2027 AHIP Final Exam LATEST UPDATE
QUESTIONS AND WELL-DETAILED ANSWERS
GUARANTEED PASS WITH RATIONALES
Mr. Khan's employer has recently dropped comprehensive creditable prescription drug coverage
that was offered to company retirees. The company told Mr. Khan that, because he was affected
by this change, he would qualify for a special election period. Mr. Khan contacted you to find out
,more about what this means. What can you tell him? - DETAILED ANSWER-It means that he
qualifies for a one-time opportunity to enroll in a Part D prescription drug plan.
Mr. Chambers suffers from diabetes which has gotten progressively worse during the last
year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription
drug plan and did not enroll in a Medicare Advantage (MA) plan during the last annual open
enrollment period (AEP) which has just closed. Mr. Chambers has heard certain MA plans might
provide him with more specialized coverage for his diabetes and wants to know if he must wait
until the next annual open enrollment period (AEP) before enrolling in such a plan. What should
you tell him? - DETAILED ANSWER-If there is a special needs plan (SNP) in Mr. Chambers's
area that specializes in caring for individuals with diabetes, he may enroll in the SNP at any time
under a special election period (SEP).
Which of the following individuals are likely to qualify for a special election period
(SEP) for either an MA or 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 to a new state providing him with new MA and Part
D options - DETAILED ANSWER-II, III, and IV only
Mr. Washington is turning 65 next month and has asked you what he can do, and when
he must do it, with respect to enrolling in Part D. What could you tell him? - DETAILED
ANSWER-He is currently in the Part D Initial Enrollment Period (IEP), and during this time, he
may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an
MA-PD plan.
Mrs. Fowler is moving and a friend told her she might qualify for a "special election
period" to enroll in a new Medicare Advantage plan. She contacted you to ask what a special
election period is. What could you tell her? - DETAILED ANSWER-It is a period, outside of
the Annual Election Period, when a Medicare beneficiary can select a new or different Medicare
Advantage and/or Part D prescription drug plan. Typically, the special election period is
beneficiary specific and results from events, such as when the beneficiary moves outside of the
service area.
When Emma 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? -
DETAILED ANSWER-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.
Mr. and Mrs. Orozco attended one of your sales presentations. They've asked you to
come to their home to clear up a few questions. During the presentation, Mrs. Orozco feels tired
and tells you that her husband can finish things up. She goes to bed. At the end of your
discussion, Mr. Orozco says that he wants to enroll both himself and his wife. What should you
do? - DETAILED ANSWER-If she can do so, only Mrs. Orozco can sign her enrollment form.
Mrs. Orozco will have to wake up to sign her form or do so at another time.
You are visiting Mr. Connor and his daughter at her request. He has advanced
Alzheimer's and is incapable of understanding the implications of choosing a Medicare
Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for
him? - DETAILED ANSWER-Mr. Connor's daughter can do so only if she is authorized under
state law as a court-appointed legal guardian, has a durable power of attorney for health care
decisions, or is authorized under state surrogate consent laws to make health decisions.
Mr. Blake is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is eligible
for Medicare. What should you tell him? - DETAILED ANSWER-Mr. Blake can disenroll from
QUESTIONS AND WELL-DETAILED ANSWERS
GUARANTEED PASS WITH RATIONALES
Mr. Khan's employer has recently dropped comprehensive creditable prescription drug coverage
that was offered to company retirees. The company told Mr. Khan that, because he was affected
by this change, he would qualify for a special election period. Mr. Khan contacted you to find out
,more about what this means. What can you tell him? - DETAILED ANSWER-It means that he
qualifies for a one-time opportunity to enroll in a Part D prescription drug plan.
Mr. Chambers suffers from diabetes which has gotten progressively worse during the last
year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription
drug plan and did not enroll in a Medicare Advantage (MA) plan during the last annual open
enrollment period (AEP) which has just closed. Mr. Chambers has heard certain MA plans might
provide him with more specialized coverage for his diabetes and wants to know if he must wait
until the next annual open enrollment period (AEP) before enrolling in such a plan. What should
you tell him? - DETAILED ANSWER-If there is a special needs plan (SNP) in Mr. Chambers's
area that specializes in caring for individuals with diabetes, he may enroll in the SNP at any time
under a special election period (SEP).
Which of the following individuals are likely to qualify for a special election period
(SEP) for either an MA or 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 to a new state providing him with new MA and Part
D options - DETAILED ANSWER-II, III, and IV only
Mr. Washington is turning 65 next month and has asked you what he can do, and when
he must do it, with respect to enrolling in Part D. What could you tell him? - DETAILED
ANSWER-He is currently in the Part D Initial Enrollment Period (IEP), and during this time, he
may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an
MA-PD plan.
Mrs. Fowler is moving and a friend told her she might qualify for a "special election
period" to enroll in a new Medicare Advantage plan. She contacted you to ask what a special
election period is. What could you tell her? - DETAILED ANSWER-It is a period, outside of
the Annual Election Period, when a Medicare beneficiary can select a new or different Medicare
Advantage and/or Part D prescription drug plan. Typically, the special election period is
beneficiary specific and results from events, such as when the beneficiary moves outside of the
service area.
When Emma 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? -
DETAILED ANSWER-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.
Mr. and Mrs. Orozco attended one of your sales presentations. They've asked you to
come to their home to clear up a few questions. During the presentation, Mrs. Orozco feels tired
and tells you that her husband can finish things up. She goes to bed. At the end of your
discussion, Mr. Orozco says that he wants to enroll both himself and his wife. What should you
do? - DETAILED ANSWER-If she can do so, only Mrs. Orozco can sign her enrollment form.
Mrs. Orozco will have to wake up to sign her form or do so at another time.
You are visiting Mr. Connor and his daughter at her request. He has advanced
Alzheimer's and is incapable of understanding the implications of choosing a Medicare
Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for
him? - DETAILED ANSWER-Mr. Connor's daughter can do so only if she is authorized under
state law as a court-appointed legal guardian, has a durable power of attorney for health care
decisions, or is authorized under state surrogate consent laws to make health decisions.
Mr. Blake is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is eligible
for Medicare. What should you tell him? - DETAILED ANSWER-Mr. Blake can disenroll from
