AHIP FINAL EXAM TEST QUESTIONS
AND ANSWERS
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief fro
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m arthritis through acupuncture. She is concerned about whether or not Medicare wil
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l cover these items and services. What should you tell her? - ANSWERS-
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Medicare does not cover acupuncture, or, in general, glasses or dentures.
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Mr. Bickford did not quite qualify for the extra help low-
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income subsidy under the Medicare Part D Prescription Drug program and he is won
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dering if there is any other option he has for obtaining help with his considerable dru
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g costs. What should you tell him? - ANSWERS-
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He could check with the manufacturers of his medications to see if they offer an assi
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stance program to help people with limited means obtain the medications they need.
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Alternatively, he could check to see whether his state has a pharmacy assistance pr gf gf gf gf gf gf gf gf gf gf gf gf gf
ogram to help him with his expenses. gf gf gf gf gf gf
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represe
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nt. It is one of three plans operated by the same organization in Mr. Lombardi's area.
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The MA PPO plan does not include drug coverage, but the other two plans do. Mr. L
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ombardi likes the PPO plan that does not include drug coverage and intends to obtai
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n his drug coverage through a stand-
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alone Medicare prescription drug plan. What should you tell him about this situation?
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- ANSWERS-
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He could enroll in one of the MA plans that include prescription drug coverage or a M
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edigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-
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only PPO plan and a stand-alone prescription drug plan.
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Mr. Torres has a small savings account. He would like to pay for his monthly Part D
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premiums with an automatic monthly withdrawal from his savings account until it is e
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xhausted, and then have his premiums withheld from his Social Security check. Wha
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t should you tell him? - ANSWERS-
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In general, he must select a single Part D premium payment mechanism that will be
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used throughout the year. gf gf gf
Agent Jennings makes a presentation on Medicare advertised as an educational eve
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nt. Agent Jennings distributes materials that are solely educational in nature. Howev
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er, she gives a brief presentation that mentions plan-
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specific premiums. Is this a prohibited activity at an event that has been advertised a
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s educational? - ANSWERS-
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Yes. When an event has been advertised as "educational," discussing plan-
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specific premiums is impermissible. gf gf gf
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare pre
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scription drug plan because, although she is entitled to Part A, she is not enrolled un
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der Medicare Part B. What should you tell her? - ANSWERS-
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Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a M
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, edicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she doe
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s not need to enroll under Part B before enrolling in a prescription drug plan.
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Mr. Jacob understands that there is a standard Medicare Part D prescription drug be
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nefit, but when he looks at information on various plans available in his area, he sees
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gfa wide range in what they charge for deductibles, premiums and cost sharing. How
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can you explain this to him? - ANSWERS-
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Medicare Part D drug plans may have different benefit structures, but on average, th
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ey must all be at least as good as the standard model established by the government
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.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent heal
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th and will have considerable income when she retires. She is concerned that her inc
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ome will make it impossible for her to qualify for Medicare. What could you tell her to
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address her concern? - ANSWERS- gf gf gf gf
Medicare is a program for people age 65 or older and those under age 65 with certai
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n disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible
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for Medicare.
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Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Hea
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lth Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ A
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gency maintains a website marketing the MA plans with which it has contracts. Agent
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Armstrong follows up with individuals who request more information about ABC MA
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plans via the website and tries to persuade them to enroll in ABC plans. What statem
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ent best describes the marketing and compliance rules that apply to Agent Armstron
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g? - ANSWERS- gf gf
Agent Armstrong needs to be licensed and appointed in every state in which benefici
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aries to whom he markets ABC MA plans are located.
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Mr. Schmidt would like to plan for retirement and has asked you what is covered und
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er Original Fee-for-Service (FFS) Medicare? What could you tell him? - ANSWERS-
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Part A, which covers hospital, skilled nursing facility, hospice and home health servic
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es and Part B, which covers professional services such as those provided by a docto
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r are covered under Original Medicare.
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You are seeking to represent an individual Medicare Advantage plan and an individu
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al Part D plan in your state. You have completed the required training for each plan,
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but you did not achieve a passing score on the tests that came after the training. Wh
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at can you do in this situation? - ANSWERS-
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You will not be able to represent any Medicare Advantage or Part D plan until you co
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mplete the training and achieve an adequate score, although you will not have to tak
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e a test if you exclusively market employer/union group plans and the companies do
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not require testing. gf gf
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
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would like to know his options since he has decided to drop his retiree coverage and
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is eligible for Medicare. What should you tell him? - ANSWERS-
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Mr. Chen can disenroll from his employer-
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sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months o
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AND ANSWERS
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief fro
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m arthritis through acupuncture. She is concerned about whether or not Medicare wil
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l cover these items and services. What should you tell her? - ANSWERS-
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Medicare does not cover acupuncture, or, in general, glasses or dentures.
