AHIP Final Exam Test Bank | Complete Practice Exam
Study Guide with Actual Exam Questions, Verified Correct
Answers and Detailed Rationales (100% Verified Correct
Solutions) - Already Graded A+
Question 1
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently
cover his prescription drug needs. He is interested in changing plans during the
upcoming MA Open Enrollment Period. What are his options during the MA OEP?
A. He can switch to an HMO plan.
B. He can switch to a MA-PD plan.
C. He can switch to a Part D-only plan.
D. He can switch to a PPO plan.
Answer: B
Rationale: During the Medicare Advantage Open Enrollment Period (MA OEP),
beneficiaries enrolled in a Medicare Advantage plan can switch to another MA
plan or disenroll from their MA plan and return to Original Medicare. They can
switch to a MA-PD plan that includes prescription drug coverage.
Question 2
You would like to market a MA plan at a neighborhood pharmacy. What should
you keep in mind to comply with the marketing requirements for MA plans?
A. You may provide gifts or prizes to all potential enrollees during an event that
does not exceed $15 in retail value.
B. You must set up your table, make marketing presentations, and accept
enrollment applications only in common areas outside of where the patient waits
for services from the pharmacist.
C. Medicare Advantage Plans may offer extra benefits that Original Medicare does
not offer such as vision, hearing, and dental services.
pg. 1
,D. None of the costs of Mr. Wingate's other medications would currently count
toward TrOOP.
Answer: B
Rationale: When marketing MA plans at a pharmacy, you must set up your table,
make marketing presentations, and accept enrollment applications only in common
areas outside of where the patient waits for services from the pharmacist. This
ensures compliance with CMS marketing guidelines.
Question 3
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day.
Mr. Vaughn takes a prescription to help to regrow his hair. They are anxious to
have their Medicare prescription drug plan cover these drug needs. What should
you tell them?
A. Medicare prescription drug plans are not permitted to cover the prescription
medications the Vaughns are interested in under Part D coverage; however, plans
may cover them as supplemental benefits and the Vaughns could look into that
possibility.
B. Mr. Zachow has a right to request a formulary exception to obtain coverage for
his Part D drug.
C. There are Programs of All-Inclusive Care for the Elderly (PACE) for frail
elderly beneficiaries.
D. Medicare Advantage Plans may offer extra benefits that Original Medicare does
not offer.
Answer: A
Rationale: Medicare Part D does not cover prescription vitamins (except certain
prenatal vitamins) or drugs for cosmetic purposes such as hair regrowth. These
may be offered as supplemental benefits by some MA plans, but not under Part D.
Question 4
Mrs. Quinn recently turned 66 and decided after many years of work to retire and
begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a
pg. 2
,letter informing her that she had been automatically enrolled in Medicare Part B.
She wants to understand what this means. What should you tell Mrs. Quinn?
A. Part B primarily covers physician services. She will be paying a monthly
premium and, except for many preventive and screening tests, generally will have
20% co-payments for these services, in addition to an annual deductible.
B. Medicare will cover Mrs. Shield's skilled nursing services provided during the
first 20 days of her stay.
C. You can present only health care related lines of business but must obtain the
beneficiary's permission.
D. Medicare prescription drug plans are required to cover drugs in each therapeutic
category.
Answer: A
Rationale: Part B covers physician services, outpatient care, and preventive
services. Beneficiaries pay a monthly premium and generally have 20%
coinsurance for most services after meeting the annual deductible.
Question 5
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?
A. Medigap plans do not cover Original Medicare benefits, but they coordinate
with Original Medicare coverage.
B. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
covered for Part A and Part B services through Original Fee-for-Service Medicare.
C. Enrollees can opt out of the program at any time.
D. You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B,
and if he lives in the PFFS plan's service area.
Answer: D
Rationale: To be eligible for a PFFS plan, a beneficiary must be entitled to
Medicare Part A, enrolled in Part B, and live in the plan's service area.
pg. 3
, Question 6
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-
sponsored retiree group health plan that includes drug coverage with nominal
copays. He heard about a neighbor's MA-PD plan that you represent and because
he takes numerous prescription drugs, he is considering signing up for it. What
should you tell him?
A. He should compare the benefits in his employer-sponsored retiree group health
plan with the benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
B. She qualifies for a special election period (SEP) that will allow her to make a
one-time election.
C. He can make as many enrollment changes as he likes during the Annual
Election Period.
D. He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
Answer: A
Rationale: Before switching from employer-sponsored retiree coverage to a MA-
PD plan, the beneficiary should compare the benefits, costs, and coverage of both
plans to determine which better meets his prescription drug needs.
Question 7
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?
A. The extra help is available to beneficiaries who have a high income but low
assets.
B. The extra help is available to any beneficiary who has a Part D plan, regardless
of income.
C. The extra help is only available to beneficiaries who are enrolled in a Medicare
Advantage plan.
D. The extra help is available to beneficiaries whose income and assets do not
pg. 4
Study Guide with Actual Exam Questions, Verified Correct
Answers and Detailed Rationales (100% Verified Correct
Solutions) - Already Graded A+
Question 1
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently
cover his prescription drug needs. He is interested in changing plans during the
upcoming MA Open Enrollment Period. What are his options during the MA OEP?
A. He can switch to an HMO plan.
B. He can switch to a MA-PD plan.
C. He can switch to a Part D-only plan.
D. He can switch to a PPO plan.
Answer: B
Rationale: During the Medicare Advantage Open Enrollment Period (MA OEP),
beneficiaries enrolled in a Medicare Advantage plan can switch to another MA
plan or disenroll from their MA plan and return to Original Medicare. They can
switch to a MA-PD plan that includes prescription drug coverage.
Question 2
You would like to market a MA plan at a neighborhood pharmacy. What should
you keep in mind to comply with the marketing requirements for MA plans?
A. You may provide gifts or prizes to all potential enrollees during an event that
does not exceed $15 in retail value.
B. You must set up your table, make marketing presentations, and accept
enrollment applications only in common areas outside of where the patient waits
for services from the pharmacist.
C. Medicare Advantage Plans may offer extra benefits that Original Medicare does
not offer such as vision, hearing, and dental services.
pg. 1
,D. None of the costs of Mr. Wingate's other medications would currently count
toward TrOOP.
Answer: B
Rationale: When marketing MA plans at a pharmacy, you must set up your table,
make marketing presentations, and accept enrollment applications only in common
areas outside of where the patient waits for services from the pharmacist. This
ensures compliance with CMS marketing guidelines.
Question 3
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day.
Mr. Vaughn takes a prescription to help to regrow his hair. They are anxious to
have their Medicare prescription drug plan cover these drug needs. What should
you tell them?
A. Medicare prescription drug plans are not permitted to cover the prescription
medications the Vaughns are interested in under Part D coverage; however, plans
may cover them as supplemental benefits and the Vaughns could look into that
possibility.
B. Mr. Zachow has a right to request a formulary exception to obtain coverage for
his Part D drug.
C. There are Programs of All-Inclusive Care for the Elderly (PACE) for frail
elderly beneficiaries.
D. Medicare Advantage Plans may offer extra benefits that Original Medicare does
not offer.
Answer: A
Rationale: Medicare Part D does not cover prescription vitamins (except certain
prenatal vitamins) or drugs for cosmetic purposes such as hair regrowth. These
may be offered as supplemental benefits by some MA plans, but not under Part D.
Question 4
Mrs. Quinn recently turned 66 and decided after many years of work to retire and
begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a
pg. 2
,letter informing her that she had been automatically enrolled in Medicare Part B.
She wants to understand what this means. What should you tell Mrs. Quinn?
A. Part B primarily covers physician services. She will be paying a monthly
premium and, except for many preventive and screening tests, generally will have
20% co-payments for these services, in addition to an annual deductible.
B. Medicare will cover Mrs. Shield's skilled nursing services provided during the
first 20 days of her stay.
C. You can present only health care related lines of business but must obtain the
beneficiary's permission.
D. Medicare prescription drug plans are required to cover drugs in each therapeutic
category.
Answer: A
Rationale: Part B covers physician services, outpatient care, and preventive
services. Beneficiaries pay a monthly premium and generally have 20%
coinsurance for most services after meeting the annual deductible.
Question 5
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?
A. Medigap plans do not cover Original Medicare benefits, but they coordinate
with Original Medicare coverage.
B. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
covered for Part A and Part B services through Original Fee-for-Service Medicare.
C. Enrollees can opt out of the program at any time.
D. You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B,
and if he lives in the PFFS plan's service area.
Answer: D
Rationale: To be eligible for a PFFS plan, a beneficiary must be entitled to
Medicare Part A, enrolled in Part B, and live in the plan's service area.
pg. 3
, Question 6
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-
sponsored retiree group health plan that includes drug coverage with nominal
copays. He heard about a neighbor's MA-PD plan that you represent and because
he takes numerous prescription drugs, he is considering signing up for it. What
should you tell him?
A. He should compare the benefits in his employer-sponsored retiree group health
plan with the benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
B. She qualifies for a special election period (SEP) that will allow her to make a
one-time election.
C. He can make as many enrollment changes as he likes during the Annual
Election Period.
D. He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
Answer: A
Rationale: Before switching from employer-sponsored retiree coverage to a MA-
PD plan, the beneficiary should compare the benefits, costs, and coverage of both
plans to determine which better meets his prescription drug needs.
Question 7
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?
A. The extra help is available to beneficiaries who have a high income but low
assets.
B. The extra help is available to any beneficiary who has a Part D plan, regardless
of income.
C. The extra help is only available to beneficiaries who are enrolled in a Medicare
Advantage plan.
D. The extra help is available to beneficiaries whose income and assets do not
pg. 4
