AHIP Practice Exam With Correct Solutions
2024
Mr. yCarlini yhas yheard ythat yMedicare yprescription ydrug yplans yare yonly yoffered ythrough
yprivate ycompanies yunder ya yprogram yknown yas yMedicare yAdvantage y(MA), ynot yby ythe
ygovernment. yHe ylikes yOriginal yMedicare yand ydoes ynot ywant yto ysign yup yfor yan yMA
yproduct, ybut yhe yalso ywants yprescription ydrug ycoverage. yWhat yshould yyou ytell yhim? y-
ycorrect yanswer.Mr. yCarlini ycan ystay ywith yOriginal yMedicare yand yalso yenroll yin ya
yMedicare yprescription ydrug yplan ythrough ya yprivate ycompany ythat yhas ycontracted ywith
ythe ygovernment yto yprovide yonly ysuch ydrug ycoverage yto yeligible yMedicare ybeneficiaries.
During ya ysales ypresentation yto yMs yDaley yfor ya yMedicare yAdvantage yplan ythat yhas ya y5-
star yrating yin ycustomer yservice yand ycare ycoordination, yand yreceived yan yoverall yplan
yperformance yof ya y4-star, ywhich yof ythe yfollowing ywould ybe ythe ycorrect ystatement yto ysay
yto yher? y- ycorrect yanswer.The yMedicare yAdvantage yplan yreceived ya y5-star yrating yin
ycustomer yservice yand ycare ycoordination ywith yan yoverall yperformance yrating yof y4-stars
Mrs. yPena yis y66 yyears yold, yhas ycoverage yunder yan yemployer yplan yand ywill yretire ynext
yyear. yShe yheard yshe ymust yenroll yin yPart yB yat ythe ybeginning yof ythe yyear yto yensure yno
ygap yin ycoverage. yWhat ycan yyou ytell yher? y- ycorrect yanswer.She ymay yenroll yat yany ytime
ywhile yshe yis ycovered yunder yher yemployer yplan, ybut yshe ywill yhave ya yspecial yeight-month
yenrollment yperiod ythat ydiffers yfrom ythe ystandard ygeneral yenrollment yperiod, yduring
ywhich yshe ymay yenroll yin yMedicare yPart yB
Mr. yBickford ydid ynot yquite yqualify yfor ythe yextra yhelp ylow-income ysubsidy yunder ythe
yMedicare yPart yD yPrescription yDrug yprogram yand yhe yis ywondering yif ythere yis yany yother
yoption yhe yhas yfor yobtaining yhelp ywith yhis yconsiderable ydrug ycosts. yWhat yshould yyou ytell
yhim? y- ycorrect yanswer.He ycould ycheck ywith ythe ymanufacturers yof yhis ymedications yto
ysee yif ythey yoffer yan yassistance yprogram yto yhelp ypeople ywith ylimited ymeans yobtain ythe
ymedications ythey yneed. yAlternatively, yhe ycould ycheck yto ysee ywhether yhis ystate yhas ya
ypharmacy yassistance yprogram yto yhelp yhim ywith yhis yexpenses.
Alice yis ya ymarketing yrepresentative yemployed yby ya yhealth yplan. yBetty yis ya ycaptive yagent
yof ya yhealth yplan ywho ymarkets yto ymultiple yplans yand ysponsors. yCarl yis ya ycaptive yagent
ywho ymarkets yto yonly yone yplan/sponsor. yDenise yis yan yindependent yagent ywho ymarkets
yto ydifferent ytypes yof ygroups. yEdward yis yan yindependent yagent ywho ymarkets yonly yto
yemployer yand yunion ygroups. yCMS ymarketing yrepresentative ycompensation yrules
, ygenerally yapply yto: y- ycorrect yanswer.Betty yand yDenise, ybut ynot yAlice y(the yemployee) yor
yCarl yor yEdward y(to ywhom yexceptions yapply).
