AHIP FINAL EXAM QUESTIONS - MASTER STUDY GUIDE
COMPLETE WITH 100% VERIFIED SOLUTIONS
1. Mrs. West wears glasses and dentures and has enjoyed
considerable pain relief from arthritis through acupuncture. She is
concerned about whether or not Medicare will cover these items and
services. What should you tell her?
A) Medicare covers acupuncture but excludes glasses and dentures.
B) Medicare covers all three services if deemed medically necessary.
C) Medicare does not cover acupuncture, or, in general, glasses or
dentures.
D) Medicare covers glasses and dentures but excludes acupuncture.
Correct Answer: C
Rationale: Original Medicare generally does not cover routine vision,
dental, or hearing care, nor does it cover acupuncture.
2. Mr. Bickford did not quite qualify for the extra help low-income
subsidy under the Medicare Part D Prescription Drug program and he
is wondering if there is any other option he has for obtaining help
with his considerable drug costs. What should you tell him?
A) He must pay out of pocket as there are no other assistance programs.
B) He could check with the manufacturers of his medications to see if
they offer an assistance program to help people with limited means
obtain the medications they need.
C) He should apply for Medicaid to get his drugs covered.
D) He can enroll in a Medigap plan to cover his prescription drugs.
Correct Answer: B
,Rationale: Pharmaceutical manufacturers often have patient assistance
programs for those who do not qualify for LIS but still need financial
help.
3. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan
that you represent. It is one of three plans operated by the same
organization in Mr. Lombardi's area. The MA PPO plan does not
include drug coverage, but the other two plans do. Mr. Lombardi likes
the PPO plan that does not include drug coverage and intends to
obtain his drug coverage through a stand-alone Medicare prescription
drug plan. What should you tell him about this situation?
A) He can enroll in the MA PPO and the stand-alone Part D plan.
B) He must enroll in one of the MA plans that includes drug coverage.
C) He can enroll in the MA-only PPO plan and a stand-alone Medicare
prescription drug plan.
D) He cannot enroll in the MA-only PPO plan and a stand-alone
prescription drug plan.
Correct Answer: D
Rationale: An individual cannot enroll in a Medicare Advantage-only
plan (like a PPO that excludes drugs) and simultaneously enroll in a
stand-alone Part D plan. They must choose either an MA-PD plan or
Original Medicare with a PDP.
4. Mr. Torres has a small savings account. He would like to pay for his
monthly Part D premiums with an automatic monthly withdrawal
from his savings account until it is exhausted, and then have his
premiums withheld from his Social Security check. What should you
tell him?
A) In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
,B) He can switch payment methods whenever he wants during the year.
C) He cannot use a savings account for automatic withdrawals.
D) He must pay his premiums in cash monthly.
Correct Answer: A
Rationale: CMS requires beneficiaries to select a single premium
payment mechanism (e.g., Social Security withholding or automatic
bank withdrawal) that must remain in effect for the entire calendar
year.
5. During the Annual Enrollment Period (AEP), a beneficiary wants to
switch from Original Medicare to a Medicare Advantage plan. When
does this change take effect?
A) January 1 of the following year.
B) The first day of the month after the AEP ends.
C) Immediately upon enrollment.
D) December 1 of the current year.
Correct Answer: A
Rationale: Elections made during the Annual Enrollment Period
(October 15 - December 7) are effective January 1 of the following year.
6. What is the primary purpose of the Medicare Advantage Open
Enrollment Period (MA OEP) which runs from January 1 to March 31?
A) To allow beneficiaries to drop Original Medicare and join an MA plan.
B) To allow beneficiaries enrolled in an MA plan to switch to another
MA plan or return to Original Medicare.
C) To allow beneficiaries to change their Part D plan.
D) To allow beneficiaries to enroll in a Medigap plan without
underwriting.
Correct Answer: B
Rationale: The MA OEP allows individuals already enrolled in an MA
, plan to make a one-time election to switch to another MA plan or
disenroll to Original Medicare (and enroll in a PDP).
7. A beneficiary is enrolled in a Medicare Advantage HMO plan. They
need to see a specialist. What is generally required?
A) They can see any specialist they want without a referral.
B) They must pay the full cost of the specialist visit.
C) They must obtain a referral from their Primary Care Physician (PCP)
and use in-network providers.
D) They must disenroll from the HMO to see a specialist.
Correct Answer: C
Rationale: HMO plans generally require beneficiaries to use in-network
providers and obtain a referral from their PCP to see a specialist.
8. Which of the following best describes a Medicare Medical Savings
Account (MSA) plan?
A) It combines a high-deductible health plan with a bank account to pay
for medical expenses.
B) It is a type of Medigap plan.
C) It only covers prescription drugs.
D) It requires a referral for every specialist visit.
Correct Answer: A
Rationale: MSA plans combine a high-deductible Medicare Advantage
plan with a tax-advantaged bank account that Medicare deposits money
into to pay for healthcare costs.
9. What is the maximum out-of-pocket (MOOP) limit for Medicare
Advantage plans?
