AHIP 2027 Medicare Certification: Complete Study Guide with 146 Practice Questions & Rationales (AHIP) Guarantee Pass (Updated Pdf)

AHIP
AHIP 2027 Medicare Certification: Complete Study Guide with
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u 146 Practice Questions & Rationales (AHIP) Guarantee Pass
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u (Updated Pdf)
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,AHIP 2027 - Complete Q&A with Rationales
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Question 1 u




Sylvester is an enrollee in Blackrock Medicare Advantage plan. Sylvester has
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u disagreed with some of the decisions made by Blackrock concerning his medical care.
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u He has recently learned that there is a formal appeals process available to MA
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u enrollees. He asks you under what circumstances can an appeal be filed. You say an
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u appeal can be filed if:
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A) Blackstone did not pay for a medical service, leaving Sylvester with
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u substantial financial liability.
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B) Sylvester believes home health care benefits are ending too soon.
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C) Sylvester believes Blackstone has not authorized a Part D drug that should have been
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u covered.
D) All of the above
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Correct Answer: D) All of the above
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Rationale: An appeal can be filed when a Medicare Advantage plan:
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, Denies payment for a medical service (A) u u u u u u




Terminates services that the enrollee believes should continue (B)
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Denies coverage for a Part D drug that should be covered (C)
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All three circumstances qualify for the formal appeals process.
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Question 2 u




Gary Summers is enrolled in Ajax Medicare Advantage plan. Gary has recently faced a
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u series of health issues leading to substantial out-of-pocket expenses. Gary
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u understands that in Original Medicare (Parts A and B) there is no annual out-of-pocket
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maximum. He asks you if the same is true of his Medicare Advantage plan? How do
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u you respond? u




A) Yes, Medicare Advantage plans also have no out-of-pocket maximum.
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B) No, Medicare Advantage plans have a higher out-of-pocket maximum than
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u Original Medicare. u




C) All Medicare Advantage (MA) plans must have a "maximum out-of-pocket" limit
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u (known as "MOOP") for Part A and Part B benefits. Once the MA plan member pays a
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specified amount of cost-sharing, the health plan pays 100 percent of the medical
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services covered.
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D) Medicare Advantage plans only have an out-of-pocket maximum if you
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u purchase additional coverage. u u




Correct Answer: C) All Medicare Advantage (MA) plans must have a "maximum out-of-
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pocket" limit (known as "MOOP") for Part A and Part B benefits. Once the MA plan
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u member pays a specified amount of cost-sharing, the health plan pays 100 percent of
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the medical services covered.
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Rationale: Unlike Original Medicare, all Medicare Advantage plans are required to have
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u an annual out-of-pocket maximum (MOOP) for Part A and Part B services. Once the
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u enrollee reaches this limit, the plan pays 100% of covered medical services for the
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u remainder of the year. u u u

, Question 3 u




Mary Alice is covered by Original Medicare Parts A and B. During her initial enrollment
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u period she purchased a standard Medigap Plan A policy from you because of its
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u relatively low cost. After speaking to her friend Stan, she asks whether any of the
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u following are "core benefits" covered in her plan?
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A) Coverage for Part A hospital coinsurance amount u u u u u u




B) Coverage for 365 additional days during an insured's lifetime after Medicare benefits
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u end
C) Coverage for 3 pints of blood u u u u u




D) All of the above
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Correct Answer: D) All of the above
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Rationale: Medigap Plan A (the most basic standardized Medigap plan) covers all
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u three of these core benefits:
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Part A hospital coinsurance
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365 additional lifetime reserve days after Medicare benefits are exhausted
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First 3 pints of blood u u u u




Question 4 u




Hernan Hertz is an independent agent. Hernan sells plans on behalf of three Medicare
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u Advantage organizations that offer a total of 10 plans but does not represent all
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u Medicare Advantage organizations offering plans that are available in his area. Which
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u of the following statements best describes any steps Hernan is required to take?
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A) Hernan must inform all potential clients that he represents all plans in the area.
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B) Prior to a discussion of any plan benefits, Hernan must use a disclaimer that says "I
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u do not offer every plan available in your area. Currently, I represent 3 organizations
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u which offer 10 plans in your area. Please contact Medicare.gov or 1-800-MEDICARE to
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u get information on all your options."
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C) Hernan does not need to disclose his limited representation.
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D) Hernan must only sell plans from organizations he represents.
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