AHIP Final Exam Test Questions and Answers- Latest
2023/2024 (Verified Answers)
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a website marketing the MA plans with which it has contracts. Agent
Armstrong follows up with individuals who request more information about ABC MA
plans via the website and tries to persuade them to enroll in ABC plans. What statement
best describes the marketing and compliance rules that apply to Agent Armstrong? -
ansAgent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an educational event.
Agent Jennings distributes materials that are solely educational in nature. However, she
gives a brief presentation that mentions plan-specific premiums. Is this a prohibited
activity at an event that has been advertised as educational? - ansYes. When an event
has been advertised as "educational," discussing plan-specific premiums is
impermissible.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks
you for advice as to whether this is possible. What should you tell her? - ansMarketing
representatives may initiate electronic contact through e-mail but the subject line must
say "marketing" and an opt-out process must be provided.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country
and wonders what her options are for continuing MA-PD coverage. What would you say
to her in regard to a special enrollment period (SEP)? - ansShe is likely to qualify for a
SEP. She can choose an effective date of up to three months after the month in which
the enrollment form is received by the new plan, but the effective date may not be
earlier than the date of her permanent move.
Another agent working for your agency claims that because you are not employed by
the Medicare Advantage plans that you represent, you are not subject to the same
requirements as the plans themselves. How should you respond to such a statement? -
ansYour coworker is not correct. Marketing on behalf of a plan is considered marketing
by the plan and requires that all contracted and employed agents comply with all
Medicare marketing rules.
During a sales presentation, your client asks you whether the Medicare agency
recommends that she sign up for your plan or stay in Original Medicare. What should
you tell her? - ansTell her that the Medicare agency does not endorse or recommend
any plan.
Mr. and Mrs. Nunez 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. Nunez
feels tired and tells you that her husband can finish things up. She goes to bed. At the
end of your discussion, Mr. Nunez says that he wants to enroll both himself and his
,AHIP Final Exam Test Questions and Answers- Latest
2023/2024 (Verified Answers)
wife. What should you do? - ansAs long as she is able to do so, only Mrs. Nunez can
sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at
another time.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included a number of services and items he
thought would be fully covered. He called you to ask what he could do? What could you
tell him? - ansYou can offer to review the plans appeal process to help him ask the plan
to review the coverage decision.
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? - ansHe 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. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him? - ansHe is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is
just about saving money, or if he will get insurance coverage for his health care
expenditures as well. What should you tell him? - ansUnder the Medicare Advantage
program. an MSA plan involves the combination of high deductible health plan and
savings account for health expenses. Medicare will make contributions to this savings
account to help him pay his health care expenses while in the deductible.
Mr. Chen 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? - ansMr. Chen can disenroll from his
employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2
months of his disenrollment, but he should revaluate if he really wants to drop his
employer coverage.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for
Medicare as well. He is concerned about changes in his cost-sharing. What should you
,AHIP Final Exam Test Questions and Answers- Latest
2023/2024 (Verified Answers)
tell him? - ansHe should know that Medicaid will pay cost sharing only for services
provided by Medicaid participating providers.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him? - ansHe may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug
benefit, but when he looks at information on various plans available in his area, he sees
a wide range in what they charge for deductibles, premiums and cost sharing. How can
you explain this to him? - ansMedicare Part D drug plans may have different benefit
structures, but on average, they must all be at least as good as the standard model
established by the government.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-
income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? -
ansHe qualifies for a special election period and can enroll in or disenroll from a Part D
plan once during that period.
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? - ansHe could enroll in one of the MA plans that include
prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan,
but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription
drug plan you represent and simply give you a check to cover his premiums for the
entire year. What should you tell him? - ansEnrollees should pay using automatic
withdrawal from a bank account or credit or debit card, direct monthly billing from the
plan, or deductions from their Social Security check.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr. Moy? - ansMedicare
Supplemental Insurance would help cover his Part A and Part B cost sharing in Original
Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does
not cover.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
when he turns 66. He wants to understand the health care costs he might be exposed to
, AHIP Final Exam Test Questions and Answers- Latest
2023/2024 (Verified Answers)
under Medicare if he were to require hospitalization as a result of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare? - ansUnder Original Medicare, there is a single deductible amount
due for the first 60 days of any inpatient
hospital stay, after which it converts into a per-day amount through day 90. After day 90,
he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for all costs
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of
an inpatient psychiatric hospital stay that Medicare will cover? - ansMedicare will cover
a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of
an inpatient psychiatric hospital stay that Medicare will cover? - ansMedicare will cover
a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work
and is covered by an employer health plan, he has not enrolled in Part B or Part D. He
receives a notice on June 1 that his employer is cutting back on prescription drug
benefits and that as of July 1 his coverage will no longer be creditable. He has come to
you for advice. What advice would you give Mr. Rockwell about special enrollment
periods (SEPs)? - ansMr. Rockwell is eligible for a SEP due to his involuntary loss of
creditable drug coverage; the SEP begins in June and ends September 1 - two months
after the loss of creditable coverage.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B
because he has coverage through an employer plan. If he wants to enroll in a Medicare
Advantage plan, what will he have to do? - ansHe will have to enroll in Part B.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - ansPart A, which
covers hospital, skilled nursing facility, hospice and home health services and Part B,
which covers professional services such as those provided by a doctor are covered
under Original Medicare.
