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Exam (elaborations)

AHIP Module 1, 2, 3, 4, 5 (ACTUAL TEST ) Questions and Answers (Solved)

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The 2024 AHIP (Annual Health Insurance Provider) Modules 1 through 5 test is a comprehensive evaluation designed to ensure that health insurance providers possess a thorough understanding of the rules and regulations governing Medicare. This mandatory test is essential for agents and brokers who wish to market Medicare Advantage and Part D plans. Module 1 provides an overview of Medicare program basics, including eligibility, enrollment, entitlement, and premiums. It delves into the details of Medicare Parts A, B, C, and D, as well as Medigap coverage and the appeals process. This module ensures that providers are well-versed in the foundational aspects of Medicare. Module 2 focuses on Medicare health plans, specifically Medicare Advantage Plans. It covers various plan types such as Coordinated Care Plans, Special Needs Plans (SNP), Private Fee-for-Service Plans, and Medicare Savings Account Plans. Additionally, it addresses eligibility requirements, benefits, and protections for enrollees, ensuring that providers can guide beneficiaries through their plan options. Module 3 is dedicated to Medicare Part D prescription drug coverage. This module examines the complexities of Part D, including plan options, formularies, the Low-Income Subsidy (LIS), and State Pharmaceutical Assistance Programs (SPAPs). Providers must understand these elements to effectively assist beneficiaries in managing their prescription drug needs. Module 4 outlines the communications and marketing rules for Medicare Advantage and Part D plans. This module sets forth the regulations for marketing these plans, including communication guidelines, marketing materials, and obtaining and maintaining marketing permissions. It ensures that providers adhere to ethical and legal standards when promoting Medicare plans. Module 5 offers enrollment guidance for Medicare Advantage and Part D plans. This final module covers the enrollment process, including Special Enrollment Periods (SEPs), retroactive coverage, and the responsibilities of agents and brokers during enrollment. It equips providers with the knowledge to facilitate smooth and accurate enrollments for beneficiaries. The test consists of multiple-choice questions that assess the provider's understanding of these critical topics. A passing score is required to achieve certification and legally market Medicare plans, thereby ensuring that providers are fully equipped to support and guide Medicare beneficiaries.

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AHIP medicare
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Uploaded on
January 6, 2025
Number of pages
146
Written in
2024/2025
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2024 AHIP
Module 1, 2, 3,
4, 5 (ACTUAL
TEST )
Questions and
Answers
(Solved)

,2|Page

2024 AHIP Module 1, 2, 3, 4, 5 (ACTUAL TEST ) Questions and Answers (Solved)



1. Mr., Moy’s, wife ,has ,a ,Medicare ,Advantage ,plan, ,but ,he ,wants ,to
,understand ,what coverage ,Medicare ,Supplemental ,Insurance ,provides ,since
,his ,health ,care ,needs ,are,different ,from ,his ,wife's ,needs. ,What ,could ,you
,tell ,Mr. ,Moy?correct ,answersMedicare Supplemental ,Insurance ,would ,help
,cover ,his ,Part ,A ,and ,Part ,B ,deductibles ,or coinsurance ,in ,Original ,Fee-for-
Service ,(FFS) ,Medicare ,as ,well ,as ,possibly ,some services ,that ,Medicare

,does ,not ,cover.


2. 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
,answersShe ,may ,enroll ,at ,any ,time ,while she ,is ,covered ,under ,her
,employer ,plan, ,but ,she ,will ,have ,a ,special ,eight-month enrollment ,period
,after ,the ,last ,month ,on ,her ,employer ,plan ,that ,differs ,from ,the standard
,general ,enrollment ,period, ,during ,which ,she ,may ,enroll ,in ,Medicare ,Part
,B.


3. 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
,answersMost ,individuals ,who ,are ,citizens ,and ,age ,65 ,or ,over ,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.

,3|Page


4. 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?correct ,answersMrs.
,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.


5. 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?correct ,answersMedicare does ,not ,cover ,massage ,therapy, ,or,
,in ,general, ,glasses ,or ,dentures.


6. Mr., Patel ,is ,in ,good ,health ,and ,is ,preparing ,a ,budget ,in ,anticipation ,of
,his
,retirement when ,he ,turns ,66. ,He ,wants ,to ,understand ,the ,health ,care ,costs
,he ,might ,be ,exposed ,to,under ,Medicare ,if ,he ,were ,to ,require ,hospitalization
,as ,a ,result ,of ,an ,illness. ,In ,general terms, ,what ,could ,you ,tell ,him ,about
,his ,costs ,for ,inpatient ,hospital ,services
under ,Original ,Medicare?correct ,answersUnder ,Original ,Medicare, ,there ,is ,a
,single deductible ,amount ,due ,for ,the ,first ,60 ,days ,of ,any ,inpatient ,hospital
,stay, ,after ,which ,it converts ,into ,a ,per-day ,coinsurance ,amount ,through ,day
,90. ,After ,day ,90, ,he ,would ,pay,a ,daily ,amount ,up ,to ,60 ,days ,over ,his
,lifetime, ,after ,which ,he ,would ,be ,responsible ,for all ,costs.


7. 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

, 4|Page


,answersTo ,obtain ,Part ,B ,coverage, she ,must ,pay ,a ,standard ,monthly
,premium, ,though ,it ,is ,higher ,for ,individuals ,with ,higher,incomes.

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