AHIP Module 5 2025 (2025) ACTUAL EXAM
COMPREHENSIVE QUESTIONS AND VERIFIED
ACCURATE SOLUTION (DETAILED & ELABORATED)
|GET IT 100% ACCURATE!! 2025 TEST!!
Ms. Claggett is sixty-six (66) years old. She has been covered under both Parts A
and B of Original Medicare for the last six years due to her disability, has never
been enrolled in a Medicare Advantage or a Part D plan before. She wants to
enroll in a Part D plan. She knows that there is such a thing as the "Part D Initial
Enrollment Period" and has concluded that, since she has never enrolled in such a
plan before, she should be eligible to enroll under this period. What should you
tell her about how the Part D Initial Enrollment Period applies to her situation?
<<<answer>>>c. It occurs three months before and three months after the
month when a beneficiary meets the eligibility requirements for Part B, so she will
not be able to use it as a justification for enrolling in a Part D plan now. Correct
When Myra first became eligible for Medicare, she enrolled in Original Medicare
(Parts A and B). She is now 67 and will turn 68 on July 1. She would now like to
enroll in a Medicare Advantage (MA) plan and approaches you about her options.
What advice would you give her? <<<answer>>>d. She should remain in
Original Medicare until the annual election period running from October 15 to
December 7, during which she can select an MA plan. Correct
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his
,eligibility? <<<answer>>>You would need to ask Mr. Kelly if he is enrolled in Part
A and Part B and if he lives in the PFFS plan's service area.
Mrs. Kumar would like her daughter, who lives in another state, to meet with you
during the Annual Election Period to help her complete her enrollment in a Part D
plan. She asked you when she should have her daughter plan to visit. What could
you tell her? <<<answer>>>Her daughter should come in November.
Ms. Claggett is sixty-six (66) years old. She has been covered under Original
Medicare for the last six years due to her disability and has never been enrolled in
a Medicare Advantage or a Part D plan before. She wants to enroll in a Part D plan.
She knows that there is such a thing as the "Part D Initial Enrollment Period" and
has concluded that, since she has never enrolled in such a plan before, she should
be eligible to enroll under this period. What should you tell her about how the
Part D Initial Enrollment Period applies to her situation? <<<answer>>>It occurs
three months before and three months after the month when a beneficiary meets
the eligibility requirements for Part B, so she will not be able to use it as a
justification for enrolling in a Part D plan now.
Willard works as a representative focused on the senior marketplace. What would
be considered prohibited activity by Willard? <<<answer>>>Implying that only
seniors can enroll in a Medicare Advantage plan when meeting with Mr.
Hernandez, who is 58 but qualifies for Medicare because she is disabled.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer
plan does not cover prescription drugs, she wants to enroll in a Medicare
prescription drug plan. Will she be able to? <<<answer>>>Yes. Mrs. Walters
, must be entitled to Part A or enrolled in Part B to be eligible for coverage under
the Medicare prescription drug program.
Mr. Barker had surgery recently and expected that he would have certain services
and items covered by the plan with minimal out-of-pocket costs because his MA-
PD coverage has been very good. However, when he received the bill, he was
surprised to see large charges in excess of his maximum out-of-pocket limit that
included a number of services and items he thought would be fully covered. He
called you to ask what he could do? What could you tell him? <<<answer>>>You
can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mr. Wilcox has been enrolled in Lexington PFFS Medicare Advantage Health Plan
(Lexington) for several years. Recently, Mr. Wilcox decided to spend time with his
children who live in another state that is not in Lexington's service area. In the
future, he may relocate near his children permanently. How does this move to
another service area impact his PFFS MA coverage? <<<answer>>>Lexington
can allow for Mr. Wilcox's continued enrollment for up to 12 months whether or
not he is in a visitor/traveler (V/T) program.
Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP), but he lost
the paper that explains what he could do during the SEP. What can you tell him?
<<<answer>>>If the SEP is for MA coverage, he will generally have one
opportunity to change his MA coverage.
Mr. Anderson is a very organized individual and has filled out and brought to you
an enrollment form on October 10 for a new plan available January 1 next year. He
is currently enrolled in Original Medicare. What should you do?
