AHIP Questions with Correct Solutions
Question:
1. Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is
eligible for Medicare. What should you tell him?
Answer:
Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage
or Part D plan within 2 months of his disenrollment.
Question:
2. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability
to access providers. What should you tell him?
Answer:
In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from
providers within the plan's network (except in an emergency or where care is unavailable
within the network).
Question:
3. 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:
XXXIt must obtain a HIPAA complaint authorization from an enrollee that indicates the plan
or plan sponsor may use their information for marketing purposes.
Question:
4. Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug
coverage that was offered to company retirees. The company told Mr. Yoo that, because he
was affected by this change, he would qualify for a Special election period. Mr. Yoo contacted
you to find out more about what this means. What can you tell him?
Answer:
It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part D
prescription drug plan.
Question:
5. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much
may Dr. Brennan charge?
,Answer:
Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS
plan's terms and condition of payment which may include balance billing up to 15% of the
Medicare rate.
Question:
6. Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover?
Answer:
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Question:
7. Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA)
and Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for
senior citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that
can be provided to potential enrollees who attend the sales presentation?
Answer:
A meal cannot be provided, but light snacks would be permitted.
Question:
8. You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her concerns?
Answer:
Tell her that Medicare guidelines allow you to conduct marketing activities in common areas
of a provider's facility.
Question:
9. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription for helping to regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them?
Answer:
Medicare prescription drug plans are not permitted to cover the prescription medications the
Vaughns are interested in under Part D coverage, however, plans may cover them as
supplemental benefits and the Vaughn's could look into that possibility.
, Question:
10. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this?
Answer:
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer
drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
Question:
11. Which of the following is/are most likely to be characterized as an involuntary
disenrollment from a Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to substantially improved health.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment period.
Answer:
I, II, and III only
Question:
12. Ms. Brooks has an aggressive cancer and would like to k
Answer:
Medicare covers hospice services and they will be available for her.
Question:
13. You are working several plans and community organizations to sponsor an educational
event. When putting together advertisements for this event, what should you do?
Answer:
You must ensure that the advertisements indicate it is an educational event, otherwise it will
be considered a marketing event.
Question:
14. Which of the following statement is/are correct about a Medicare Savings Account (MSA)
Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay
them as payment in full.
Question:
1. Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is
eligible for Medicare. What should you tell him?
Answer:
Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage
or Part D plan within 2 months of his disenrollment.
Question:
2. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability
to access providers. What should you tell him?
Answer:
In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from
providers within the plan's network (except in an emergency or where care is unavailable
within the network).
Question:
3. 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:
XXXIt must obtain a HIPAA complaint authorization from an enrollee that indicates the plan
or plan sponsor may use their information for marketing purposes.
Question:
4. Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug
coverage that was offered to company retirees. The company told Mr. Yoo that, because he
was affected by this change, he would qualify for a Special election period. Mr. Yoo contacted
you to find out more about what this means. What can you tell him?
Answer:
It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part D
prescription drug plan.
Question:
5. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much
may Dr. Brennan charge?
,Answer:
Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS
plan's terms and condition of payment which may include balance billing up to 15% of the
Medicare rate.
Question:
6. Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover?
Answer:
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Question:
7. Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA)
and Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for
senior citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that
can be provided to potential enrollees who attend the sales presentation?
Answer:
A meal cannot be provided, but light snacks would be permitted.
Question:
8. You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her concerns?
Answer:
Tell her that Medicare guidelines allow you to conduct marketing activities in common areas
of a provider's facility.
Question:
9. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription for helping to regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them?
Answer:
Medicare prescription drug plans are not permitted to cover the prescription medications the
Vaughns are interested in under Part D coverage, however, plans may cover them as
supplemental benefits and the Vaughn's could look into that possibility.
, Question:
10. Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this?
Answer:
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer
drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
Question:
11. Which of the following is/are most likely to be characterized as an involuntary
disenrollment from a Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to substantially improved health.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment period.
Answer:
I, II, and III only
Question:
12. Ms. Brooks has an aggressive cancer and would like to k
Answer:
Medicare covers hospice services and they will be available for her.
Question:
13. You are working several plans and community organizations to sponsor an educational
event. When putting together advertisements for this event, what should you do?
Answer:
You must ensure that the advertisements indicate it is an educational event, otherwise it will
be considered a marketing event.
Question:
14. Which of the following statement is/are correct about a Medicare Savings Account (MSA)
Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay
them as payment in full.
