2025 AHIP Module 1–5 Exam || All
Questions & Answers (100% Verified)
Mrs. Margolis contacts you in August because she will become eligible for Medicare for
the first time in November. She would like to meet and discuss plan choices with you.
What advice should you give her? - ANSWER - Tell her to wait until October to discuss
plan choices with you so that you can share plan benefits for the current year as well as
any changes for the following year that may impact her choice.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-
income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? -
ANSWER - He qualifies for a special election period and can enroll in or disenroll from a
Part D plan once during that period.
Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren.
As a result, Mary has been admitted to a rehabilitation hospital where she is expected to
reside for several months. The rehabilitation hospital is located outside the geographic
area served by her current Medicare Advantage (MA) plan. What options are available
to Mary regarding her health plan coverage? - ANSWER - Mary may make an unlimited
number of MA enrollment requests and may disenroll from her current MA plan.
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action
could you help him take during this time? - ANSWER - He will have one opportunity to
enroll in a Medicare Advantage plan.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the
presentation, Mrs. Midler tells you that she has a copy of her medical records available
because she thinks this will help you understand her needs. She suggests that you will
know which questions to ask her about her health status in order to best assist her in
selecting a plan. What should you do? - ANSWER - You can only ask Mrs. Midler
questions about conditions that affect eligibility, specifically, whether she has one of the
conditions that would qualify her for a special needs plan.
Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial
Coverage Election Period (ICEP) has just begun. Which of the following can she not do
during the ICEP? - ANSWER - She can enroll in a Medigap plan to supplement the
benefits of the MA plan that she's also enrolling in.
Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received a
notice that his plan sponsor identified him as a "potential at-risk" beneficiary. This
month, he started receiving assistance from Medicaid. He wants to find a different Part
D plan that's more suitable to his current prescription drug needs. He believes he's
entitled to a SEP since he is now a dual eligible. Is he able to change to a different Part
D plan during a SEP for dual eligible individuals? - ANSWER - No. Once he is identified
, by the plan sponsor as a "potential at-risk" beneficiary, he cannot use the dual eligible
SEP to change plans while this designation is in place.
Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during
the Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her
about the Medicare Advantage (MA) plan he selected. He also told her there was an
open enrollment period that she might be able to use to enroll in a MA plan. Ms.
Gonzales comes to you for advice shortly after speaking to her neighbor. What should
you tell her? - ANSWER - There is a MA Open Enrollment Period (OEP) that takes
place between January 1 and March 31, but Ms. Gonzales cannot use it because
eligibility to use the OEP is available only to MA enrollees.
Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he
must do it, with respect to enrolling in Part D. What could you tell him? - ANSWER - He
is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may
make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or
an MA-PD plan.
Mrs. Parker likes to handle most of her business matters through telephone calls. She
currently is enrolled in Original Medicare Parts A and B but has heard about a Medicare
Advantage plan offered by Senior Health from a neighbor. Mrs. Parker asks you
whether she can enroll in Senior Health's MA plan over the telephone. What can you tell
her?
I. Enrollment requests can only be made in face-to-face interviews or by mail.
II. Telephone enrollment request calls must be recorded.
III. Telephonic enrollments must include all required elements necessary to complete an
enrollment.
IV. The signature element must be completed via certified mail. - ANSWER - II and III
only
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work
and is covered by an employer health plan, he has not enrolled in Part B or Part D. He
receives a notice on June 1 that his employer is cutting back on prescription drug
benefits and that as of July 1 his coverage will no longer be creditable. He has come to
you for advice. What advice would you give Mr. Rockwell about special election periods
(SEPs)? - ANSWER - Mr. Rockwell is eligible for a SEP due to his involuntary loss of
creditable drug coverage; the SEP begins in June and ends on September 1- two
months after the loss of creditable coverage.
