AHIP FINAL PRACTICE EXAM |
QUESTIONS AND ANSWERS
GRADED A+ | 2024/2025 GUIDE
Mrs. Parker likes to handle most of her business matters through
telephone calls. She currently is enrolled in Original Medicare Parts A
and B but has heard about a Medicare Advantage plan offered by Senior
Health from a neighbor. Mrs. Parker asks you whether she can enroll in
Senior Health's MA plan over the telephone. What can tell her?
I. Enrollment requests can only be made in face-to-face interviews or by
mail.
II. Telephone enrollment request calls must be recorded.
III. Telephonic enrollments must include all required elements necessary
to complete an enrollment.
IV. The signature element must be completed via certified mail.
- Correct Answer - II and III only
Mr. Ziegler 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?
- Correct Answer - During the Part D IEP, beneficiaries may make one
Part D enrollment choice, including enrollment in a stand-alone Part D
plan or an MA-PD plan if they are eligible for MA
,Torie Jones is a new marketing representative. Torie asks you for advice
as to what topics must be discussed with a Medicare beneficiary prior to
enrollment in a Medicare Advantage plan. What should you say?
- Correct Answer - CMS requires that more than just premiums be
discussed prior to and enrollment. Questions and topics to be discussed
include information regarding whether the beneficiary's primary care
providers and specialists are in the plan network, whether or not a
beneficiary's current prescriptions are covered and their costs, as well as
premiums, benefits, and cost of health care services. Other required
topics include whether or not the beneficiary's current pharmacy is in the
plan's network and the beneficiary's specific health care needs
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives
in an area that has suffered from major flooding that has been declared
a major disaster by both the Federal government and her state. As a
result of dealing with the flooding issues and being evacuated from her
home. Edna missed her chance to enroll in MA during her ICEP.......
- Correct Answer - Edna would qualify for a SEP because government
officials have declared a major disaster for her area and she did not
enroll in MA during her ICEP due to the emergency. George would
qualify for an SEP. Harriet would also qualify for an SEP
Mrs. Goodman enrolled in an MA-PD plan during the Annual Election
Period. In mid-January of the following year, she wants to switch back to
,Original Medicare and enroll in a stand-alone prescription drug plan.
What should you tell her?
- Correct Answer - During the MA OEP, she may disenroll from the MA-
PD plan into Original Medicare and also may add a stand-alone
prescription drug plan
A client wants to give you an enrollment application on October 1 before
the beginning of the AEP because he is leaving on vacation for two
weeks and does not want to forget about turning it in. What should you
tell him?
- Correct Answer - Marketing representatives may not accept enrollment
forms before October 15 for enrollments under the AEP. However, if a
beneficiary sends an unsolicited AEP paper enrollment request to the
plan on or after October 1 but before the AEP begins, the plan will
process the application beginning on the first day of the election period
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in
his area has an attractive premium. He wants to know if he must use
doctors in a network like his current HMO plan requires him to do. What
should you tell him?
- Correct Answer - He may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the doctor the plan's
identification card and the doctor agrees to accept the PFFS plan's
payment terms and conditions, which could include balance billing
, Mr. Kumar is considering a Medicare Advantage HMO and has questions
about his ability to access providers. What should you tell him?
- Correct Answer - In most Medicare Advantage HMOs, Mr. Kumar must
generally obtain his services only from providers within the plan's
network
Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and Mr.
Greco would like to join that plan. What should you tell him?
- Correct Answer - SNPs limit enrollment to certain subpopulations of
beneficiaries. Given his current situation, he is unlikely to qualify and
would not be able to enroll in the SNP
Mrs. Burton is a retiree with substantial income. She is enrolled in an
MA-PD plan and was disappointed with the service she received from
her primary care physician because she was told she would have to wait
five weeks to get an appointment when she was feeling ill. She called
you to ask what she could do so she would not have to put up with such
poor access to care. What could you tell her?
