AHIP ACTUAL EXAM QUESTIONS WITH
CORRECT ANSWERS 2023-2024
Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are
available through this program. What should you tell him about the
types of health plans that are available through the Medicare
Advantage program? - Correct Answer- They are Medicare health plans
such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct
description? - Correct Answer- Medicare Advantage is a way of
covering all of the Original Medicare benefits through private health
insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that
she has heard about a type of Medicare health plan known as Private
Fee-for-Service (PFFS). She wants to know if this would be available to
her. What should you tell her about PFFS plans? - Correct Answer- A
PFFS plan is one of various types of Medicare Advantage plans offered
by private entities and she may enroll in one if it is available in her
area.
(W) Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her? -
Correct Answer- Mrs. Radford must be entitled to Part A and enrolled
in Part B to enroll in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part
B but has recently stopped paying his Part B premium. He would like
to enroll in a Medicare Advantage (MA) plan and is still covered by Part
,A. What should you tell him? - Correct Answer- He is not eligible to
enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part
B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan
several years ago. Her doctor recently confirmed a diagnosis of end-
stage renal disease (ESRD). What options does Mrs. Billings have in
regard to her MA plan during the next open enrollment season? -
Correct Answer- She may remain in her ABC MA plan or enroll in a
Special Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area
Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? - Correct Answer- In most Medicare Advantage HMOs, Mr. Kumar
must obtain his services only from providers who have a contractual
relationship with the plan (except in an emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care.
What should you tell her? - Correct Answer- Mrs. Ramos can obtain
care from any provider who participates in Original Medicare, but
generally will be charged a lower co-payment if she goes to one of the
plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied
with the care he has received under Original Medicare, but he would
like to know more about Medicare Advantage Special Needs Plans
(SNPs). What could you tell him? - Correct Answer- SNPs have special
programs for enrollees with chronic conditions, like Mr. Sinclair, and
they provide prescription drug coverage that could be very helpful as
well
,(W) Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and
Mr. Greco would like to join that plan. What should you tell him? -
Correct Answer- SNPs limit enrollment to certain sub-populations of
beneficiaries. Given his current situation, he is unlikely to qualify and
would not be able to enroll in the SNP.
(W) 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 not qualify for coverage under part A
because she was not born in the United States. What should you tell
her? - Correct Answer- Most individuals who are citizens and over age
65 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.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was
declared disabled by the Social Security Administration and has been
receiving disability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him? - Correct Answer-
After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits
from the Social Security Administration for 12 months. Can you sell
him a Medicare Advantage or Part D Prescription Drug policy? - Correct
Answer- No, he cannot purchase a Medicare Advantage or Part D
policy because he has not received Social Security or Railroad
Retirement disability benefits for 24 months.
, (W) 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? - Correct Answer- In order to obtain Part B coverage, she must
pay a standard monthly premium, though it is higher for individuals
with higher incomes
(W) Mr. Diaz continued working with his company and was insured
under his employer's group plan until he reached age 68. He has heard
that there is a premium penalty for those who did not sign up for Part
B when first eligible and wants to know how much he will have to pay.
What should you tell him? - Correct Answer- Mr. Diaz will not pay any
penalty because he had continuous coverage under his employer's
plan.
(W) Mrs. Peňa is 66 years old, has coverage under an employer plan
and will retire next year. She heard she must enroll in Part B at the
beginning of the year to ensure no gap in coverage. What can you tell
her? - Correct Answer- She may enroll at any time while she is covered
under her employer plan, but she will have a special eight-month
enrollment period that differs from the standard general enrollment
period, during which she may enroll in Medicare Part B
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She
is considering enrollment in a Medicare health plan. What should you
advise her to do before she will be able to enroll into a Medicare
health plan? - Correct Answer- In order to join a Medicare health plan,
she also must enroll in Part B
Mrs. Park has a low, fixed income. What could you tell her that might
be of assistance? - Correct 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
CORRECT ANSWERS 2023-2024
Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are
available through this program. What should you tell him about the
types of health plans that are available through the Medicare
Advantage program? - Correct Answer- They are Medicare health plans
such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct
description? - Correct Answer- Medicare Advantage is a way of
covering all of the Original Medicare benefits through private health
insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that
she has heard about a type of Medicare health plan known as Private
Fee-for-Service (PFFS). She wants to know if this would be available to
her. What should you tell her about PFFS plans? - Correct Answer- A
PFFS plan is one of various types of Medicare Advantage plans offered
by private entities and she may enroll in one if it is available in her
area.
