AHIP FINAL EXAM TEST QUESTIONS
AND ANSWERS
Mrs.uWestuwearsuglassesuandudenturesuanduhasuenjoyeduconsiderableupainureli
efufromuarthritisuthroughuacupuncture.uSheuisuconcerneduaboutuwhetheruorunotu
Medicareuwillucoverutheseuitemsuanduservices.uWhatushoulduyouutelluher?u-
uans-Medicareudoesunotucoveruacupuncture,uor,uinugeneral,uglassesuorudentures.
Mr.uBickfordudidunotuquiteuqualifyuforutheuextrauhelpulow-
incomeusubsidyuunderutheuMedicareuPartuDuPrescriptionuDruguprogramuanduheu
isuwonderinguifuthereuisuanyuotheruoptionuheuhasuforuobtaininguhelpuwithuhisuco
nsiderableudrugucosts.uWhatushoulduyouutelluhim?u-uans-
Heucoulducheckuwithutheumanufacturersuofuhisumedicationsutouseeuifutheyuofferu
anuassistanceuprogramutouhelpupeopleuwithulimitedumeansuobtainutheumedication
sutheyuneed.uAlternatively,uheucoulducheckutouseeuwhetheruhisustateuhasuaupha
rmacyuassistanceuprogramutouhelpuhimuwithuhisuexpenses.
Mr.uLombardiuisuinteresteduinuauMedicareuAdvantageu(MA)uPPOuplanuthatuyouur
epresent.uItuisuoneuofuthreeuplansuoperatedubyutheusameuorganizationuinuMr.uL
ombardi'suarea.uTheuMAuPPOuplanudoesunotuincludeudrugucoverage,ubututheuot
herutwouplansudo.uMr.uLombardiulikesutheuPPOuplanuthatudoesunotuincludeudru
gucoverageuanduintendsutouobtainuhisudrugucoverageuthroughuaustand-
aloneuMedicareuprescriptionudruguplan.uWhatushoulduyouutelluhimuaboututhisusitu
ation?u-uans-
HeucoulduenrolluinuoneuofutheuMAuplansuthatuincludeuprescriptionudrugucoverag
euoruauMedigapuplanuanduaustand-
aloneuprescriptionudruguplan,ubutuheucannotuenrolluinutheuMA-
onlyuPPOuplanuanduaustand-aloneuprescriptionudruguplan.
Mr.uTorresuhasuausmallusavingsuaccount.uHeuwouldulikeutoupayuforuhisumonthly
uPartuDupremiumsuwithuanuautomaticumonthlyuwithdrawalufromuhisusavingsuacco
untuuntiluituisuexhausted,uanduthenuhaveuhisupremiumsuwithheldufromuhisuSocial
uSecurityucheck.uWhatushoulduyouutelluhim?u-uans-
Inugeneral,uheumustuselectuausingleuPartuDupremiumupaymentumechanismuthatu
willubeuuseduthroughoututheuyear.
AgentuJenningsumakesuaupresentationuonuMedicareuadvertiseduasuanueducationa
luevent.uAgentuJenningsudistributesumaterialsuthatuareusolelyueducationaluinunatur
e.uHowever,usheugivesuaubriefupresentationuthatumentionsuplan-
specificupremiums.uIsuthisuauprohibiteduactivityuatuanueventuthatuhasubeenuadver
tiseduasueducational?u-uans-
, Yes.uWhenuanueventuhasubeenuadvertiseduasu"educational,"udiscussinguplan-
specificupremiumsuisuimpermissible.
Mrs.uMulcahyuisuconcerneduthatusheumayunotuqualifyuforuenrollmentuinuauMedic
areuprescriptionudruguplanubecause,ualthoughusheuisuentitledutouPartuA,usheuisu
notuenrolleduunderuMedicareuPartuB.uWhatushoulduyouutelluher?u-uans-
EveryoneuwhouisuentitledutouPartuAuoruenrolleduunderuPartuBuisueligibleutouenr
olluinuauMedicareuprescriptionudruguplan.uAsulonguasuMrs.uMulcahyuisuentitledut
ouPartuA,usheudoesunotuneedutouenrolluunderuPartuBubeforeuenrollinguinuaupre
scriptionudruguplan.
Mr.uJacobuunderstandsuthatuthereuisuaustandarduMedicareuPartuDuprescriptionud
rugubenefit,ubutuwhenuheulooksuatuinformationuonuvariousuplansuavailableuinuhis
uarea,uheuseesuauwideurangeuinuwhatutheyuchargeuforudeductibles,upremiumsua
nducostusharing.uHowucanuyouuexplainuthisutouhim?u-uans-
MedicareuPartuDudruguplansumayuhaveudifferentubenefitustructures,ubutuonuaver
age,utheyumustuallubeuatuleastuasugooduasutheustandardumodeluestablisheduby
utheugovernment.
