AHIP 2025 Final Exam with Questions And Verified Answers 100%
Correct
Hank's Fish Store, Inc. is a small company with just 15 employees located in
Florida. Hank, the store owner, has provided excellent health benefits to the store's
workforce. William, one of the store's long-time employees, will soon be reaching
age 65 and eligible for Medicare. William is in good health. He intends to remain
an active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to
offer William? - answer > Hank's can continue to offer William the same employee
health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a
Medicare Advantage plan that is offered to the public.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through massage therapy. She is concerned about whether or not
Medicare will cover these items and services. What should you tell her? - answer >
Medicare does not cover massage therapy, or, in general, glasses or dentures.
Your colleague works at a third-party marketing organization (TMO) and she said
she did not need to take the Medicare training for brokers and agents or pass a test
to market Medicare plans since her contract is with the TMO, not the plans that
have the products she sells. What could you say to her? - answer > You could tell
her she is wrong, and that only agents selling employer/union group plans are
permitted an exemption from testing, but some employer/union group plans may
require testing to promote agent compliance with CMS marketing requirements.
You are meeting with Mrs. Hall in her home. On her scope of appointment form,
she asked to discuss Medicare Advantage plans. During the meeting, she asked to
discuss a stand-alone prescription drug plan. She is leaving the next day to visit her
family for a week in another state, so she needs to decide before she leaves. What
must happen before that additional discussion can take place? - answer > Since
Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may
do so, as long as she signs a new scope of appointment form first, indicating that
she wants to discuss the Part D plan.
,You plan to participate in an educational event sponsored by a large regional health
care system. One of your colleagues suggests that you do a presentation on one of
the Medicare Health plans you market and modify it to include information about
preventive screening tests showcased at the event. How should you respond to your
colleague's suggestion? - answer > You should tell your colleague no, because
marketing representatives are not permitted to participate, in any way, in an
educational event.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park that might be of assistance? - answer > She should contact her state
Medicaid agency to see if she qualifies for one of several programs that can help
with Medicare costs for which she is responsible.
Mr. Alonso receives some help paying for his two generic prescription drugs from
his employer's retiree coverage, but he wants to compare it to a Part D prescription
drug plan. He asks you what costs he would generally expect to encounter when
enrolling into a standard Medicare Part D prescription drug plan. What should you
tell him? - answer > He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,
but it provides no drug coverage. She would like to keep the coverage she has but
replace her existing Medigap plan with one that provides drug coverage. What
should you tell her? - answer > Mrs. Gonzalez cannot purchase a Medigap plan
that covers drugs, but she could keep her Medigap policy and enroll in a Part D
prescription drug plan.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal
disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain
coverage under Medicare. What should you tell him? - answer > He may sign-up
for Medicare at any time however coverage usually begins on the fourth month
after dialysis treatments start.
, Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her? - answer > Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because the features of Part D might have
changed. Mrs. Geisler can't remember what Part D is so she called you to ask what
her neighbor was talking about. What could you tell her? - answer > Part D covers
prescription drugs and she should look at her premiums, formulary, and cost-
sharing among other factors to see if they have changed.
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.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes
the health coverage provided to Medicare beneficiaries? - answer > Beneficiaries
under Original Medicare have no cost-sharing for most preventive services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? - answer > Mr. Singh can enroll in a
stand-alone prescription drug plan and continue to be covered for Part A and Part B
services through Original Fee-for-Service Medicare.
Mrs. Chen 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
Correct
Hank's Fish Store, Inc. is a small company with just 15 employees located in
Florida. Hank, the store owner, has provided excellent health benefits to the store's
workforce. William, one of the store's long-time employees, will soon be reaching
age 65 and eligible for Medicare. William is in good health. He intends to remain
an active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to
offer William? - answer > Hank's can continue to offer William the same employee
health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a
Medicare Advantage plan that is offered to the public.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through massage therapy. She is concerned about whether or not
Medicare will cover these items and services. What should you tell her? - answer >
Medicare does not cover massage therapy, or, in general, glasses or dentures.
Your colleague works at a third-party marketing organization (TMO) and she said
she did not need to take the Medicare training for brokers and agents or pass a test
to market Medicare plans since her contract is with the TMO, not the plans that
have the products she sells. What could you say to her? - answer > You could tell
her she is wrong, and that only agents selling employer/union group plans are
permitted an exemption from testing, but some employer/union group plans may
require testing to promote agent compliance with CMS marketing requirements.
You are meeting with Mrs. Hall in her home. On her scope of appointment form,
she asked to discuss Medicare Advantage plans. During the meeting, she asked to
discuss a stand-alone prescription drug plan. She is leaving the next day to visit her
family for a week in another state, so she needs to decide before she leaves. What
must happen before that additional discussion can take place? - answer > Since
Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may
do so, as long as she signs a new scope of appointment form first, indicating that
she wants to discuss the Part D plan.
,You plan to participate in an educational event sponsored by a large regional health
care system. One of your colleagues suggests that you do a presentation on one of
the Medicare Health plans you market and modify it to include information about
preventive screening tests showcased at the event. How should you respond to your
colleague's suggestion? - answer > You should tell your colleague no, because
marketing representatives are not permitted to participate, in any way, in an
educational event.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park that might be of assistance? - answer > She should contact her state
Medicaid agency to see if she qualifies for one of several programs that can help
with Medicare costs for which she is responsible.
Mr. Alonso receives some help paying for his two generic prescription drugs from
his employer's retiree coverage, but he wants to compare it to a Part D prescription
drug plan. He asks you what costs he would generally expect to encounter when
enrolling into a standard Medicare Part D prescription drug plan. What should you
tell him? - answer > He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,
but it provides no drug coverage. She would like to keep the coverage she has but
replace her existing Medigap plan with one that provides drug coverage. What
should you tell her? - answer > Mrs. Gonzalez cannot purchase a Medigap plan
that covers drugs, but she could keep her Medigap policy and enroll in a Part D
prescription drug plan.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal
disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain
coverage under Medicare. What should you tell him? - answer > He may sign-up
for Medicare at any time however coverage usually begins on the fourth month
after dialysis treatments start.
, Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her? - answer > Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because the features of Part D might have
changed. Mrs. Geisler can't remember what Part D is so she called you to ask what
her neighbor was talking about. What could you tell her? - answer > Part D covers
prescription drugs and she should look at her premiums, formulary, and cost-
sharing among other factors to see if they have changed.
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.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes
the health coverage provided to Medicare beneficiaries? - answer > Beneficiaries
under Original Medicare have no cost-sharing for most preventive services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? - answer > Mr. Singh can enroll in a
stand-alone prescription drug plan and continue to be covered for Part A and Part B
services through Original Fee-for-Service Medicare.
Mrs. Chen 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
