AHIP 2027 FINAL EXAM COMPLETE STUDY
GUIDE WITH SOLVED QUESTIONS
◉ 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. 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.
GUIDE WITH SOLVED QUESTIONS
◉ 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. 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.