Mrs. yValentino yis ycurrently yenrolled yin ya yMedicare yCost yplan. yThis yplan yis yno ylonger
ymeeting yher yneeds, ybut yit yis ynow ymid-year yand ypast ythe yannual yelection yperiod y(AEP).
yWhat ywould yyou ysay yto yMrs. yValentino yregarding yher yoptions? y- ycorrect yanswer.Mrs.
yValentino ycan ysubmit ya ywritten yrequest yto yMedicare yto ybe ydisenrolled yfrom ythe yCost
yplan yand yenroll yin yOriginal yMedicare.
When yMyra yfirst ybecame yeligible yfor yMedicare, yshe yenrolled yin yOriginal yMedicare y(Parts
yA yand yB). yShe yis ynow y67 yand ywill yturn y68 yon yJuly y1. yShe ywould ynow ylike yto yenroll yin ya
yMedicare yAdvantage y(MA) yplan yand yapproaches yyou yabout yher yoptions. yWhat yadvice
ywould yyou ygive yher? y- ycorrect yanswer.She yshould yremain yin yOriginal yMedicare yuntil ythe
yannual yelection yperiod yrunning yfrom yOctober y15 yto yDecember y7, yduring ywhich yshe ycan
yselect yan yMA yplan.
Mrs. yTanner yis yenrolled yin ya yMedicare yAdvantage yHMO ythat yoffers ya ypoint yof yservice
yoptions. yThis yallows yMrs. yTanner yto ydo ywhich yof ythe yfollowing? y- ycorrect yanswer.Mrs.
yTanner ycan ygo yto ynon-plan ydoctors yfor ycertain yservices ywithout yreceiving yprior yapproval
Agent yHarriet yWalker yhas yrecently ybegun ymarketing yMedicare yAdvantage yand yrelated
yproducts yaimed yat ymeeting ythe yneeds yof ysenior ycitizens. yClient yMildred yJones yhas
yexpressed yinterest yin ya yMedicare yAdvantage yplan. yIt yis ynow ythe ybeginning yof
ySeptember. yIf yyou ywere yin yAgent yWalker's yposition, ywhat ywould yyou ydo? y- ycorrect
yanswer.Inquire ywhether ythe yclient yqualifies yfor ya yspecial yenrollment yperiod, yand yif ynot,
ysolicit yan yenrollment yapplication yonce ythe yannual yopen yenrollment yelection yperiod
ybegins yon yOctober y15th.
Mrs. yChen ywill ybe y65 ysoon, yhas ybeen ya ycitizen yfor ytwelve yyears, yhas ybeen yemployed yfull
ytime, yand ypaid ytaxes yduring ythat yentire yperiod. yShe yis yconcerned ythat yshe ywill ynot
yqualify yfor ycoverage yunder ypart yA ybecause yshe ywas ynot yborn yin ythe yUnited yStates.
yWhat yshould yyou ytell yher? y- ycorrect yanswer.Most yindividuals ywho yare ycitizens yand yover
yage y65 yare ycovered yunder yPart yA yby yvirtue yof yhaving ypaid yMedicare ytaxes ywhile
yworking, ythough ysome ymay ybe ycovered yas ya yresult yof ypaying ymonthly ypremiums.
Mr. yKatz yreached ythe yPart yD ycoverage ygap yin yAugust ylast yyear. yHis yprescriptions yhave
ynot ybeen ychanged, yhe yis ykeeping ythe ysame yPart yD yplan yand ythe ybenefits, ycost-sharing,
yand ycoverage yof yhis ydrugs yare yall ythe ysame yas ylast yyear. yHe yasked ywhat yto yexpect yfor
ythis yyear yabout yhis yout-of-pocket ycosts. yWhat ycould yyou ytell yhim? y- ycorrect
yanswer.Because yhe yreached ythe ycoverage ygap ylast yyear, yhe ywill yprobably yreah yit yagain
ythis yyear yclose yto ythe ysame ytime.
