AHIP
AHIP 2027 Medicare Certification: Complete Study Guide with
146 Practice Questions & Rationales (AHIP) Guarantee Pass
(Updated Pdf)
Gradegurus
➢
➢Complete Study Guide with 146 Practice Questions &
➢
,AHIP 2027 - Complete Q&A with Rationales
Question 1
Sylvester is an enrollee in Blackrock Medicare Advantage plan. Sylvester has
disagreed with some of the decisions made by Blackrock concerning his medical care.
He has recently learned that there is a formal appeals process available to MA
enrollees. He asks you under what circumstances can an appeal be filed. You say an
appeal can be filed if:
A) Blackstone did not pay for a medical service, leaving Sylvester with substantial
financial liability.
B) Sylvester believes home health care benefits are ending too soon.
C) Sylvester believes Blackstone has not authorized a Part D drug that should have been
covered.
D) All of the above
Correct Answer: D) All of the above
Rationale: An appeal can be filed when a Medicare Advantage plan:
, Denies payment for a medical service (A)
Terminates services that the enrollee believes should continue (B)
Denies coverage for a Part D drug that should be covered (C)
All three circumstances qualify for the formal appeals process.
Question 2
Gary Summers is enrolled in Ajax Medicare Advantage plan. Gary has recently faced a
series of health issues leading to substantial out-of-pocket expenses. Gary
understands that in Original Medicare (Parts A and B) there is no annual out-of-pocket
maximum. He asks you if the same is true of his Medicare Advantage plan? How do
you respond?
A) Yes, Medicare Advantage plans also have no out-of-pocket maximum.
B) No, Medicare Advantage plans have a higher out-of-pocket maximum than Original
Medicare.
C) All Medicare Advantage (MA) plans must have a "maximum out-of-pocket" limit
(known as "MOOP") for Part A and Part B benefits. Once the MA plan member pays a
specified amount of cost-sharing, the health plan pays 100 percent of the medical
services covered.
D) Medicare Advantage plans only have an out-of-pocket maximum if you purchase
additional coverage.
Correct Answer: C) All Medicare Advantage (MA) plans must have a "maximum out-of-
pocket" limit (known as "MOOP") for Part A and Part B benefits. Once the MA plan
member pays a specified amount of cost-sharing, the health plan pays 100 percent of
the medical services covered.
Rationale: Unlike Original Medicare, all Medicare Advantage plans are required to have
an annual out-of-pocket maximum (MOOP) for Part A and Part B services. Once the
enrollee reaches this limit, the plan pays 100% of covered medical services for the
remainder of the year.
, Question 3
Mary Alice is covered by Original Medicare Parts A and B. During her initial enrollment
period she purchased a standard Medigap Plan A policy from you because of its
relatively low cost. After speaking to her friend Stan, she asks whether any of the
following are "core benefits" covered in her plan?
A) Coverage for Part A hospital coinsurance amount
B) Coverage for 365 additional days during an insured's lifetime after Medicare benefits
end
C) Coverage for 3 pints of blood
D) All of the above
Correct Answer: D) All of the above
Rationale: Medigap Plan A (the most basic standardized Medigap plan) covers all three
of these core benefits:
Part A hospital coinsurance
365 additional lifetime reserve days after Medicare benefits are exhausted
First 3 pints of blood
Question 4
Hernan Hertz is an independent agent. Hernan 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 Hernan is required to take?
A) Hernan must inform all potential clients that he represents all plans in the area.
B) Prior to a discussion of any plan benefits, Hernan must use a disclaimer that says "I
do not offer every plan available in your area. Currently, I represent 3 organizations
which offer 10 plans in your area. Please contact Medicare.gov or 1-800-MEDICARE to
get information on all your options."
C) Hernan does not need to disclose his limited representation.
D) Hernan must only sell plans from organizations he represents.
AHIP 2027 Medicare Certification: Complete Study Guide with
146 Practice Questions & Rationales (AHIP) Guarantee Pass
(Updated Pdf)
Gradegurus
➢
➢Complete Study Guide with 146 Practice Questions &
➢
,AHIP 2027 - Complete Q&A with Rationales
Question 1
Sylvester is an enrollee in Blackrock Medicare Advantage plan. Sylvester has
disagreed with some of the decisions made by Blackrock concerning his medical care.
He has recently learned that there is a formal appeals process available to MA
enrollees. He asks you under what circumstances can an appeal be filed. You say an
appeal can be filed if:
A) Blackstone did not pay for a medical service, leaving Sylvester with substantial
financial liability.
B) Sylvester believes home health care benefits are ending too soon.
C) Sylvester believes Blackstone has not authorized a Part D drug that should have been
covered.
D) All of the above
Correct Answer: D) All of the above
Rationale: An appeal can be filed when a Medicare Advantage plan:
, Denies payment for a medical service (A)
Terminates services that the enrollee believes should continue (B)
Denies coverage for a Part D drug that should be covered (C)
All three circumstances qualify for the formal appeals process.
Question 2
Gary Summers is enrolled in Ajax Medicare Advantage plan. Gary has recently faced a
series of health issues leading to substantial out-of-pocket expenses. Gary
understands that in Original Medicare (Parts A and B) there is no annual out-of-pocket
maximum. He asks you if the same is true of his Medicare Advantage plan? How do
you respond?
A) Yes, Medicare Advantage plans also have no out-of-pocket maximum.
B) No, Medicare Advantage plans have a higher out-of-pocket maximum than Original
Medicare.
C) All Medicare Advantage (MA) plans must have a "maximum out-of-pocket" limit
(known as "MOOP") for Part A and Part B benefits. Once the MA plan member pays a
specified amount of cost-sharing, the health plan pays 100 percent of the medical
services covered.
D) Medicare Advantage plans only have an out-of-pocket maximum if you purchase
additional coverage.
Correct Answer: C) All Medicare Advantage (MA) plans must have a "maximum out-of-
pocket" limit (known as "MOOP") for Part A and Part B benefits. Once the MA plan
member pays a specified amount of cost-sharing, the health plan pays 100 percent of
the medical services covered.
Rationale: Unlike Original Medicare, all Medicare Advantage plans are required to have
an annual out-of-pocket maximum (MOOP) for Part A and Part B services. Once the
enrollee reaches this limit, the plan pays 100% of covered medical services for the
remainder of the year.
, Question 3
Mary Alice is covered by Original Medicare Parts A and B. During her initial enrollment
period she purchased a standard Medigap Plan A policy from you because of its
relatively low cost. After speaking to her friend Stan, she asks whether any of the
following are "core benefits" covered in her plan?
A) Coverage for Part A hospital coinsurance amount
B) Coverage for 365 additional days during an insured's lifetime after Medicare benefits
end
C) Coverage for 3 pints of blood
D) All of the above
Correct Answer: D) All of the above
Rationale: Medigap Plan A (the most basic standardized Medigap plan) covers all three
of these core benefits:
Part A hospital coinsurance
365 additional lifetime reserve days after Medicare benefits are exhausted
First 3 pints of blood
Question 4
Hernan Hertz is an independent agent. Hernan 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 Hernan is required to take?
A) Hernan must inform all potential clients that he represents all plans in the area.
B) Prior to a discussion of any plan benefits, Hernan must use a disclaimer that says "I
do not offer every plan available in your area. Currently, I represent 3 organizations
which offer 10 plans in your area. Please contact Medicare.gov or 1-800-MEDICARE to
get information on all your options."
C) Hernan does not need to disclose his limited representation.
D) Hernan must only sell plans from organizations he represents.