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Mr. Bickford did not quite qualify for the extra help low-
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income subsidy under the Medicare Part D Prescription Drug program and he is won
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dering if there is any other option he has for obtaining help with his considerable dru
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g costs. What should you tell him? - ANSWERS-
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He could check with the manufacturers of his medications to see if they offer an assi
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stance program to help people with limited means obtain the medications they need.
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Alternatively, he could check to see whether his state has a pharmacy assistance pr gf gf gf gf gf gf gf gf gf gf gf gf gf
ogram to help him with his expenses. gf gf gf gf gf gf
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represe
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nt. It is one of three plans operated by the same organization in Mr. Lombardi's area.
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The MA PPO plan does not include drug coverage, but the other two plans do. Mr. L
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ombardi likes the PPO plan that does not include drug coverage and intends to obtai
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n his drug coverage through a stand-
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alone Medicare prescription drug plan. What should you tell him about this situation?
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- ANSWERS-
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He could enroll in one of the MA plans that include prescription drug coverage or a M
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edigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-
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only PPO plan and a stand-alone prescription drug plan.
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Mr. Torres has a small savings account. He would like to pay for his monthly Part D
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premiums with an automatic monthly withdrawal from his savings account until it is e
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xhausted, and then have his premiums withheld from his Social Security check. Wha
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t should you tell him? - ANSWERS-
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In general, he must select a single Part D premium payment mechanism that will be
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used throughout the year. gf gf gf
Agent Jennings makes a presentation on Medicare advertised as an educational eve
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nt. Agent Jennings distributes materials that are solely educational in nature. Howev
gf gf gf gf gf gf gf gf gf gf gf
er, she gives a brief presentation that mentions plan-
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specific premiums. Is this a prohibited activity at an event that has been advertised a
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s educational? - ANSWERS-
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Yes. When an event has been advertised as "educational," discussing plan-
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specific premiums is impermissible. gf gf gf
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare pre
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scription drug plan because, although she is entitled to Part A, she is not enrolled un
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der Medicare Part B. What should you tell her? - ANSWERS-
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Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a M
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, edicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she doe
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s not need to enroll under Part B before enrolling in a prescription drug plan.
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Mr. Jacob understands that there is a standard Medicare Part D prescription drug be
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nefit, but when he looks at information on various plans available in his area, he sees
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gfa wide range in what they charge for deductibles, premiums and cost sharing. How
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can you explain this to him? - ANSWERS-
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Medicare Part D drug plans may have different benefit structures, but on average, th
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ey must all be at least as good as the standard model established by the government
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.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent heal
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th and will have considerable income when she retires. She is concerned that her inc
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ome will make it impossible for her to qualify for Medicare. What could you tell her to
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address her concern? - ANSWERS- gf gf gf gf
Medicare is a program for people age 65 or older and those under age 65 with certai
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n disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible
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for Medicare.
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Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Hea
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lth Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ A
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gency maintains a website marketing the MA plans with which it has contracts. Agent
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Armstrong follows up with individuals who request more information about ABC MA
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plans via the website and tries to persuade them to enroll in ABC plans. What statem
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ent best describes the marketing and compliance rules that apply to Agent Armstron
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g? - ANSWERS- gf gf
Agent Armstrong needs to be licensed and appointed in every state in which benefici
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aries to whom he markets ABC MA plans are located.
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Mr. Schmidt would like to plan for retirement and has asked you what is covered und
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er Original Fee-for-Service (FFS) Medicare? What could you tell him? - ANSWERS-
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Part A, which covers hospital, skilled nursing facility, hospice and home health servic
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es and Part B, which covers professional services such as those provided by a docto
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r are covered under Original Medicare.
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You are seeking to represent an individual Medicare Advantage plan and an individu
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al Part D plan in your state. You have completed the required training for each plan,
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but you did not achieve a passing score on the tests that came after the training. Wh
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at can you do in this situation? - ANSWERS-
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You will not be able to represent any Medicare Advantage or Part D plan until you co
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mplete the training and achieve an adequate score, although you will not have to tak
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e a test if you exclusively market employer/union group plans and the companies do
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not require testing. gf gf
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
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would like to know his options since he has decided to drop his retiree coverage and
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is eligible for Medicare. What should you tell him? - ANSWERS-
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Mr. Chen can disenroll from his employer-
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sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months o
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