AHIP MEDCARE CARE BASIS 2026|2027
ACCURATE|VERIFIED
Correct
Incorrect
1 of 145
Term
Conrad is 64, retiring soon, and considering enrollment in his
employer-sponsored MA retiree group health plan that includes drug
coverage with nominal copays. He heard about a neighbor's MA-PD
plan that you represent and because he takes numerous prescription
drugs, he is considering signing up for it. What should you tell him?
Give this one a try later!
HMOs require prior authorization for out-of-network services except for emergency
services and certain other carved-out services. HMOs may also require referrals for
in-network specialist services.
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. Ellis will not pay any penalty because he had continuous coverage under his
employer's plan and he enrolled in Part B within the 8-month period immediately
following the last month he had group coverage.
He should compare the benefits in his employer-sponsored retiree group
health plan with the benefits in his neighbor's MA-PD plan to determine which
one will provide sufficient coverage for his prescription needs.
Don't know?
2 of 145
Term
Ms. Sutton is enrolled in an MA-PD plan but will be moving out of the
plan's service area next month. She is worried that she will not be able
to enroll in another plan available in her new residence until the Annual
Election Period. What should you tell her?
Give this one a try later!
She may make such a change during the Annual Election Period that runs from
October 15 to December 7, or during the MA Open Enrollment Period, which takes
place from January 1- March 31 of each year.
Due to his participation in the workforce, he will not have to pay premiums for Part
A but he will pay higher premiums for Part B due to the amount of his income.
, She is eligible for a special election period (SEP) that begins either the month
before her permanent move, if the plan is notified in advance, or the month
she provides notice of the move, and this period typically lasts an additional
two months.
He is currently in the Part D Initial Enrollment Period (IEP), and during this time, he
may make one Part D enrollment choice, including enrollment in a stand-alone Part
D plan or an MA-PD plan.
Don't know?
3 of 145
Term
Mr. Peters 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?
Give this one a try later!
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.
All Medicare Advantage (MA) plans must have a "maximum out-of-pocket" limit
(known as "MOOP") for Part A and Part B benefits. Once the MA plan member pays
a specified amount of cost-sharing that health plan pays 100 percent of the medical
services covered.
, If there is a special needs plan (SNP) in Mr. Chambers's area that specializes in
caring for individuals with diabetes, he may enroll in the SNP at any time under a
special election period (SEP).
Ms. Archer is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding
using only approved call scripts.
Don't know?
4 of 145
Term
Mrs. Sanders 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?
Give this one a try later!
She may make such a change during the Annual Election Period that runs from
October 15 to December 7, or during the MA Open Enrollment Period, which takes
place from January 1- March 31 of each year.
ACCURATE|VERIFIED
Correct
Incorrect
1 of 145
Term
Conrad is 64, retiring soon, and considering enrollment in his
employer-sponsored MA retiree group health plan that includes drug
coverage with nominal copays. He heard about a neighbor's MA-PD
plan that you represent and because he takes numerous prescription
drugs, he is considering signing up for it. What should you tell him?
Give this one a try later!
HMOs require prior authorization for out-of-network services except for emergency
services and certain other carved-out services. HMOs may also require referrals for
in-network specialist services.
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. Ellis will not pay any penalty because he had continuous coverage under his
employer's plan and he enrolled in Part B within the 8-month period immediately
following the last month he had group coverage.
He should compare the benefits in his employer-sponsored retiree group
health plan with the benefits in his neighbor's MA-PD plan to determine which
one will provide sufficient coverage for his prescription needs.
Don't know?
2 of 145
Term
Ms. Sutton is enrolled in an MA-PD plan but will be moving out of the
plan's service area next month. She is worried that she will not be able
to enroll in another plan available in her new residence until the Annual
Election Period. What should you tell her?
Give this one a try later!
She may make such a change during the Annual Election Period that runs from
October 15 to December 7, or during the MA Open Enrollment Period, which takes
place from January 1- March 31 of each year.
Due to his participation in the workforce, he will not have to pay premiums for Part
A but he will pay higher premiums for Part B due to the amount of his income.
, She is eligible for a special election period (SEP) that begins either the month
before her permanent move, if the plan is notified in advance, or the month
she provides notice of the move, and this period typically lasts an additional
two months.
He is currently in the Part D Initial Enrollment Period (IEP), and during this time, he
may make one Part D enrollment choice, including enrollment in a stand-alone Part
D plan or an MA-PD plan.
Don't know?
3 of 145
Term
Mr. Peters 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?
Give this one a try later!
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.
All Medicare Advantage (MA) plans must have a "maximum out-of-pocket" limit
(known as "MOOP") for Part A and Part B benefits. Once the MA plan member pays
a specified amount of cost-sharing that health plan pays 100 percent of the medical
services covered.
, If there is a special needs plan (SNP) in Mr. Chambers's area that specializes in
caring for individuals with diabetes, he may enroll in the SNP at any time under a
special election period (SEP).
Ms. Archer is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding
using only approved call scripts.
Don't know?
4 of 145
Term
Mrs. Sanders 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?
Give this one a try later!
She may make such a change during the Annual Election Period that runs from
October 15 to December 7, or during the MA Open Enrollment Period, which takes
place from January 1- March 31 of each year.
