AHIP Module 1 Quiz 4 Questions And Answers
BEST GUIDE 2025/2026
Which of the following steps may a Part D sponsor adopt for beneficiaries who
are at risk of misusing or abusing frequently abused drugs? - answer-I. Identifying
at risk individuals by using criteria that includes the number of opioid
prescriptions the beneficiary has and the number of prescribers who have written
those prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through acupuncture. She is concerned about whether or not
Medicare will cover these items and services. What should you tell her? - answer-
Medicare does not cover acupuncture, or, in general, glasses or dentures.
Which statement best describes PACE plans? - answer-It includes comprehensive
medical and social service delivery systems using an interdisciplinary team
approach in an adult day health center, supplemented by in-home and referral
services.
Mr. Shultz was still working when he first qualified for Medicare. At that time, he
had employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with his drug
coverage. It is now a year later and Mr. Shultz has lost his employer group
,coverage. How would you advise him? - answer-Mr. Schultz should enroll in a Part
D plan before he has a 63-day break in coverage in order to avoid a premium
penalty.
For which of the following individuals would a Cost Plan be most appropriate? -
answer-Ms. Baker who is enrolled in Medicare Part B and is willing to continue
paying Part B premiums plus any plan premiums.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription drug
plan. Under what circumstances can she do this? - answer-If the Medicare
Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug
coverage or a Medical Savings Account, Mrs. Berkowitz can do this.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his
MA-PD plan. He is worried that he will lose his coverage now when he needs it
the most. He is certain his plan will disenroll him because that is what happened
to a friend of his in a similar type of plan. What can you tell Mr. Robinson about
his situation? - answer-II, III, and IV only.
Which of the following individuals are likely to qualify for a special enrollment
period (SEP) for both MA and Part D due to a change of residence?
,I. Edward (enrolled in MA and Part D) moves to a new home within the same
neighborhood in his existing plan's service area.
II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her
existing plan's service area.
III. Gilbert moves into a plan service area where there is now a Part D plan
available to him from a service area where no Part D plan was available.
IV. Henry makes a permanent move providing him with new MA and Part D
options. - answer-
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent
health and will have considerable income when she retires. She is concerned that
her income will make it impossible for her to qualify for Medicare. What could
you tell her to address her concern? - answer-Medicare is a program for people
age 65 or older and those under age 65 with certain disabilities, end stage renal
disease or Lou Gehrig's disease, so she will be eligible for Medicare
Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for-Service (FFS) Medicare? What could you tell him? - answer-
Part A, which covers hospital, skilled nursing facility, hospice and home health
services and Part B, which covers professional services such as those provided by
a doctor are covered under Original Medicare.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan,
the health plan may, at some time in the future, reduce his benefits below what is
available in Original Medicare. What should you tell him about his concern? -
answer-Medicare health plans must cover all benefits available under Medicare
Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
weeks. She concerned about having prescription drug coverage. Which of the
, following statements provides the best advice? - answer-Prescription drug
coverage can be obtained by enrolling in a Medicare Advantage plan that includes
Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefit package of a Medicare Health Plan before she starts
looking at specific plans. What could you tell her? - answer-Medicare Health Plans
may offer extra benefits that Original Medicare does not offer such as vision,
hearing, and dental services and must include a maximum out-of-pocket limit on
Part A and Part B services.
Mr. Meoni'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.Meoni? -
answer-Medicare Supplemental Insurance would help cover his Part A and Part B
cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
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? - 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.
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? - answer-After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
BEST GUIDE 2025/2026
Which of the following steps may a Part D sponsor adopt for beneficiaries who
are at risk of misusing or abusing frequently abused drugs? - answer-I. Identifying
at risk individuals by using criteria that includes the number of opioid
prescriptions the beneficiary has and the number of prescribers who have written
those prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through acupuncture. She is concerned about whether or not
Medicare will cover these items and services. What should you tell her? - answer-
Medicare does not cover acupuncture, or, in general, glasses or dentures.
Which statement best describes PACE plans? - answer-It includes comprehensive
medical and social service delivery systems using an interdisciplinary team
approach in an adult day health center, supplemented by in-home and referral
services.
Mr. Shultz was still working when he first qualified for Medicare. At that time, he
had employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with his drug
coverage. It is now a year later and Mr. Shultz has lost his employer group
,coverage. How would you advise him? - answer-Mr. Schultz should enroll in a Part
D plan before he has a 63-day break in coverage in order to avoid a premium
penalty.
For which of the following individuals would a Cost Plan be most appropriate? -
answer-Ms. Baker who is enrolled in Medicare Part B and is willing to continue
paying Part B premiums plus any plan premiums.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription drug
plan. Under what circumstances can she do this? - answer-If the Medicare
Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug
coverage or a Medical Savings Account, Mrs. Berkowitz can do this.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his
MA-PD plan. He is worried that he will lose his coverage now when he needs it
the most. He is certain his plan will disenroll him because that is what happened
to a friend of his in a similar type of plan. What can you tell Mr. Robinson about
his situation? - answer-II, III, and IV only.
Which of the following individuals are likely to qualify for a special enrollment
period (SEP) for both MA and Part D due to a change of residence?
,I. Edward (enrolled in MA and Part D) moves to a new home within the same
neighborhood in his existing plan's service area.
II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her
existing plan's service area.
III. Gilbert moves into a plan service area where there is now a Part D plan
available to him from a service area where no Part D plan was available.
IV. Henry makes a permanent move providing him with new MA and Part D
options. - answer-
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent
health and will have considerable income when she retires. She is concerned that
her income will make it impossible for her to qualify for Medicare. What could
you tell her to address her concern? - answer-Medicare is a program for people
age 65 or older and those under age 65 with certain disabilities, end stage renal
disease or Lou Gehrig's disease, so she will be eligible for Medicare
Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for-Service (FFS) Medicare? What could you tell him? - answer-
Part A, which covers hospital, skilled nursing facility, hospice and home health
services and Part B, which covers professional services such as those provided by
a doctor are covered under Original Medicare.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan,
the health plan may, at some time in the future, reduce his benefits below what is
available in Original Medicare. What should you tell him about his concern? -
answer-Medicare health plans must cover all benefits available under Medicare
Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
weeks. She concerned about having prescription drug coverage. Which of the
, following statements provides the best advice? - answer-Prescription drug
coverage can be obtained by enrolling in a Medicare Advantage plan that includes
Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefit package of a Medicare Health Plan before she starts
looking at specific plans. What could you tell her? - answer-Medicare Health Plans
may offer extra benefits that Original Medicare does not offer such as vision,
hearing, and dental services and must include a maximum out-of-pocket limit on
Part A and Part B services.
Mr. Meoni'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.Meoni? -
answer-Medicare Supplemental Insurance would help cover his Part A and Part B
cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
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? - 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.
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? - answer-After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
