AHIP 2024 Final Exam Test Questions and Answers Updated (Verified Answers)
A client wants to give you an enrollment application on October 1 before the beginning of the Annual
Election Period because he is leaving on vacation for two weeks and does not want to forget about
turning it in. What should you tell him? - ansYou must tell him you are not permitted to take the form. If he
sends the form directly to the plan, the plan will process the enrollment on the day the Annual Election
Period begins.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to market
non-health related products such as life insurance and annuities. Which statement best describes ABC's
obligation to its enrollees regarding marketing such products? - ansb.
It must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan sponsor
may use their information for marketing purposes.
Agent Daniel Webber has properly set up a sales appointment to meet with client Edward Young at Agent
Webber's office. At the agreed upon appointment time, Mr. Young arrives with his elderly neighbor - Clara
Burton, who wants to learn about her Medicare Advantage options. What should Agent Daniel Webber
do? - ans
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare
Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for
several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller
to proceed? - ansTell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as
to whether this is possible. What should you tell her? - ansMarketing representatives may initiate
electronic contact through e-mail but an opt-out process must be provided.
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 Initial Coverage Election Period. Felix lives in an area with a Medicare
Advantage plan with a 4-star rating that he would like to join. George dropped his Medigap policy six
months ago when he first enrolled in a Medicare Advantage plan. He now wants to return to Original
Medicare. Harriet has recently developed diabetes and would like to enroll in a Medicare Advantage plan
that focuses on care for those with that disease. Which, if any, of these individuals would qualify for a
special election period (SEP)? - ansEdna would qualify for a SEP because government officials have
declared a major disaster for her area and she did not enroll in MA during her ICEP due to the
emergency. George would qualify for an SEP because he enrolled in Medicare Advantage (MA) plan for
the first time and would now like to return to Original Medicare within the first 12 months of his enrollment.
Harriet would also qualify for a SEP to enroll in a C-SNP because she has developed a chronic condition.
Felix would not qualify for a SEP since he seeks to enroll in a 4-star not a 5-star MA plan.
Hector Hernandez is an independent agent. Hector sells plans on behalf of three Medicare Advantage
organizations that offer a total of 10 plans but does not represent all Medicare Advantage organizations
offering plans that are available in his area. Which of the following statements best describes any steps
Hector is required to take? - ansDuring the first minute of a sales call, Hector must send an email to the
prospect stating that "I represent 3 plans but not every plan available in your area. Please contact
Medicare.gov to get information on all your options.
If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type
of Medicare health plan could the individual also enroll in, without being automatically disenrolled from the
stand-alone prescription drug plan? - ansThe beneficiary could enroll in a private fee-for-service (PFFS)
plan that does not include prescription drug coverage; a cost plan; or a Medicare Medical Savings
Account (MSA) plan.
,AHIP 2024 Final Exam Test Questions and Answers Updated (Verified Answers)
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago
but is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and
contributed to the Medicare system. Juan suffers from diabetes. He will soon retire and asks you if he can
enroll in a Medicare Advantage plan that you represent. How would you respond? - ansJuan is eligible to
enroll in a Medicare Advantage as long as he is entitled to Part A and enrolled in Part B. Juan should go
to the Social Security website to enroll in Medicare Part A and B if he has not done so already. Once he is
enrolled, he can choose a Medicare Advantage plan.
Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed
into the Medicare system. He also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked part-time for the last three years, will
soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you
tell her? - ansYou should tell Madeline that she will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband's long work record and participation in the Medicare system. You
should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less
than the highest rate due her substantial income.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently learned
that she is suffering from inoperable cancer and has just a few months to live. She would like to spend
these final months in hospice care. Mildred's family asks you whether hospice benefits will be paid for
under the Allcare Medicare Advantage plan. What should you say? - ansMildred may remain enrolled in
Allcare and make a hospice election. Hospice benefits will be paid for by Original Medicare under Part A
and Allcare will continue to pay for any non-hospice services.
Mr. Albert has heard about something called the Star Rating system for Medicare Advantage plans. He
asks you to explain it to him since he is interested in enrolling in a plan that is newly available in his area.
