AHIP 2023 Final Questions with Correct
Answers
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? - correct answers:He will need to mail in his payment with his enrollment form.
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? - correct answers:She could enroll in a PFFS plan and a stand-alone Medicare prescription
drug plan.
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? - correct answers: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.
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? - correct answers: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.
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? - correct answers: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.
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? - correct answers: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.
, Mrs. Fiore is a retired federal worker with coverage under a Federal Employee 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 plan?
- correct answers: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.
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? - correct answers: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.
Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed
into the Medicare system. He also left a substantial 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? - correct answers: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.
Winthrop Brokerage wishes to place an advertisement in the local newspaper 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? - correct answers:Winthrop Brokerage does not need to submit the advertisement 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.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for
pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most
appropriate for him? - correct answers:C-SNP
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
Answers
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? - correct answers:He will need to mail in his payment with his enrollment form.
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? - correct answers:She could enroll in a PFFS plan and a stand-alone Medicare prescription
drug plan.
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? - correct answers: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.
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? - correct answers: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.
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? - correct answers: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.
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? - correct answers: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.
, Mrs. Fiore is a retired federal worker with coverage under a Federal Employee 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 plan?
- correct answers: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.
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? - correct answers: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.
Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed
into the Medicare system. He also left a substantial 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? - correct answers: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.
Winthrop Brokerage wishes to place an advertisement in the local newspaper 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? - correct answers:Winthrop Brokerage does not need to submit the advertisement 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.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for
pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most
appropriate for him? - correct answers:C-SNP
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
