2024 AHIP FWA EXAM QUESTIONS AND VERIFIED
ANSWERS ALREADY GRADED A+
Ms. O'Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent.
She plans to switch from her old MA HMO plan to the new MA-PD plan during the Annual Election
Period. However, she wants to make sure she does not end up paying premiums for two plans. What
can you tell her?
She only needs to enroll in the new MA-PD plan and she will automatically be disenrolled from her old
MA plan.
Mr. Wendt 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. Wendt 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?
If there is a special needs plan (SNP) in Mr. Wendt'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)
Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She has recently also become eligible for
Medicaid and would like to enroll in a MA-PD plan. Since this is her first experience with Medicare
Advantage, she is concerned that she will be locked into a plan and unable to make any coverage
changes for at least a year if not longer. What should you tell her?
Since Mrs. Jenkins has Medicare Part A and Part B and receives Medicaid, she has a special election
period (SEP) that will allow her to enroll or disenroll from an MA or MA-PD plan during the first 9
months of each calendar year.
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On
December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-
PD plan. What enrollment rules would apply in this case?
,He can make as many enrollment changes as he likes during the Annual Election Period and the last
choice made prior to the end of the period will be the effective one as of January 1.
Willard works as a representative focused on the senior marketplace. What would be considered
prohibited activity by Willard?
Implying that only seniors can enroll in a Medicare Advantage plan when meeting with Mr.
Hernandez, who is 58 but qualifies for Medicare because he is disabled.
Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on
October 10 for a new plan available January 1 next year. He is currently enrolled in Original Medicare.
What should you do?
Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period
begins.
Mrs. Johnson calls to tell you she has not received her new plan ID card yet, but she needs to see a
doctor. What can she expect to receive from the plan after the plan has received her enrollment form?
Evidence of plan membership, information on how to obtain services, and the effective date of
coverage.
Miles is a licensed agent who represents Colgate Health and its Medicare Advantage (MA) plans. Miles
has several clients who have recently come to him for help. They are in their initial coverage period9s)
(ICEP) and are interested in enrolling in one of Colgate Health's MA plans. Adam will soon turn 68 and
has decided to retire. Betty is about to turn 65 and has also decided to retire. Adam and Betty both
currently have coverage through Colgate Health. Charles had health coverage through Colgate but
dropped the coverage when he retired early to travel to Europe. Charles has just turned age 65 and is
now back in the United States. Diedre, who will turn 65 next month, currently has coverage through
Ditmas Health - a company that Miles also represents. Who qualifies for the opt-in simplified enrollment
mechanism?
Adam and Betty because each of them will not have a break between their non-Medicare and
Medicare coverage through Colgate Health Plan.
,Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his prescription
drug needs. He is interested in changing plans during the upcoming MA Open Enrollment Period. What
are his options during the MA OEP?
He can switch to a MA-PD plan.
Which of the following individuals has enrolled in a plan based on a fixed enrollment period?
Ben, who enrolls in a Medicare Advantage plan during the Medicare Advantage Open Enrollment
Period (MA OEP).
Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his first Medicare
eligibility date will be by June 1. Mr. Liu's ICEP and Part D IEP begin March 1 and end on September 30.
He wants prescription drug coverage with his Part A and Part B benefits. What advice can you provide
him?
He can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A.
You work for Caring Health, a Medicare Advantage (MA) plan sponsor. Recently, Mrs. Garcia has
completed an enrollment application for a plan offered by Caring Health, which is waiting for a reply
from CMS indicating whether or not Mrs. Garcia's enrollment has been accepted. Once CMS replies,
how long does Caring Health have to notify Mrs. Garcia that her enrollment has been accepted and in
what format? 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 election periods (SEPs)?
The plan has 10 calendar days to notify Mrs. Garcia in writing.
Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is
interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she
be able to obtain drug coverage if she enrolled in the SNP?
, Maybe. Some SNPs offer Part D coverage for prescription drugs and some do not.
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?
Enrollees 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.
Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has recently
received a letter from her Medigap carrier informing her that her drug coverage is not "creditable." She
wants to know what this means. What should you tell her?
The letter is to inform her that the drug coverage offered through her Medigap plan does not offer
drug coverage that is at least comparable to that provided under the Medicare Part D prescription
drug program. If she does not have such creditable coverage during periods when she is first eligible
for the Part D program, she will face a premium penalty if she enrolls in a Part D plan at a later date.
Which of the following is/are most likely to be characterized as an involuntary disenrollment from a
Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An individual materially misrepresents information to a PDP sponsor regarding reimbursement for
third-party coverage.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment period.
I, II, and III only
Under ACA Section 1557, a health plan premium sold through a state exchange may, based on an
individual's age,
charge higher premiums.