ABC yis ya yMedicare yAdvantage y(MA) yplan ysponsor. yIt ywould ylike yto yuse yits yenrollees'
yprotected yhealth yinformation yto ymarket ynon-health yrelated yproducts ysuch yas ylife
yinsurance yand yannuities. yTo ydo yso yit ymust yobtain yauthorization yfrom ythe yenrollees.
yWhich ystatement ybest ydescribes ythe yauthorization yprocess? y- ycorrect
2024
Mr. yCarlini yhas yheard ythat yMedicare yprescription ydrug yplans yare yonly yoffered ythrough
yprivate ycompanies yunder ya yprogram yknown yas yMedicare yAdvantage y(MA), ynot yby ythe
ygovernment. yHe ylikes yOriginal yMedicare yand ydoes ynot ywant yto ysign yup yfor yan yMA
yproduct, ybut yhe yalso ywants yprescription ydrug ycoverage. yWhat yshould yyou ytell yhim? y-
ycorrect yanswer.Mr. yCarlini ycan ystay ywith yOriginal yMedicare yand yalso yenroll yin ya
yMedicare yprescription ydrug yplan ythrough ya yprivate ycompany ythat yhas ycontracted ywith
ythe ygovernment yto yprovide yonly ysuch ydrug ycoverage yto yeligible yMedicare ybeneficiaries.
During ya ysales ypresentation yto yMs yDaley yfor ya yMedicare yAdvantage yplan ythat yhas ya y5-
star yrating yin ycustomer yservice yand ycare ycoordination, yand yreceived yan yoverall yplan
yperformance yof ya y4-star, ywhich yof ythe yfollowing ywould ybe ythe ycorrect ystatement yto ysay
yto yher? y- ycorrect yanswer.The yMedicare yAdvantage yplan yreceived ya y5-star yrating yin
ycustomer yservice yand ycare ycoordination ywith yan yoverall yperformance yrating yof y4-stars
Mrs. yPena yis y66 yyears yold, yhas ycoverage yunder yan yemployer yplan yand ywill yretire ynext
yyear. yShe yheard yshe ymust yenroll yin yPart yB yat ythe ybeginning yof ythe yyear yto yensure yno
ygap yin ycoverage. yWhat ycan yyou ytell yher? y- ycorrect yanswer.She ymay yenroll yat yany ytime
ywhile yshe yis ycovered yunder yher yemployer yplan, ybut yshe ywill yhave ya yspecial yeight-month
yenrollment yperiod ythat ydiffers yfrom ythe ystandard ygeneral yenrollment yperiod, yduring
ywhich yshe ymay yenroll yin yMedicare yPart yB
Mr. yBickford ydid ynot yquite yqualify yfor ythe yextra yhelp ylow-income ysubsidy yunder ythe
yMedicare yPart yD yPrescription yDrug yprogram yand yhe yis ywondering yif ythere yis yany yother
yoption yhe yhas yfor yobtaining yhelp ywith yhis yconsiderable ydrug ycosts. yWhat yshould yyou ytell
yhim? y- ycorrect yanswer.He ycould ycheck ywith ythe ymanufacturers yof yhis ymedications yto
ysee yif ythey yoffer yan yassistance yprogram yto yhelp ypeople ywith ylimited ymeans yobtain ythe
ymedications ythey yneed. yAlternatively, yhe ycould ycheck yto ysee ywhether yhis ystate yhas ya
ypharmacy yassistance yprogram yto yhelp yhim ywith yhis yexpenses.
Alice yis ya ymarketing yrepresentative yemployed yby ya yhealth yplan. yBetty yis ya ycaptive yagent
yof ya yhealth yplan ywho ymarkets yto ymultiple yplans yand ysponsors. yCarl yis ya ycaptive yagent
ywho ymarkets yto yonly yone yplan/sponsor. yDenise yis yan yindependent yagent ywho ymarkets
yto ydifferent ytypes yof ygroups. yEdward yis yan yindependent yagent ywho ymarkets yonly yto
yemployer yand yunion ygroups. yCMS ymarketing yrepresentative ycompensation yrules
, ygenerally yapply yto: y- ycorrect yanswer.Betty yand yDenise, ybut ynot yAlice y(the yemployee) yor
yCarl yor yEdward y(to ywhom yexceptions yapply).
