AHIP Final Exam Test Questions
Mrs. West 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? - ANSWER-Medicare does not cover acupuncture, or, in
general, glasses or dentures.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare
Part D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him? - ANSWER-He could
check with the manufacturers of his medications to see if they offer an assistance program to
help people with limited means obtain the medications they need. Alternatively, he could check
to see whether his state has a pharmacy assistance program to help him with his expenses.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does
not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that
does not include drug coverage and intends to obtain his drug coverage through a stand-alone
Medicare prescription drug plan. What should you tell him about this situation? - ANSWER-He
could enroll in one of the MA plans that include prescription drug coverage or a Medigap plan
and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and a
stand-alone prescription drug plan.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums
with an automatic monthly withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What should you tell him? -
ANSWER-In general, he must select a single Part D premium payment mechanism that will be
used throughout the year.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a brief
presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that
, has been advertised as educational? - ANSWER-Yes. When an event has been advertised as
"educational," discussing plan-specific premiums is impermissible.
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? - ANSWER-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.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in
what they charge for deductibles, premiums and cost sharing. How can you explain this to him?
- ANSWER-Medicare Part D drug plans may have different benefit structures, but on average,
they must all be at least as good as the standard model established by the government.
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 and those under age 65 with certain
disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible for Medicare.
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? - ANSWER-Agent Armstrong needs to be
licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans
are located.
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? - ANSWER-Part A, which covers
Mrs. West 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? - ANSWER-Medicare does not cover acupuncture, or, in
general, glasses or dentures.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare
Part D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him? - ANSWER-He could
check with the manufacturers of his medications to see if they offer an assistance program to
help people with limited means obtain the medications they need. Alternatively, he could check
to see whether his state has a pharmacy assistance program to help him with his expenses.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does
not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that
does not include drug coverage and intends to obtain his drug coverage through a stand-alone
Medicare prescription drug plan. What should you tell him about this situation? - ANSWER-He
could enroll in one of the MA plans that include prescription drug coverage or a Medigap plan
and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and a
stand-alone prescription drug plan.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums
with an automatic monthly withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What should you tell him? -
ANSWER-In general, he must select a single Part D premium payment mechanism that will be
used throughout the year.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a brief
presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that
, has been advertised as educational? - ANSWER-Yes. When an event has been advertised as
"educational," discussing plan-specific premiums is impermissible.
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? - ANSWER-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.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in
what they charge for deductibles, premiums and cost sharing. How can you explain this to him?
- ANSWER-Medicare Part D drug plans may have different benefit structures, but on average,
they must all be at least as good as the standard model established by the government.
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 and those under age 65 with certain
disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible for Medicare.
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? - ANSWER-Agent Armstrong needs to be
licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans
are located.
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? - ANSWER-Part A, which covers