(W) Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her? -
Correct Answer- Mrs. Radford must be entitled to Part A and enrolled
in Part B to enroll in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part
B but has recently stopped paying his Part B premium. He would like
to enroll in a Medicare Advantage (MA) plan and is still covered by Part
,A. What should you tell him? - Correct Answer- He is not eligible to
enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part
B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan
several years ago. Her doctor recently confirmed a diagnosis of end-
stage renal disease (ESRD). What options does Mrs. Billings have in
regard to her MA plan during the next open enrollment season? -
Correct Answer- She may remain in her ABC MA plan or enroll in a
Special Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area
Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? - Correct Answer- In most Medicare Advantage HMOs, Mr. Kumar
must obtain his services only from providers who have a contractual
relationship with the plan (except in an emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care.
What should you tell her? - Correct Answer- Mrs. Ramos can obtain
care from any provider who participates in Original Medicare, but
generally will be charged a lower co-payment if she goes to one of the
plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied
with the care he has received under Original Medicare, but he would
like to know more about Medicare Advantage Special Needs Plans
(SNPs). What could you tell him? - Correct Answer- SNPs have special
programs for enrollees with chronic conditions, like Mr. Sinclair, and
they provide prescription drug coverage that could be very helpful as
well
,(W) Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and
Mr. Greco would like to join that plan. What should you tell him? -
Correct Answer- SNPs limit enrollment to certain sub-populations of
beneficiaries. Given his current situation, he is unlikely to qualify and
would not be able to enroll in the SNP.
(W) 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 not qualify for coverage under part A
because she was not born in the United States. What should you tell
her? - Correct Answer- Most individuals who are citizens and over age
65 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.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was
declared disabled by the Social Security Administration and has been
receiving disability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him? - Correct Answer-
After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits
from the Social Security Administration for 12 months. Can you sell
him a Medicare Advantage or Part D Prescription Drug policy? - Correct
Answer- No, he cannot purchase a Medicare Advantage or Part D
policy because he has not received Social Security or Railroad
Retirement disability benefits for 24 months.
, (W) 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? - Correct Answer- In order to obtain Part B coverage, she must
pay a standard monthly premium, though it is higher for individuals
with higher incomes
(W) Mr. Diaz continued working with his company and was insured
under his employer's group plan until he reached age 68. He has heard
that there is a premium penalty for those who did not sign up for Part
B when first eligible and wants to know how much he will have to pay.
What should you tell him? - Correct Answer- Mr. Diaz will not pay any
penalty because he had continuous coverage under his employer's
plan.
(W) Mrs. Peňa is 66 years old, has coverage under an employer plan
and will retire next year. She heard she must enroll in Part B at the
beginning of the year to ensure no gap in coverage. What can you tell
her? - Correct Answer- She may enroll at any time while she is covered
under her employer plan, but she will have a special eight-month
enrollment period that differs from the standard general enrollment
period, during which she may enroll in Medicare Part B
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She
is considering enrollment in a Medicare health plan. What should you
advise her to do before she will be able to enroll into a Medicare
health plan? - Correct Answer- In order to join a Medicare health plan,
she also must enroll in Part B
Mrs. Park has a low, fixed income. What could you tell her that might
be of assistance? - Correct 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