Ms.uMooreuplansutouretireuwhenusheuturnsu65uinuaufewumonths.uSheuisuinuexc
ellentuhealthuanduwilluhaveuconsiderableuincomeuwhenusheuretires.uSheuisuconc
erneduthatuheruincomeuwillumakeuituimpossibleuforuherutouqualifyuforuMedicare.u
Whatucoulduyouutelluherutouaddressuheruconcern?u-uans-
Medicareuisuauprogramuforupeopleuageu65uoruolderuanduthoseuunderuageu65uw
ithucertainudisabilities,uendustageurenaludiseaseuoruLouuGehrig'sudisease,usoushe
uwillubeueligibleuforuMedicare.
AgentuArmstronguisuemployedubyuXYZuAgency,uwhichuisuunderucontractuwithuA
BCuHealthuPlan,uauMedicareuAdvantageu(MA)uplanuthatuoffersuplansuinumultiple
ustates.uXYZuAgencyumaintainsuauwebsiteumarketingutheuMAuplansuwithuwhichui
tuhasucontracts.uAgentuArmstrongufollowsuupuwithuindividualsuwhourequestumore
uinformationuaboutuABCuMAuplansuviautheuwebsiteuandutriesutoupersuadeuthem
utouenrolluinuABCuplans.uWhatustatementubestudescribesutheumarketinguanduco
mplianceurulesuthatuapplyutouAgentuArmstrong?u-uans-
AgentuArmstronguneedsutoubeulicenseduanduappointeduinueveryustateuinuwhichu
beneficiariesutouwhomuheumarketsuABCuMAuplansuareulocated.
Mr.uSchmidtuwouldulikeutouplanuforuretirementuanduhasuaskeduyouuwhatuisucove
reduunderuOriginaluFee-for-Serviceu(FFS)uMedicare?uWhatucoulduyouutelluhim?u-
uans-
PartuA,uwhichucoversuhospital,uskilledunursingufacility,uhospiceuanduhomeuhealth
uservicesuanduPartuB,uwhichucoversuprofessionaluservicesusuchuasuthoseuprovid
edubyuaudoctoruareucovereduunderuOriginaluMedicare.
YouuareuseekingutourepresentuanuindividualuMedicareuAdvantageuplanuanduanuin
dividualuPartuDuplanuinuyourustate.uYouuhaveucompletedutheurequiredutrainingufo
AND ANSWERS
Mrs.uWestuwearsuglassesuandudenturesuanduhasuenjoyeduconsiderableupainureli
efufromuarthritisuthroughuacupuncture.uSheuisuconcerneduaboutuwhetheruorunotu
Medicareuwillucoverutheseuitemsuanduservices.uWhatushoulduyouutelluher?u-
uans-Medicareudoesunotucoveruacupuncture,uor,uinugeneral,uglassesuorudentures.
Mr.uBickfordudidunotuquiteuqualifyuforutheuextrauhelpulow-
incomeusubsidyuunderutheuMedicareuPartuDuPrescriptionuDruguprogramuanduheu
isuwonderinguifuthereuisuanyuotheruoptionuheuhasuforuobtaininguhelpuwithuhisuco
nsiderableudrugucosts.uWhatushoulduyouutelluhim?u-uans-
Heucoulducheckuwithutheumanufacturersuofuhisumedicationsutouseeuifutheyuofferu
anuassistanceuprogramutouhelpupeopleuwithulimitedumeansuobtainutheumedication
sutheyuneed.uAlternatively,uheucoulducheckutouseeuwhetheruhisustateuhasuaupha
rmacyuassistanceuprogramutouhelpuhimuwithuhisuexpenses.
Mr.uLombardiuisuinteresteduinuauMedicareuAdvantageu(MA)uPPOuplanuthatuyouur
epresent.uItuisuoneuofuthreeuplansuoperatedubyutheusameuorganizationuinuMr.uL
ombardi'suarea.uTheuMAuPPOuplanudoesunotuincludeudrugucoverage,ubututheuot
herutwouplansudo.uMr.uLombardiulikesutheuPPOuplanuthatudoesunotuincludeudru
gucoverageuanduintendsutouobtainuhisudrugucoverageuthroughuaustand-
aloneuMedicareuprescriptionudruguplan.uWhatushoulduyouutelluhimuaboututhisusitu
ation?u-uans-
HeucoulduenrolluinuoneuofutheuMAuplansuthatuincludeuprescriptionudrugucoverag
euoruauMedigapuplanuanduaustand-
aloneuprescriptionudruguplan,ubutuheucannotuenrolluinutheuMA-
onlyuPPOuplanuanduaustand-aloneuprescriptionudruguplan.