After you explain that it is the way for consumers to judge plan performance, what else would you say? -
ansNew plans and Part D sponsors that do not have any Star Rating are not required to provide Star
Rating information until the next contract year.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery 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 some services and items he thought would be
fully covered. He called you to ask what he could do? What could you tell him? - ansYou can offer to
review the plans appeal process to help him ask the plan to review the coverage decision.
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 - ansAfter receiving such disability payments for 24
months, he will be automatically enrolled in Medicare, regardless of age.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage
(MA) plan and is still covered by Part A. What should you tell him? - ansHe is not eligible to enroll in a
Medicare Advantage plan until he re-enrolls in Medicare Part B.
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? - ansThe
penalty will be a permanent 10% increase in his Part B premium for every 12-month period that passed
during which he could have enrolled and did not.
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help
him take during this time? - ansHe will have one opportunity to enroll in a Medicare Advantage plan
,AHIP 2024 Final Exam Test Questions and Answers Updated (Verified Answers)
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to
do. What should you tell him? - ansHe may receive health care services from any doctor allowed to bill
Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept
the PFFS plan's payment terms and conditions, which could include balance billing.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the
Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to
purchase extra coverage that he will not need. What should you tell him? - ansHe will need to enroll in a
Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium
penalty. To reduce his expenses, he should look for a plan with a zero premium.
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? - ansYou 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.
Mr. Lee was intending to enroll in MaxCare's Medicare Advantage plan this year. However, due to his
current medical condition, his daughter Debbie has been appointed as his legal representative over both
health and financial matters. Debbie would like to ensure that her father is still able to enroll in MaxCare's
plan, but she is unsure what her role is to help with his enrollment request. What advice can you give her?
- ansDebbie can submit an telephonic enrollment request on Mr. Lee's behalf as long as she attests that
she has the legal authority to do so
Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement
surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr.
Roberts is about to be discharged. What advice would you give him regarding his health coverage
options? - ansHis open enrollment period as an institutionalized individual will continue for two months
after the month he moves out of the facility.
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)? - ansMr. Rockwell is eligible for a SEP due to his involuntary loss of creditable
drug coverage; the SEP begins in June and ends September 1 - two months after the loss of creditable
coverage.
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? - ansPart 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. Schultz 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. Schultz has lost his employer group
coverage within the last two weeks. How would you advise him? - ansMr. Schultz should enroll in a Part D
plan before he has a 63-day break in coverage in order to avoid a premium penalty.
Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help
paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know
whether he might qualify. What should you tell him? - ansThe extra help is available to beneficiaries
whose income and assets do not exceed annual limits specified by the government.
, AHIP 2024 Final Exam Test Questions and Answers Updated (Verified Answers)
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? - ansMedicare Advantage is a way of covering all the Original
Medicare benefits through private health insurance companies.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in
a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug
coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? - ansMrs. Chi may
enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.
Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill
out the paperwork. What could you tell her? - ansThe Part D low income subsidy could substantially lower
her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security
Administration.
Mrs. Imelda Diaz is a Medicare beneficiary enrolled in a MA-PD plan you represent. Her neighbor recently
suffered from a painful case of shingles. Mrs. Diaz hopes to avoid such an illness through vaccination.
She asks you whether the cost of shingles vaccination will be covered under the plan you represent. What
should you say? - ansYes, there is no cost sharing for the shingles vaccine even in the deductible phase
of her prescription drug plan because it is an adult vaccine recommended by the Advisory Committee on
Immunization Practices (AICP).
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? - ansHer daughter should come in November.
Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan.
She agreed to sign a scope of appointment form and meet with you on October 15. During the
appointment, what are you permitted to do? - ansYou may provide her with the required enrollment
materials and take her completed enrollment application.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance? - ansShe should contact her state Medicaid agency to see if she qualifies forprograms
that can help with Medicare costs for which she is responsible.
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? -
ansShe 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.
Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses no
medications and sees no reason to spend money on a Medicare prescription drug plan if she does not
need the coverage. She currently does not have creditable coverage. What could you tell her about the
implications of such a decision? - ansIf she does not sign up for a Medicare prescription drug plan as
soon as she is eligible to do so, if she does sign up at a later date, her premium will be permanently
increased by 1% of the national average premium for every month that she was not covered.
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? - ansMrs. Ramos can obtain care from any provider
who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a
provider who/that is not a part of the PPO network.