COMPREHENSIVE QUESTIONS AND VERIFIED
ACCURATE SOLUTION (DETAILED & ELABORATED)
|GET IT 100% ACCURATE!! 2025 TEST!!
Ms. Claggett is sixty-six (66) years old. She has been covered under both Parts A
and B of Original Medicare for the last six years due to her disability, has never
been enrolled in a Medicare Advantage or a Part D plan before. She wants to
enroll in a Part D plan. She knows that there is such a thing as the "Part D Initial
Enrollment Period" and has concluded that, since she has never enrolled in such a
plan before, she should be eligible to enroll under this period. What should you
tell her about how the Part D Initial Enrollment Period applies to her situation?
<<<answer>>>c. It occurs three months before and three months after the
month when a beneficiary meets the eligibility requirements for Part B, so she will
not be able to use it as a justification for enrolling in a Part D plan now. Correct
When Myra first became eligible for Medicare, she enrolled in Original Medicare
(Parts A and B). She is now 67 and will turn 68 on July 1. She would now like to
enroll in a Medicare Advantage (MA) plan and approaches you about her options.
What advice would you give her? <<<answer>>>d. She should remain in
Original Medicare until the annual election period running from October 15 to
December 7, during which she can select an MA plan. Correct
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his
,eligibility? <<<answer>>>You would need to ask Mr. Kelly if he is enrolled in Part
A and Part B and if he lives in the PFFS plan's service area.
Mrs. Kumar would like her daughter, who lives in another state, to meet with you
during the Annual Election Period to help her complete her enrollment in a Part D
plan. She asked you when she should have her daughter plan to visit. What could
you tell her? <<<answer>>>Her daughter should come in November.
Ms. Claggett is sixty-six (66) years old. She has been covered under Original
Medicare for the last six years due to her disability and has never been enrolled in
a Medicare Advantage or a Part D plan before. She wants to enroll in a Part D plan.
She knows that there is such a thing as the "Part D Initial Enrollment Period" and
has concluded that, since she has never enrolled in such a plan before, she should
be eligible to enroll under this period. What should you tell her about how the
Part D Initial Enrollment Period applies to her situation? <<<answer>>>It occurs
three months before and three months after the month when a beneficiary meets
the eligibility requirements for Part B, so she will not be able to use it as a
justification for enrolling in a Part D plan now.
Willard works as a representative focused on the senior marketplace. What would
be considered prohibited activity by Willard? <<<answer>>>Implying that only
seniors can enroll in a Medicare Advantage plan when meeting with Mr.
Hernandez, who is 58 but qualifies for Medicare because she is disabled.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer
plan does not cover prescription drugs, she wants to enroll in a Medicare
prescription drug plan. Will she be able to? <<<answer>>>Yes. Mrs. Walters
, must be entitled to Part A or enrolled in Part B to be eligible for coverage under
the Medicare prescription drug program.
Mr. Barker had surgery recently and expected that he would have certain services
and items covered by the plan with minimal out-of-pocket costs because his MA-
PD coverage has been very good. However, when he received the bill, he was
surprised to see large charges in excess of his maximum out-of-pocket limit that
included a number of services and items he thought would be fully covered. He
called you to ask what he could do? What could you tell him? <<<answer>>>You
can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mr. Wilcox has been enrolled in Lexington PFFS Medicare Advantage Health Plan
(Lexington) for several years. Recently, Mr. Wilcox decided to spend time with his
children who live in another state that is not in Lexington's service area. In the
future, he may relocate near his children permanently. How does this move to
another service area impact his PFFS MA coverage? <<<answer>>>Lexington
can allow for Mr. Wilcox's continued enrollment for up to 12 months whether or
not he is in a visitor/traveler (V/T) program.
Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP), but he lost
the paper that explains what he could do during the SEP. What can you tell him?
<<<answer>>>If the SEP is for MA coverage, he will generally have one
opportunity to change his MA coverage.
Mr. Anderson is a very organized individual and has filled out and brought to you
an enrollment form on October 10 for a new plan available January 1 next year. He
is currently enrolled in Original Medicare. What should you do?
