreed upon appointment time, Mr.
Young arrives with his elderly neighbor – Clara Burton, who wants to learn about
her Medicare Advantage options. What should Agent Daniel Webber do?
Answer:
You have been providing a pre-Thanksgiving meal during sales presentations in
November for many years and your clients look forward to attending this annual
event. When marketing Medicare Advantage and Part D plans, what are you
permitted to do with respect to meals?
Answer:
You may provide light snacks, but a Thanksgiving style meal would be prohibited,
regardless of who provides or pays for the meal.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees’
information to market non-health related products such as life insurance and
annuities. Which statement best describes ABC’s obligation to its enrollees
regarding marketing such products?
Answer:
b.
It must obtain a HIPAA compliant authorization from an enrollee that indicates the
plan or plan sponsor may use their information for marketing purposes.
Wendy Park becomes eligible for Medicare for the first time in July. With the help
of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an
effective date of July 1st. Which statement best describes how Agent Chan may be
compensated under CMS rules?
Answer:
FeelBetter will pay Agent Chan initial year compensation for the months July
through December. Renewal amounts will be paid starting in January if Ms. Park
remains enrolled the following year.
AHIP Final Exam QUESTIONS
Types of Medicare Advantage Plans
Answer:
PPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans
Answer:
Serve both Medicare and Medicaid individuals. Include Part D coverage.
Individuals sometimes referred to as dual eligible
Medicare Cost Plan
Answer:
Type of Medicare health plan. Have Part B to enroll. Can join anytime plan is
accepting new members. A non-network provider will can charge higher
coinsurances and deductibles. Different enrollment/disenrollment periods apply.
Can get Part D Rx coverage if available, or apply for a separate PDP.
Medicare Entitlement/Enrollment – Part A & Part B
Answer:
Individuals with ESRD may sign up at any time. Date on which coverage begins is
the fourth month after dialysis begins.
Medicare Enrollment Period
Answer:
Individuals who do not enroll in Part B when first eligible can enroll during a
General Enrollment Period, Jan 1st to Mar 31st each year. Coverage begins July 1st
of that year.
Medicare Enrollment Period – Group Health Coverage
Answer:
Individuals who have group health coverage through employer may enroll in Part A
and/or Part B anytime while on group coverage during a Special Enrollment Period.
Occurs during the 8 month period following last month of group coverage.
Medicare Part A Premium
Answer:
Free if worked 40 quarters of your life and paid Medicare taxes. Premium is $240.00
for individuals or spouses who paid Medicare taxes for 30 – 39 quarters. Premium is
$437.00 for less than 30 quarters.
Medicare Part A Penalty
Answer:
Don’t enroll in Part A when fist eligible, will pay a late penalty of up to 10% unless
enroll during a Special Enrollment Period.
Medicare Part B Premium
Answer:
In 2019, the standard monthly premium is $135.50 or higher depending on income.
Deducted from S.S. check or Railroad Retirement check. Do not enroll when first
eligible, premium is increased 10% for each 12-month period not enrolled.
Deductible for 2019 is $185.00
Part C Medicare Advantage plans
Answer:
Entitled to benefits under Part A AND enrolled in Part B.
Part D Prescription Drug benefits
Answer:
Entitled to benefits under Part A but not enrolled in Part B. Must be entitled to
Part A AND/OR enrolled in Part B.
Part D Low Income Subsidy
Answer:
Do not qualify for Part D Low Income Subsidy, but are of limited means, may
qualify for help in Part D costs through State Pharmaceutical Assistance Program.
Part A Benefits
Answer:
$1364.00 deductible for each benefit period. Days 1 – 60: $0 coinsurance. Days 61 –
90: $341.00 coinsurance per day. days 91 and beyond: $682.00 coinsurance per each
“lifetime reserve day” after day 90 for each benefit period (up to 60 days over a
beneficiary’s lifetime. Beyond lifetime reserve days, all costs.