A client wants to give you an enrollment application on October 1 before the beginning of the Annual
Election Period because he is leaving on vacation for two weeks and does not want to forget about
turning it in. What should you tell him? - ansYou must tell him you are not permitted to take the form. If he
sends the form directly to the plan, the plan will process the enrollment on the day the Annual Election
Period begins.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to market
non-health related products such as life insurance and annuities. Which statement best describes ABC's
obligation to its enrollees regarding marketing such products? - ansb.
It must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan sponsor
may use their information for marketing purposes.
Agent Daniel Webber has properly set up a sales appointment to meet with client Edward Young at Agent
Webber's office. At the agreed upon appointment time, Mr. Young arrives with his elderly neighbor - Clara
Burton, who wants to learn about her Medicare Advantage options. What should Agent Daniel Webber
do? - ans
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare
Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for
several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller
to proceed? - ansTell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for advice as
to whether this is possible. What should you tell her? - ansMarketing representatives may initiate
electronic contact through e-mail but an opt-out process must be provided.
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 Initial Coverage Election Period. Felix lives in an area with a Medicare
Advantage plan with a 4-star rating that he would like to join. George dropped his Medigap policy six
months ago when he first enrolled in a Medicare Advantage plan. He now wants to return to Original
Medicare. Harriet has recently developed diabetes and would like to enroll in a Medicare Advantage plan
that focuses on care for those with that disease. Which, if any, of these individuals would qualify for a
special election period (SEP)? - ansEdna would qualify for a SEP because government officials have
declared a major disaster for her area and she did not enroll in MA during her ICEP due to the
emergency. George would qualify for an SEP because he enrolled in Medicare Advantage (MA) plan for
the first time and would now like to return to Original Medicare within the first 12 months of his enrollment.
Harriet would also qualify for a SEP to enroll in a C-SNP because she has developed a chronic condition.
Felix would not qualify for a SEP since he seeks to enroll in a 4-star not a 5-star MA plan.
Hector Hernandez is an independent agent. Hector sells plans on behalf of three Medicare Advantage
organizations that offer a total of 10 plans but does not represent all Medicare Advantage organizations
offering plans that are available in his area. Which of the following statements best describes any steps
Hector is required to take? - ansDuring the first minute of a sales call, Hector must send an email to the
prospect stating that "I represent 3 plans but not every plan available in your area. Please contact
Medicare.gov to get information on all your options.
If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type
of Medicare health plan could the individual also enroll in, without being automatically disenrolled from the
stand-alone prescription drug plan? - ansThe beneficiary could enroll in a private fee-for-service (PFFS)
plan that does not include prescription drug coverage; a cost plan; or a Medicare Medical Savings
Account (MSA) plan.
,AHIP 2024 Final Exam Test Questions and Answers Updated (Verified Answers)
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago
but is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and
contributed to the Medicare system. Juan suffers from diabetes. He will soon retire and asks you if he can
enroll in a Medicare Advantage plan that you represent. How would you respond? - ansJuan is eligible to
enroll in a Medicare Advantage as long as he is entitled to Part A and enrolled in Part B. Juan should go
to the Social Security website to enroll in Medicare Part A and B if he has not done so already. Once he is
enrolled, he can choose a Medicare Advantage plan.
Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed
into the Medicare system. He also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked part-time for the last three years, will
soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you
tell her? - ansYou should tell Madeline that she will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband's long work record and participation in the Medicare system. You
should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less
than the highest rate due her substantial income.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently learned
that she is suffering from inoperable cancer and has just a few months to live. She would like to spend
these final months in hospice care. Mildred's family asks you whether hospice benefits will be paid for
under the Allcare Medicare Advantage plan. What should you say? - ansMildred may remain enrolled in
Allcare and make a hospice election. Hospice benefits will be paid for by Original Medicare under Part A
and Allcare will continue to pay for any non-hospice services.
Mr. Albert has heard about something called the Star Rating system for Medicare Advantage plans. He
asks you to explain it to him since he is interested in enrolling in a plan that is newly available in his area.
After you explain that it is the way for consumers to judge plan performance, what else would you say? -
ansNew plans and Part D sponsors that do not have any Star Rating are not required to provide Star
Rating information until the next contract year.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery 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 some services and items he thought would be
fully covered. He called you to ask what he could do? What could you tell him? - ansYou can offer to
review the plans appeal process to help him ask the plan to review the coverage decision.