Mr.uTorresuhasuausmallusavingsuaccount.uHeuwouldulikeutoupayuforuhisumonthly
uPartuDupremiumsuwithuanuautomaticumonthlyuwithdrawalufromuhisusavingsuacco
untuuntiluituisuexhausted,uanduthenuhaveuhisupremiumsuwithheldufromuhisuSocial
uSecurityucheck.uWhatushoulduyouutelluhim?u-uans-
Inugeneral,uheumustuselectuausingleuPartuDupremiumupaymentumechanismuthatu
willubeuuseduthroughoututheuyear.
AgentuJenningsumakesuaupresentationuonuMedicareuadvertiseduasuanueducationa
luevent.uAgentuJenningsudistributesumaterialsuthatuareusolelyueducationaluinunatur
e.uHowever,usheugivesuaubriefupresentationuthatumentionsuplan-
specificupremiums.uIsuthisuauprohibiteduactivityuatuanueventuthatuhasubeenuadver
tiseduasueducational?u-uans-
, Yes.uWhenuanueventuhasubeenuadvertiseduasu"educational,"udiscussinguplan-
specificupremiumsuisuimpermissible.
Mrs.uMulcahyuisuconcerneduthatusheumayunotuqualifyuforuenrollmentuinuauMedic
areuprescriptionudruguplanubecause,ualthoughusheuisuentitledutouPartuA,usheuisu
notuenrolleduunderuMedicareuPartuB.uWhatushoulduyouutelluher?u-uans-
EveryoneuwhouisuentitledutouPartuAuoruenrolleduunderuPartuBuisueligibleutouenr
olluinuauMedicareuprescriptionudruguplan.uAsulonguasuMrs.uMulcahyuisuentitledut
ouPartuA,usheudoesunotuneedutouenrolluunderuPartuBubeforeuenrollinguinuaupre
scriptionudruguplan.
Mr.uJacobuunderstandsuthatuthereuisuaustandarduMedicareuPartuDuprescriptionud
rugubenefit,ubutuwhenuheulooksuatuinformationuonuvariousuplansuavailableuinuhis
uarea,uheuseesuauwideurangeuinuwhatutheyuchargeuforudeductibles,upremiumsua
nducostusharing.uHowucanuyouuexplainuthisutouhim?u-uans-
MedicareuPartuDudruguplansumayuhaveudifferentubenefitustructures,ubutuonuaver
age,utheyumustuallubeuatuleastuasugooduasutheustandardumodeluestablisheduby
utheugovernment.
Ms.uMooreuplansutouretireuwhenusheuturnsu65uinuaufewumonths.uSheuisuinuexc
ellentuhealthuanduwilluhaveuconsiderableuincomeuwhenusheuretires.uSheuisuconc
erneduthatuheruincomeuwillumakeuituimpossibleuforuherutouqualifyuforuMedicare.u
Whatucoulduyouutelluherutouaddressuheruconcern?u-uans-
Medicareuisuauprogramuforupeopleuageu65uoruolderuanduthoseuunderuageu65uw
ithucertainudisabilities,uendustageurenaludiseaseuoruLouuGehrig'sudisease,usoushe
uwillubeueligibleuforuMedicare.
AgentuArmstronguisuemployedubyuXYZuAgency,uwhichuisuunderucontractuwithuA
BCuHealthuPlan,uauMedicareuAdvantageu(MA)uplanuthatuoffersuplansuinumultiple
ustates.uXYZuAgencyumaintainsuauwebsiteumarketingutheuMAuplansuwithuwhichui
tuhasucontracts.uAgentuArmstrongufollowsuupuwithuindividualsuwhourequestumore
uinformationuaboutuABCuMAuplansuviautheuwebsiteuandutriesutoupersuadeuthem
utouenrolluinuABCuplans.uWhatustatementubestudescribesutheumarketinguanduco
mplianceurulesuthatuapplyutouAgentuArmstrong?u-uans-
AgentuArmstronguneedsutoubeulicenseduanduappointeduinueveryustateuinuwhichu
beneficiariesutouwhomuheumarketsuABCuMAuplansuareulocated.
Mr.uSchmidtuwouldulikeutouplanuforuretirementuanduhasuaskeduyouuwhatuisucove
reduunderuOriginaluFee-for-Serviceu(FFS)uMedicare?uWhatucoulduyouutelluhim?u-
uans-
PartuA,uwhichucoversuhospital,uskilledunursingufacility,uhospiceuanduhomeuhealth
uservicesuanduPartuB,uwhichucoversuprofessionaluservicesusuchuasuthoseuprovid
edubyuaudoctoruareucovereduunderuOriginaluMedicare.
YouuareuseekingutourepresentuanuindividualuMedicareuAdvantageuplanuanduanuin
dividualuPartuDuplanuinuyourustate.uYouuhaveucompletedutheurequiredutrainingufo