- Correct Answer - She could file a grievance with her plan to complain
about the lack of timeliness in getting an appointment
Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug
QUESTIONS AND ANSWERS
GRADED A+ | 2024/2025 GUIDE
Mrs. Parker likes to handle most of her business matters through
telephone calls. She currently is enrolled in Original Medicare Parts A
and B but has heard about a Medicare Advantage plan offered by Senior
Health from a neighbor. Mrs. Parker asks you whether she can enroll in
Senior Health's MA plan over the telephone. What can tell her?
I. Enrollment requests can only be made in face-to-face interviews or by
mail.
II. Telephone enrollment request calls must be recorded.
III. Telephonic enrollments must include all required elements necessary
to complete an enrollment.
IV. The signature element must be completed via certified mail.
- Correct Answer - II and III only
Mr. Ziegler 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?
- Correct Answer - During the Part D IEP, beneficiaries may make one
Part D enrollment choice, including enrollment in a stand-alone Part D
plan or an MA-PD plan if they are eligible for MA
,Torie Jones is a new marketing representative. Torie asks you for advice
as to what topics must be discussed with a Medicare beneficiary prior to
enrollment in a Medicare Advantage plan. What should you say?
- Correct Answer - CMS requires that more than just premiums be
discussed prior to and enrollment. Questions and topics to be discussed
include information regarding whether the beneficiary's primary care
providers and specialists are in the plan network, whether or not a
beneficiary's current prescriptions are covered and their costs, as well as
premiums, benefits, and cost of health care services. Other required
topics include whether or not the beneficiary's current pharmacy is in the
plan's network and the beneficiary's specific health care needs
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives
in an area that has suffered from major flooding that has been declared
a major disaster by both the Federal government and her state. As a
result of dealing with the flooding issues and being evacuated from her
home. Edna missed her chance to enroll in MA during her ICEP.......
- Correct Answer - Edna would qualify for a SEP because government
officials have declared a major disaster for her area and she did not
enroll in MA during her ICEP due to the emergency. George would
qualify for an SEP. Harriet would also qualify for an SEP
Mrs. Goodman enrolled in an MA-PD plan during the Annual Election
Period. In mid-January of the following year, she wants to switch back to
,Original Medicare and enroll in a stand-alone prescription drug plan.
What should you tell her?
- Correct Answer - During the MA OEP, she may disenroll from the MA-
PD plan into Original Medicare and also may add a stand-alone
prescription drug plan
A client wants to give you an enrollment application on October 1 before
the beginning of the AEP because he is leaving on vacation for two
weeks and does not want to forget about turning it in. What should you
tell him?
- Correct Answer - Marketing representatives may not accept enrollment
forms before October 15 for enrollments under the AEP. However, if a
beneficiary sends an unsolicited AEP paper enrollment request to the
plan on or after October 1 but before the AEP begins, the plan will
process the application beginning on the first day of the election period
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in
his area has an attractive premium. He wants to know if he must use
doctors in a network like his current HMO plan requires him to do. What
should you tell him?
- Correct Answer - He may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the doctor the plan's
identification card and the doctor agrees to accept the PFFS plan's
payment terms and conditions, which could include balance billing
, Mr. Kumar is considering a Medicare Advantage HMO and has questions
about his ability to access providers. What should you tell him?
- Correct Answer - In most Medicare Advantage HMOs, Mr. Kumar must
generally obtain his services only from providers within the plan's
network
Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and Mr.
Greco would like to join that plan. What should you tell him?
- Correct Answer - SNPs limit enrollment to certain subpopulations of
beneficiaries. Given his current situation, he is unlikely to qualify and
would not be able to enroll in the SNP
Mrs. Burton is a retiree with substantial income. She is enrolled in an
MA-PD plan and was disappointed with the service she received from
her primary care physician because she was told she would have to wait
five weeks to get an appointment when she was feeling ill. She called
you to ask what she could do so she would not have to put up with such
poor access to care. What could you tell her?
- Correct Answer - She could file a grievance with her plan to complain
about the lack of timeliness in getting an appointment
Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug
