AHIP Final
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthri s through acupuncture. She is concerned about whether or not Medicare will cover
these items and services. What should you tell her?
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 Prescrip on Drug program and he is wondering if there is any other op on he has for
obtaining help with his considerable drug costs. What should you tell him?
He could check with the manufacturers of his medica ons to see if they offer an assistance
program to help people with limited means obtain the medica ons they need. Alterna vely,
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 organiza on 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 prescrip on drug plan. What should you tell him about this situa on?
He could enroll in one of the MA plans that include prescrip on drug coverage or a Medigap
plan and a stand-alone prescrip on drug plan, but he cannot enroll in the MA-only PPO plan
and a stand-alone prescrip on drug plan.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums
with an automa c monthly withdrawal from his savings account un l it is exhausted, and
then have his premiums withheld from his Social Security check. What should you tell him?
In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
Agent Jennings makes a presenta on on Medicare adver sed as an educa onal event. Agent
Jennings distributes materials that are solely educa onal in nature. However, she gives a
brief presenta on that men ons plan-specific premiums. Is this a prohibited ac vity at an
event that has been adver sed as educa onal?
Yes. When an event has been adver sed as "educa onal," discussing plan-specific premiums
is impermissible.
, Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare
prescrip on drug plan because, although she is en tled to Part A, she is not enrolled under
Medicare Part B. What should you tell her?
Everyone who is en tled to Part A or enrolled under Part B is eligible to enroll in a Medicare
prescrip on drug plan. As long as Mrs. Mulcahy is en tled to Part A, she does not need to
enroll under Part B before enrolling in a prescrip on drug plan.
Mr. Jacob understands that there is a standard Medicare Part D prescrip on drug benefit,
but when he looks at informa on on various plans available in his area, he sees a wide range
in what they charge for deduc bles, premiums and cost sharing. How can you explain this to
him?
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 re re when she turns 65 in a few months. She is in excellent health and
will have considerable income when she re res. 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
disabili es, 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 mul ple states. XYZ Agency maintains a
website marke ng the MA plans with which it has contracts. Agent Armstrong follows up
with individuals who request more informa on about ABC MA plans via the website and
tries to persuade them to enroll in ABC plans. What statement best describes the marke ng
and compliance rules that apply to Agent Armstrong?
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 re rement and has asked you what is covered under
Original 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.
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 a=er the training. What can you do in this
situa on?
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthri s through acupuncture. She is concerned about whether or not Medicare will cover
these items and services. What should you tell her?
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 Prescrip on Drug program and he is wondering if there is any other op on he has for
obtaining help with his considerable drug costs. What should you tell him?
He could check with the manufacturers of his medica ons to see if they offer an assistance
program to help people with limited means obtain the medica ons they need. Alterna vely,
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 organiza on 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 prescrip on drug plan. What should you tell him about this situa on?
He could enroll in one of the MA plans that include prescrip on drug coverage or a Medigap
plan and a stand-alone prescrip on drug plan, but he cannot enroll in the MA-only PPO plan
and a stand-alone prescrip on drug plan.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums
with an automa c monthly withdrawal from his savings account un l it is exhausted, and
then have his premiums withheld from his Social Security check. What should you tell him?
In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
Agent Jennings makes a presenta on on Medicare adver sed as an educa onal event. Agent
Jennings distributes materials that are solely educa onal in nature. However, she gives a
brief presenta on that men ons plan-specific premiums. Is this a prohibited ac vity at an
event that has been adver sed as educa onal?
Yes. When an event has been adver sed as "educa onal," discussing plan-specific premiums
is impermissible.
, Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare
prescrip on drug plan because, although she is en tled to Part A, she is not enrolled under
Medicare Part B. What should you tell her?
Everyone who is en tled to Part A or enrolled under Part B is eligible to enroll in a Medicare
prescrip on drug plan. As long as Mrs. Mulcahy is en tled to Part A, she does not need to
enroll under Part B before enrolling in a prescrip on drug plan.
Mr. Jacob understands that there is a standard Medicare Part D prescrip on drug benefit,
but when he looks at informa on on various plans available in his area, he sees a wide range
in what they charge for deduc bles, premiums and cost sharing. How can you explain this to
him?
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 re re when she turns 65 in a few months. She is in excellent health and
will have considerable income when she re res. 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
disabili es, 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 mul ple states. XYZ Agency maintains a
website marke ng the MA plans with which it has contracts. Agent Armstrong follows up
with individuals who request more informa on about ABC MA plans via the website and
tries to persuade them to enroll in ABC plans. What statement best describes the marke ng
and compliance rules that apply to Agent Armstrong?
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 re rement and has asked you what is covered under
Original 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.
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 a=er the training. What can you do in this
situa on?
