AHIP 2023 Final
1. Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover his
premiums for the entire year. What should you tell him?: He will need to mail in
his payment with his enrollment form.
2. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area
that does not include drug coverage. She wants to enroll in the plan and enroll
in a stand-alone prescription drug plan. What should you tell her?: She could
enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
3. Mrs. Roswell is a new Medicare beneficiary who has just retired from retail
work. She is interested in selecting a Medicare Part D prescription drug plan.
She takes a number of medications and is concerned that she has not been
able to identify a plan that covers all of her medications. She does not want
to make an abrupt change to new drugs that would be covered and asks what
she should do. What should you tell her?: Every Part D drug plan is required to
cover a single one-month fill of her existing medications sometime during a 90-day
transition period.
4. Mr. Robinson was quite ill recently and forgot to pay his monthly premium
for his MA-PD plan. He is worried that he will lose his coverage now when
he needs it the most. He is certain his plan will disenroll him because that is
what happened to a friend of his in a similar type of plan. What can you tell
Mr. Robinson about his situation?: Plan sponsors have the option to do nothing
when a plan member does not pay their premiums or disenroll the member after a
grace period and notice.
5. Mrs. Allen has a rare condition for which two different brand name drugs
are the only available treatment. She is concerned that since no generic
prescription drug is available and these drugs are very high cost, she will not
be able to find a Medicare Part D prescription drug plan that covers either
one of them. What should you tell her?: Medicare prescription drug plans are
required to cover drugs in each therapeutic category. She should be able to enroll
in a Medicare prescription drug plan that covers the medications she needs.
6. One of your clients, Lauren Nichols, has heard about a Medicare concept
from one of her neighbors called TrOOP. She asks you to explain it. What
do you say?: TrOOP stands for true out-of-pocket expenses that count toward
the Medicare Part D catastrophic limit and include not only expenses paid by a
beneficiary but also in some instances drug manufacturer discounts.
7. Mrs. Fiore is a retired federal worker with coverage under a Federal Employ-
ee Health Benefits (FEHB) plan that includes creditable drug coverage. She is
ready to turn 65 and become Medicare eligible for the first time. What issues
might she consider about whether to enroll in a Medicare prescription drug
1/8
, AHIP 2023 Final
plan?: She could compare the coverage to see if the Medicare Part D plan offers
better benefits and coverage than the FEHB plan for the specific medications she
needs and whether any additional benefits are worth the Part D premium costs on
top of her FEHB contribution.
8. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture
and is being successfully treated for that condition. However, she and her
physicians feel that after her lengthy hospital stay she will need a month or two
of nursing and rehabilitative care. What should you tell them about Original
Medicare's coverage of care in a skilled nursing facility?: Medicare will cover
Mrs. Shield's skilled nursing services provided during the first 20 days of her stay,
after which she would have a copay until she has been in the facility for 100 days.
9. Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substan-
tial estate which provides Madeline with an annual income of approximately
$130,000. Madeline, who has only worked part-time for the last three years,
will soon turn age 65 and hopes to enroll in Original Medicare. She comes to
you for advice. What should you tell her?: You should tell Madeline that she will
be able to enroll in Medicare Part A without paying monthly premiums due to her
husband's long work record and participation in the Medicare system. You should
also tell Madeline that she will pay Part B premiums at more than the standard lowest
rate but less than the highest rate due her substantial income.
10. Winthrop Brokerage wishes to place an advertisement in the local newspa-
per that says: "We offer Medicare Advantage plans offered by AB Health and
Top Choice Health. Contact us if you would like to learn more." Which of the
following best describes the obligation(s) of Winthrop Brokerage regarding
the advertisement?: Winthrop Brokerage does not need to submit the advertise-
ment to CMS for prior approval because it does not include information about the
plans' benefits structures, cost-sharing, or information about measures or ranking
standards.
11. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis,
putting him at severe risk for pneumonia. Otherwise, he has no problems func-
tioning. Which type of SNP is likely to be most appropriate for him?: C-SNP
12. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 years and paying Medicare taxes. What should you tell her?: To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
13. You are scheduled to give a sales presentation at a local senior center at
which a drawing will be held for a prize. At the beginning of the presentation,
2/8
1. Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover his
premiums for the entire year. What should you tell him?: He will need to mail in
his payment with his enrollment form.
2. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area
that does not include drug coverage. She wants to enroll in the plan and enroll
in a stand-alone prescription drug plan. What should you tell her?: She could
enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
3. Mrs. Roswell is a new Medicare beneficiary who has just retired from retail
work. She is interested in selecting a Medicare Part D prescription drug plan.
She takes a number of medications and is concerned that she has not been
able to identify a plan that covers all of her medications. She does not want
to make an abrupt change to new drugs that would be covered and asks what
she should do. What should you tell her?: Every Part D drug plan is required to
cover a single one-month fill of her existing medications sometime during a 90-day
transition period.
4. Mr. Robinson was quite ill recently and forgot to pay his monthly premium
for his MA-PD plan. He is worried that he will lose his coverage now when
he needs it the most. He is certain his plan will disenroll him because that is
what happened to a friend of his in a similar type of plan. What can you tell
Mr. Robinson about his situation?: Plan sponsors have the option to do nothing
when a plan member does not pay their premiums or disenroll the member after a
grace period and notice.
5. Mrs. Allen has a rare condition for which two different brand name drugs
are the only available treatment. She is concerned that since no generic
prescription drug is available and these drugs are very high cost, she will not
be able to find a Medicare Part D prescription drug plan that covers either
one of them. What should you tell her?: Medicare prescription drug plans are
required to cover drugs in each therapeutic category. She should be able to enroll
in a Medicare prescription drug plan that covers the medications she needs.
6. One of your clients, Lauren Nichols, has heard about a Medicare concept
from one of her neighbors called TrOOP. She asks you to explain it. What
do you say?: TrOOP stands for true out-of-pocket expenses that count toward
the Medicare Part D catastrophic limit and include not only expenses paid by a
beneficiary but also in some instances drug manufacturer discounts.
7. Mrs. Fiore is a retired federal worker with coverage under a Federal Employ-
ee Health Benefits (FEHB) plan that includes creditable drug coverage. She is
ready to turn 65 and become Medicare eligible for the first time. What issues
might she consider about whether to enroll in a Medicare prescription drug
1/8
, AHIP 2023 Final
plan?: She could compare the coverage to see if the Medicare Part D plan offers
better benefits and coverage than the FEHB plan for the specific medications she
needs and whether any additional benefits are worth the Part D premium costs on
top of her FEHB contribution.
8. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture
and is being successfully treated for that condition. However, she and her
physicians feel that after her lengthy hospital stay she will need a month or two
of nursing and rehabilitative care. What should you tell them about Original
Medicare's coverage of care in a skilled nursing facility?: Medicare will cover
Mrs. Shield's skilled nursing services provided during the first 20 days of her stay,
after which she would have a copay until she has been in the facility for 100 days.
9. Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substan-
tial estate which provides Madeline with an annual income of approximately
$130,000. Madeline, who has only worked part-time for the last three years,
will soon turn age 65 and hopes to enroll in Original Medicare. She comes to
you for advice. What should you tell her?: You should tell Madeline that she will
be able to enroll in Medicare Part A without paying monthly premiums due to her
husband's long work record and participation in the Medicare system. You should
also tell Madeline that she will pay Part B premiums at more than the standard lowest
rate but less than the highest rate due her substantial income.
10. Winthrop Brokerage wishes to place an advertisement in the local newspa-
per that says: "We offer Medicare Advantage plans offered by AB Health and
Top Choice Health. Contact us if you would like to learn more." Which of the
following best describes the obligation(s) of Winthrop Brokerage regarding
the advertisement?: Winthrop Brokerage does not need to submit the advertise-
ment to CMS for prior approval because it does not include information about the
plans' benefits structures, cost-sharing, or information about measures or ranking
standards.
11. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis,
putting him at severe risk for pneumonia. Otherwise, he has no problems func-
tioning. Which type of SNP is likely to be most appropriate for him?: C-SNP
12. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 years and paying Medicare taxes. What should you tell her?: To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
13. You are scheduled to give a sales presentation at a local senior center at
which a drawing will be held for a prize. At the beginning of the presentation,
2/8