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that
has suffered from major flooding that has been declared a major disaster by both the
Federal government and her state. As a result of dealing with the flooding issues and
being evacuated from her home, Edna missed her chance to enroll in MA during her
Questions & Answers (100% Verified)
Mrs. Margolis contacts you in August because she will become eligible for Medicare for
the first time in November. She would like to meet and discuss plan choices with you.
What advice should you give her? - ANSWER - Tell her to wait until October to discuss
plan choices with you so that you can share plan benefits for the current year as well as
any changes for the following year that may impact her choice.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-
income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? -
ANSWER - He qualifies for a special election period and can enroll in or disenroll from a
Part D plan once during that period.
Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren.
As a result, Mary has been admitted to a rehabilitation hospital where she is expected to
reside for several months. The rehabilitation hospital is located outside the geographic
area served by her current Medicare Advantage (MA) plan. What options are available
to Mary regarding her health plan coverage? - ANSWER - Mary may make an unlimited
number of MA enrollment requests and may disenroll from her current MA plan.
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action
could you help him take during this time? - ANSWER - He will have one opportunity to
enroll in a Medicare Advantage plan.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the
presentation, Mrs. Midler tells you that she has a copy of her medical records available
because she thinks this will help you understand her needs. She suggests that you will
know which questions to ask her about her health status in order to best assist her in
selecting a plan. What should you do? - ANSWER - You can only ask Mrs. Midler
questions about conditions that affect eligibility, specifically, whether she has one of the
conditions that would qualify her for a special needs plan.
Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial
Coverage Election Period (ICEP) has just begun. Which of the following can she not do
during the ICEP? - ANSWER - She can enroll in a Medigap plan to supplement the
benefits of the MA plan that she's also enrolling in.
Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received a
notice that his plan sponsor identified him as a "potential at-risk" beneficiary. This
month, he started receiving assistance from Medicaid. He wants to find a different Part
D plan that's more suitable to his current prescription drug needs. He believes he's
entitled to a SEP since he is now a dual eligible. Is he able to change to a different Part
D plan during a SEP for dual eligible individuals? - ANSWER - No. Once he is identified
, by the plan sponsor as a "potential at-risk" beneficiary, he cannot use the dual eligible
SEP to change plans while this designation is in place.
Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during
the Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her
about the Medicare Advantage (MA) plan he selected. He also told her there was an
open enrollment period that she might be able to use to enroll in a MA plan. Ms.
Gonzales comes to you for advice shortly after speaking to her neighbor. What should
you tell her? - ANSWER - There is a MA Open Enrollment Period (OEP) that takes
place between January 1 and March 31, but Ms. Gonzales cannot use it because
eligibility to use the OEP is available only to MA enrollees.
Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he
must do it, with respect to enrolling in Part D. What could you tell him? - ANSWER - He
is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may
make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or
an MA-PD plan.
Mrs. Parker likes to handle most of her business matters through telephone calls. She
currently is enrolled in Original Medicare Parts A and B but has heard about a Medicare
Advantage plan offered by Senior Health from a neighbor. Mrs. Parker asks you
whether she can enroll in Senior Health's MA plan over the telephone. What can you tell
her?
I. Enrollment requests can only be made in face-to-face interviews or by mail.
II. Telephone enrollment request calls must be recorded.
III. Telephonic enrollments must include all required elements necessary to complete an
enrollment.
IV. The signature element must be completed via certified mail. - ANSWER - II and III
only
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work
and is covered by an employer health plan, he has not enrolled in Part B or Part D. He
receives a notice on June 1 that his employer is cutting back on prescription drug
benefits and that as of July 1 his coverage will no longer be creditable. He has come to
you for advice. What advice would you give Mr. Rockwell about special election periods
(SEPs)? - ANSWER - Mr. Rockwell is eligible for a SEP due to his involuntary loss of
creditable drug coverage; the SEP begins in June and ends on September 1- two
months after the loss of creditable coverage.
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that
has suffered from major flooding that has been declared a major disaster by both the
Federal government and her state. As a result of dealing with the flooding issues and
being evacuated from her home, Edna missed her chance to enroll in MA during her