Mrs. yValentino yis ycurrently yenrolled yin ya yMedicare yCost yplan. yThis yplan yis yno ylonger
ymeeting yher yneeds, ybut yit yis ynow ymid-year yand ypast ythe yannual yelection yperiod y(AEP).
yWhat ywould yyou ysay yto yMrs. yValentino yregarding yher yoptions? y- ycorrect yanswer.Mrs.
yValentino ycan ysubmit ya ywritten yrequest yto yMedicare yto ybe ydisenrolled yfrom ythe yCost
yplan yand yenroll yin yOriginal yMedicare.
When yMyra yfirst ybecame yeligible yfor yMedicare, yshe yenrolled yin yOriginal yMedicare y(Parts
yA yand yB). yShe yis ynow y67 yand ywill yturn y68 yon yJuly y1. yShe ywould ynow ylike yto yenroll yin ya
yMedicare yAdvantage y(MA) yplan yand yapproaches yyou yabout yher yoptions. yWhat yadvice
ywould yyou ygive yher? y- ycorrect yanswer.She yshould yremain yin yOriginal yMedicare yuntil ythe
yannual yelection yperiod yrunning yfrom yOctober y15 yto yDecember y7, yduring ywhich yshe ycan
yselect yan yMA yplan.
Mrs. yTanner yis yenrolled yin ya yMedicare yAdvantage yHMO ythat yoffers ya ypoint yof yservice
yoptions. yThis yallows yMrs. yTanner yto ydo ywhich yof ythe yfollowing? y- ycorrect yanswer.Mrs.
yTanner ycan ygo yto ynon-plan ydoctors yfor ycertain yservices ywithout yreceiving yprior yapproval
Agent yHarriet yWalker yhas yrecently ybegun ymarketing yMedicare yAdvantage yand yrelated
yproducts yaimed yat ymeeting ythe yneeds yof ysenior ycitizens. yClient yMildred yJones yhas
yexpressed yinterest yin ya yMedicare yAdvantage yplan. yIt yis ynow ythe ybeginning yof
ySeptember. yIf yyou ywere yin yAgent yWalker's yposition, ywhat ywould yyou ydo? y- ycorrect
yanswer.Inquire ywhether ythe yclient yqualifies yfor ya yspecial yenrollment yperiod, yand yif ynot,
ysolicit yan yenrollment yapplication yonce ythe yannual yopen yenrollment yelection yperiod
ybegins yon yOctober y15th.
Mrs. yChen ywill ybe y65 ysoon, yhas ybeen ya ycitizen yfor ytwelve yyears, yhas ybeen yemployed yfull
ytime, yand ypaid ytaxes yduring ythat yentire yperiod. yShe yis yconcerned ythat yshe ywill ynot
yqualify yfor ycoverage yunder ypart yA ybecause yshe ywas ynot yborn yin ythe yUnited yStates.
yWhat yshould yyou ytell yher? y- ycorrect yanswer.Most yindividuals ywho yare ycitizens yand yover
yage y65 yare ycovered yunder yPart yA yby yvirtue yof yhaving ypaid yMedicare ytaxes ywhile
yworking, ythough ysome ymay ybe ycovered yas ya yresult yof ypaying ymonthly ypremiums.
Mr. yKatz yreached ythe yPart yD ycoverage ygap yin yAugust ylast yyear. yHis yprescriptions yhave
ynot ybeen ychanged, yhe yis ykeeping ythe ysame yPart yD yplan yand ythe ybenefits, ycost-sharing,
yand ycoverage yof yhis ydrugs yare yall ythe ysame yas ylast yyear. yHe yasked ywhat yto yexpect yfor
ythis yyear yabout yhis yout-of-pocket ycosts. yWhat ycould yyou ytell yhim? y- ycorrect
yanswer.Because yhe yreached ythe ycoverage ygap ylast yyear, yhe ywill yprobably yreah yit yagain
ythis yyear yclose yto ythe ysame ytime.
ABC yis ya yMedicare yAdvantage y(MA) yplan ysponsor. yIt ywould ylike yto yuse yits yenrollees'
yprotected yhealth yinformation yto ymarket ynon-health yrelated yproducts ysuch yas ylife
yinsurance yand yannuities. yTo ydo yso yit ymust yobtain yauthorization yfrom ythe yenrollees.
yWhich ystatement ybest ydescribes ythe yauthorization yprocess? y- ycorrect
