2027 AHIP Medicare Certification
Final Exam (Modules 1–5): A -
Question Competency Assessment
Based on CMS Standards, Requiring a
90% Passing Score
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?
– 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? – 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? -
answer Mr. Blake can disenroll from his employer-sponsored coverage to
,elect a Medicare Advantage or Part D plan within 2 months of his
disenrollment.
Mrs. Farmer would like to enroll in a Medicare Cost plan that offers Part D
prescription drug coverage. She is coming to you for advice about when
she can enroll in a plan you have previously discussed. What should you
tell her? - answer Enrollment in Cost plans offering Part D coverage is
available only during enrollment periods under the Part D program, and
Cost plans must accept enrollments during these periods.
Mrs. Dunn would like her daughter, who lives in another state, to meet with
you during the Annual Election Period to help her complete her enrollment
in a Part D plan. She asked you when she should have her daughter plan
to visit. What could you tell her? - answer Her daughter should come in
November.
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? - 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? - 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 - 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? - 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? -
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? -
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. Jerome Summers participated in Original Medicare (Parts A and B) for
several years before electing to enroll in a Medicare Savings Account
(MSA) Medicare Advantage Plan for the first time on November 1st during
the Annual Election Period. Almost immediately thereafter, Mr. Summers
contacts you to tell you that he regrets his decision and wants to change
his election back to Original Medicare. How would you advise him? -
answer Mr. Summers may revoke his election if he does it no later than
Final Exam (Modules 1–5): A -
Question Competency Assessment
Based on CMS Standards, Requiring a
90% Passing Score
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?
– 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? – 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? -
answer Mr. Blake can disenroll from his employer-sponsored coverage to
,elect a Medicare Advantage or Part D plan within 2 months of his
disenrollment.
Mrs. Farmer would like to enroll in a Medicare Cost plan that offers Part D
prescription drug coverage. She is coming to you for advice about when
she can enroll in a plan you have previously discussed. What should you
tell her? - answer Enrollment in Cost plans offering Part D coverage is
available only during enrollment periods under the Part D program, and
Cost plans must accept enrollments during these periods.
Mrs. Dunn would like her daughter, who lives in another state, to meet with
you during the Annual Election Period to help her complete her enrollment
in a Part D plan. She asked you when she should have her daughter plan
to visit. What could you tell her? - answer Her daughter should come in
November.
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? - 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? - 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 - 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? - 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? -
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? -
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. Jerome Summers participated in Original Medicare (Parts A and B) for
several years before electing to enroll in a Medicare Savings Account
(MSA) Medicare Advantage Plan for the first time on November 1st during
the Annual Election Period. Almost immediately thereafter, Mr. Summers
contacts you to tell you that he regrets his decision and wants to change
his election back to Original Medicare. How would you advise him? -
answer Mr. Summers may revoke his election if he does it no later than