A) There is no limit.
B) $5,000 annually.
COMPLETE WITH 100% VERIFIED SOLUTIONS
1. Mrs. West wears glasses and dentures and has enjoyed
considerable pain relief from arthritis through acupuncture. She is
concerned about whether or not Medicare will cover these items and
services. What should you tell her?
A) Medicare covers acupuncture but excludes glasses and dentures.
B) Medicare covers all three services if deemed medically necessary.
C) Medicare does not cover acupuncture, or, in general, glasses or
dentures.
D) Medicare covers glasses and dentures but excludes acupuncture.
Correct Answer: C
Rationale: Original Medicare generally does not cover routine vision,
dental, or hearing care, nor does it cover acupuncture.
2. Mr. Bickford did not quite qualify for the extra help low-income
subsidy under the Medicare Part D Prescription Drug program and he
is wondering if there is any other option he has for obtaining help
with his considerable drug costs. What should you tell him?
A) He must pay out of pocket as there are no other assistance programs.
B) He could check with the manufacturers of his medications to see if
they offer an assistance program to help people with limited means
obtain the medications they need.
C) He should apply for Medicaid to get his drugs covered.
D) He can enroll in a Medigap plan to cover his prescription drugs.
Correct Answer: B
,Rationale: Pharmaceutical manufacturers often have patient assistance
programs for those who do not qualify for LIS but still need financial
help.
3. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan
that you represent. It is one of three plans operated by the same
organization in Mr. Lombardi's area. The MA PPO plan does not
include drug coverage, but the other two plans do. Mr. Lombardi likes
the PPO plan that does not include drug coverage and intends to
obtain his drug coverage through a stand-alone Medicare prescription
drug plan. What should you tell him about this situation?
A) He can enroll in the MA PPO and the stand-alone Part D plan.
B) He must enroll in one of the MA plans that includes drug coverage.
C) He can enroll in the MA-only PPO plan and a stand-alone Medicare
prescription drug plan.
D) He cannot enroll in the MA-only PPO plan and a stand-alone
prescription drug plan.
Correct Answer: D
Rationale: An individual cannot enroll in a Medicare Advantage-only
plan (like a PPO that excludes drugs) and simultaneously enroll in a
stand-alone Part D plan. They must choose either an MA-PD plan or
Original Medicare with a PDP.
4. Mr. Torres has a small savings account. He would like to pay for his
monthly Part D premiums with an automatic monthly withdrawal
from his savings account until it is exhausted, and then have his
premiums withheld from his Social Security check. What should you
tell him?
A) In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
,B) He can switch payment methods whenever he wants during the year.
C) He cannot use a savings account for automatic withdrawals.
D) He must pay his premiums in cash monthly.
Correct Answer: A
Rationale: CMS requires beneficiaries to select a single premium
payment mechanism (e.g., Social Security withholding or automatic
bank withdrawal) that must remain in effect for the entire calendar
year.
5. During the Annual Enrollment Period (AEP), a beneficiary wants to
switch from Original Medicare to a Medicare Advantage plan. When
does this change take effect?
A) January 1 of the following year.
B) The first day of the month after the AEP ends.
C) Immediately upon enrollment.
D) December 1 of the current year.
Correct Answer: A
Rationale: Elections made during the Annual Enrollment Period
(October 15 - December 7) are effective January 1 of the following year.
6. What is the primary purpose of the Medicare Advantage Open
Enrollment Period (MA OEP) which runs from January 1 to March 31?
A) To allow beneficiaries to drop Original Medicare and join an MA plan.
B) To allow beneficiaries enrolled in an MA plan to switch to another
MA plan or return to Original Medicare.
C) To allow beneficiaries to change their Part D plan.
D) To allow beneficiaries to enroll in a Medigap plan without
underwriting.
Correct Answer: B
Rationale: The MA OEP allows individuals already enrolled in an MA
, plan to make a one-time election to switch to another MA plan or
disenroll to Original Medicare (and enroll in a PDP).
7. A beneficiary is enrolled in a Medicare Advantage HMO plan. They
need to see a specialist. What is generally required?
A) They can see any specialist they want without a referral.
B) They must pay the full cost of the specialist visit.
C) They must obtain a referral from their Primary Care Physician (PCP)
and use in-network providers.
D) They must disenroll from the HMO to see a specialist.
Correct Answer: C
Rationale: HMO plans generally require beneficiaries to use in-network
providers and obtain a referral from their PCP to see a specialist.
8. Which of the following best describes a Medicare Medical Savings
Account (MSA) plan?
A) It combines a high-deductible health plan with a bank account to pay
for medical expenses.
B) It is a type of Medigap plan.
C) It only covers prescription drugs.
D) It requires a referral for every specialist visit.
Correct Answer: A
Rationale: MSA plans combine a high-deductible Medicare Advantage
plan with a tax-advantaged bank account that Medicare deposits money
into to pay for healthcare costs.
9. What is the maximum out-of-pocket (MOOP) limit for Medicare
Advantage plans?
A) There is no limit.
B) $5,000 annually.