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 - ansAfter receiving such disability payments for 24
months, he will be automatically enrolled in Medicare, regardless of age.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage
(MA) plan and is still covered by Part A. What should you tell him? - ansHe is not eligible to enroll in a
Medicare Advantage plan until he re-enrolls in Medicare Part B.
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? - ansThe
penalty will be a permanent 10% increase in his Part B premium for every 12-month period that passed
during which he could have enrolled and did not.
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help
him take during this time? - ansHe will have one opportunity to enroll in a Medicare Advantage plan
,AHIP 2024 Final Exam Test Questions and Answers Updated (Verified Answers)
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to
do. What should you tell him? - ansHe may receive health care services from any doctor allowed to bill
Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept
the PFFS plan's payment terms and conditions, which could include balance billing.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the
Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to
purchase extra coverage that he will not need. What should you tell him? - ansHe will need to enroll in a
Medicare prescription drug plan upon becoming eligible for the program in order to avoid a premium
penalty. To reduce his expenses, he should look for a plan with a zero premium.
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? - ansYou 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.
Mr. Lee was intending to enroll in MaxCare's Medicare Advantage plan this year. However, due to his
current medical condition, his daughter Debbie has been appointed as his legal representative over both
health and financial matters. Debbie would like to ensure that her father is still able to enroll in MaxCare's
plan, but she is unsure what her role is to help with his enrollment request. What advice can you give her?
- ansDebbie can submit an telephonic enrollment request on Mr. Lee's behalf as long as she attests that
she has the legal authority to do so
Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement
surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr.
Roberts is about to be discharged. What advice would you give him regarding his health coverage
options? - ansHis open enrollment period as an institutionalized individual will continue for two months
after the month he moves out of the facility.
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)? - ansMr. Rockwell is eligible for a SEP due to his involuntary loss of creditable
drug coverage; the SEP begins in June and ends September 1 - two months after the loss of creditable
coverage.
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? - ansPart 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. Schultz 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. Schultz has lost his employer group
coverage within the last two weeks. How would you advise him? - ansMr. Schultz should enroll in a Part D
plan before he has a 63-day break in coverage in order to avoid a premium penalty.
Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help
paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know
whether he might qualify. What should you tell him? - ansThe extra help is available to beneficiaries
whose income and assets do not exceed annual limits specified by the government.
, AHIP 2024 Final Exam Test Questions and Answers Updated (Verified Answers)
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? - ansMedicare Advantage is a way of covering all the Original
Medicare benefits through private health insurance companies.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in
a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug
coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? - ansMrs. Chi may
enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.
Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill
out the paperwork. What could you tell her? - ansThe Part D low income subsidy could substantially lower
her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security
Administration.
Mrs. Imelda Diaz is a Medicare beneficiary enrolled in a MA-PD plan you represent. Her neighbor recently
suffered from a painful case of shingles. Mrs. Diaz hopes to avoid such an illness through vaccination.
She asks you whether the cost of shingles vaccination will be covered under the plan you represent. What
should you say? - ansYes, there is no cost sharing for the shingles vaccine even in the deductible phase
of her prescription drug plan because it is an adult vaccine recommended by the Advisory Committee on
Immunization Practices (AICP).
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? - ansHer daughter should come in November.
Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan.
She agreed to sign a scope of appointment form and meet with you on October 15. During the
appointment, what are you permitted to do? - ansYou may provide her with the required enrollment
materials and take her completed enrollment application.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance? - ansShe should contact her state Medicaid agency to see if she qualifies forprograms
that can help with Medicare costs for which she is responsible.
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? -
ansShe 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.
Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses no
medications and sees no reason to spend money on a Medicare prescription drug plan if she does not
need the coverage. She currently does not have creditable coverage. What could you tell her about the
implications of such a decision? - ansIf she does not sign up for a Medicare prescription drug plan as
soon as she is eligible to do so, if she does sign up at a later date, her premium will be permanently
increased by 1% of the national average premium for every month that she was not covered.
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? - ansMrs. Ramos can obtain care from any provider
who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a
provider who/that is not a part of the PPO network.