ANSWERS ALREADY GRADED A+
Ms. O'Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent.
She plans to switch from her old MA HMO plan to the new MA-PD plan during the Annual Election
Period. However, she wants to make sure she does not end up paying premiums for two plans. What
can you tell her?
She only needs to enroll in the new MA-PD plan and she will automatically be disenrolled from her old
MA plan.
Mr. Wendt 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. Wendt 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?
If there is a special needs plan (SNP) in Mr. Wendt'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)
Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She has recently also become eligible for
Medicaid and would like to enroll in a MA-PD plan. Since this is her first experience with Medicare
Advantage, she is concerned that she will be locked into a plan and unable to make any coverage
changes for at least a year if not longer. What should you tell her?
Since Mrs. Jenkins has Medicare Part A and Part B and receives Medicaid, she has a special election
period (SEP) that will allow her to enroll or disenroll from an MA or MA-PD plan during the first 9
months of each calendar year.
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On
December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-
PD plan. What enrollment rules would apply in this case?
,He can make as many enrollment changes as he likes during the Annual Election Period and the last
choice made prior to the end of the period will be the effective one as of January 1.
Willard works as a representative focused on the senior marketplace. What would be considered
prohibited activity by Willard?
Implying that only seniors can enroll in a Medicare Advantage plan when meeting with Mr.
Hernandez, who is 58 but qualifies for Medicare because he is disabled.
Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on
October 10 for a new plan available January 1 next year. He is currently enrolled in Original Medicare.
What should you do?
Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period
begins.
Mrs. Johnson calls to tell you she has not received her new plan ID card yet, but she needs to see a
doctor. What can she expect to receive from the plan after the plan has received her enrollment form?
Evidence of plan membership, information on how to obtain services, and the effective date of
coverage.
Miles is a licensed agent who represents Colgate Health and its Medicare Advantage (MA) plans. Miles
has several clients who have recently come to him for help. They are in their initial coverage period9s)
(ICEP) and are interested in enrolling in one of Colgate Health's MA plans. Adam will soon turn 68 and
has decided to retire. Betty is about to turn 65 and has also decided to retire. Adam and Betty both
currently have coverage through Colgate Health. Charles had health coverage through Colgate but
dropped the coverage when he retired early to travel to Europe. Charles has just turned age 65 and is
now back in the United States. Diedre, who will turn 65 next month, currently has coverage through
Ditmas Health - a company that Miles also represents. Who qualifies for the opt-in simplified enrollment
mechanism?
Adam and Betty because each of them will not have a break between their non-Medicare and
Medicare coverage through Colgate Health Plan.
,Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his prescription
drug needs. He is interested in changing plans during the upcoming MA Open Enrollment Period. What
are his options during the MA OEP?
He can switch to a MA-PD plan.
Which of the following individuals has enrolled in a plan based on a fixed enrollment period?
Ben, who enrolls in a Medicare Advantage plan during the Medicare Advantage Open Enrollment
Period (MA OEP).
Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his first Medicare
eligibility date will be by June 1. Mr. Liu's ICEP and Part D IEP begin March 1 and end on September 30.
He wants prescription drug coverage with his Part A and Part B benefits. What advice can you provide
him?
He can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A.
You work for Caring Health, a Medicare Advantage (MA) plan sponsor. Recently, Mrs. Garcia has
completed an enrollment application for a plan offered by Caring Health, which is waiting for a reply
from CMS indicating whether or not Mrs. Garcia's enrollment has been accepted. Once CMS replies,
how long does Caring Health have to notify Mrs. Garcia that her enrollment has been accepted and in
what format? 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 election periods (SEPs)?
The plan has 10 calendar days to notify Mrs. Garcia in writing.
Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is
interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she
be able to obtain drug coverage if she enrolled in the SNP?
, Maybe. Some SNPs offer Part D coverage for prescription drugs and some do not.
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?
Enrollees 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.
Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has recently
received a letter from her Medigap carrier informing her that her drug coverage is not "creditable." She
wants to know what this means. What should you tell her?
The letter is to inform her that the drug coverage offered through her Medigap plan does not offer
drug coverage that is at least comparable to that provided under the Medicare Part D prescription
drug program. If she does not have such creditable coverage during periods when she is first eligible
for the Part D program, she will face a premium penalty if she enrolls in a Part D plan at a later date.
Which of the following is/are most likely to be characterized as an involuntary disenrollment from a
Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An individual materially misrepresents information to a PDP sponsor regarding reimbursement for
third-party coverage.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment period.
I, II, and III only
Under ACA Section 1557, a health plan premium sold through a state exchange may, based on an
individual's age,
charge higher premiums.