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? - ansIn general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
2023/2024 (Verified Answers)
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a website marketing the MA plans with which it has contracts. Agent
Armstrong follows up with individuals who request more information about ABC MA
plans via the website and tries to persuade them to enroll in ABC plans. What statement
best describes the marketing and compliance rules that apply to Agent Armstrong? -
ansAgent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an educational event.
Agent Jennings distributes materials that are solely educational in nature. However, she
gives a brief presentation that mentions plan-specific premiums. Is this a prohibited
activity at an event that has been advertised as educational? - ansYes. When an event
has been advertised as "educational," discussing plan-specific premiums is
impermissible.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks
you for advice as to whether this is possible. What should you tell her? - ansMarketing
representatives may initiate electronic contact through e-mail but the subject line must
say "marketing" and an opt-out process must be provided.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country
and wonders what her options are for continuing MA-PD coverage. What would you say
to her in regard to a special enrollment period (SEP)? - ansShe is likely to qualify for a
SEP. She can choose an effective date of up to three months after the month in which
the enrollment form is received by the new plan, but the effective date may not be
earlier than the date of her permanent move.
Another agent working for your agency claims that because you are not employed by
the Medicare Advantage plans that you represent, you are not subject to the same
requirements as the plans themselves. How should you respond to such a statement? -
ansYour coworker is not correct. Marketing on behalf of a plan is considered marketing
by the plan and requires that all contracted and employed agents comply with all
Medicare marketing rules.
During a sales presentation, your client asks you whether the Medicare agency
recommends that she sign up for your plan or stay in Original Medicare. What should
you tell her? - ansTell her that the Medicare agency does not endorse or recommend
any plan.
Mr. and Mrs. Nunez 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. Nunez
feels tired and tells you that her husband can finish things up. She goes to bed. At the
end of your discussion, Mr. Nunez says that he wants to enroll both himself and his
,AHIP Final Exam Test Questions and Answers- Latest
2023/2024 (Verified Answers)
wife. What should you do? - ansAs long as she is able to do so, only Mrs. Nunez can
sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at
another time.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included a number of services and items he
thought would be fully covered. He called you to ask what he could do? What could you
tell him? - ansYou can offer to review the plans appeal process to help him ask the plan
to review the coverage decision.
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? - ansHe 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. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him? - ansHe is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is
just about saving money, or if he will get insurance coverage for his health care
expenditures as well. What should you tell him? - ansUnder the Medicare Advantage
program. an MSA plan involves the combination of high deductible health plan and
savings account for health expenses. Medicare will make contributions to this savings
account to help him pay his health care expenses while in the deductible.
Mr. Chen 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? - ansMr. Chen can disenroll from his
employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2
months of his disenrollment, but he should revaluate if he really wants to drop his
employer coverage.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for
Medicare as well. He is concerned about changes in his cost-sharing. What should you
,AHIP Final Exam Test Questions and Answers- Latest
2023/2024 (Verified Answers)
tell him? - ansHe should know that Medicaid will pay cost sharing only for services
provided by Medicaid participating providers.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him? - ansHe may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug
benefit, but when he looks at information on various plans available in his area, he sees
a wide range in what they charge for deductibles, premiums and cost sharing. How can
you explain this to him? - ansMedicare Part D drug plans may have different benefit
structures, but on average, they must all be at least as good as the standard model
established by the government.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-
income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? -
ansHe qualifies for a special election period and can enroll in or disenroll from a Part D
plan once during that period.
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? - ansHe could enroll in one of the MA plans that include
prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan,
but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription
drug plan you represent and simply give you a check to cover his premiums for the
entire year. What should you tell him? - ansEnrollees should pay using automatic
withdrawal from a bank account or credit or debit card, direct monthly billing from the
plan, or deductions from their Social Security check.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr. Moy? - ansMedicare
Supplemental Insurance would help cover his Part A and Part B cost sharing in Original
Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does
not cover.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
when he turns 66. He wants to understand the health care costs he might be exposed to
, AHIP Final Exam Test Questions and Answers- Latest
2023/2024 (Verified Answers)
under Medicare if he were to require hospitalization as a result of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare? - ansUnder Original Medicare, there is a single deductible amount
due for the first 60 days of any inpatient
hospital stay, after which it converts into a per-day amount through day 90. After day 90,
he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for all costs
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of
an inpatient psychiatric hospital stay that Medicare will cover? - ansMedicare will cover
a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of
an inpatient psychiatric hospital stay that Medicare will cover? - ansMedicare will cover
a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work
and is covered by an employer health plan, he has not enrolled in Part B or Part D. He
receives a notice on June 1 that his employer is cutting back on prescription drug
benefits and that as of July 1 his coverage will no longer be creditable. He has come to
you for advice. What advice would you give Mr. Rockwell about special enrollment
periods (SEPs)? - ansMr. Rockwell is eligible for a SEP due to his involuntary loss of
creditable drug coverage; the SEP begins in June and ends September 1 - two months
after the loss of creditable coverage.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B
because he has coverage through an employer plan. If he wants to enroll in a Medicare
Advantage plan, what will he have to do? - ansHe will have to enroll in Part B.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - ansPart A, which
covers hospital, skilled nursing facility, hospice and home health services and Part B,
which covers professional services such as those provided by a doctor are covered
under Original Medicare.
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? - ansIn general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
