AHIP 2024/2025 TEST GUIDE
QUESTIONS WITH CORRECT ANSWERS
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefits package of a Medicare Advantage Plan before she starts
looking at specific plans. What could you tell her? - Answer-Medicare Advantage Plans
may offer extra benefits that Original Medicare does not offer such as vision, hearing,
and dental services and must include a maximum out-of-pocket limit on Part A and Part
B services.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after
her lengthy hospital stay she will need a month or two of nursing and rehabilitative care.
What should you tell them about Original Medicare's coverage of care in a skilled
nursing facility? - Answer-Medicare will cover Mrs. Shield's skilled nursing services
provided during the first 20 days of her stay, after which she would have a copay until
she has been in the facility for 100 days.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD
plan. He is worried that he will lose his coverage now when he needs it the most. He is
certain his plan will disenroll him because that is what happened to a friend of his in a
similar type of plan. What can you tell Mr. Robinson about his situation? - Answer-Plan
sponsors have the option to do nothing when a plan member does not pay their
premiums or disenroll the member after a grace period and notice.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - Answer-SNPs have
special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well.
Willard works as a representative focused on the senior marketplace. What would be
considered prohibited activity by Willard? - Answer-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.
Agent Harriet Walker has recently begun marketing Medicare Advantage and related
products aimed at meeting the needs of senior citizens. Client Mildred Jones has
expressed interest in a Medicare Advantage plan. It is now the beginning of September.
If you were in Agent Walker's position, what would you do? - Answer-Inquire whether
the client qualifies for a special enrollment period, and if not, solicit an enrollment
application once the annual open enrollment election period begins on October 15th.
, Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but
he did not enroll in Part B because he has employer-sponsored coverage and intends to
keep working for several more years. But he is considering enrolling in Part D
prescription drug coverage because he believes it is superior to his employer plan. How
would you advise him? - Answer-Mr. Landry is eligible for Part D since he has Part A,
and his initial enrollment period (IEP) for Part D will continue for three months after his
65th birthday.
Agent Marvin Millner wants to reach out to his current clients for referrals. What advice
would you give to Marvin? - Answer-Marvin should consult with the health plans he
represents to determine whether those plans impose requirements around beneficiary
referrals.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - Answer-
Medicare covers the periodic performance of a range of screening tests that are meant
to provide early detection of disease. Mr. Buck will need to check specific tests before
obtaining them to see if they will be covered.
If you are to comply with Medicare's guidance regarding educational events, which of
the following would be acceptable activities? - Answer-You may distribute business
cards to individuals who request information on how to contact you for further details on
the plan(s) you represent.
You market many different types of insurance and ordinarily you spend time each
evening calling potential clients. To comply with requirements for marketing Medicare
Advantage and Part D plans, what must you do about contacting potential clients to
market those plans? - Answer-You will have to avoid calling any potential client unless
he or she initiates contact with you and specifically asks that you give him or her a call.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard
about a neighbor's MA-PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should you tell him? -
Answer-He should compare the benefits in his employer-sponsored retiree group health
plan with the benefits in his neighbor's MA-PD plan to determine which one will provide
sufficient coverage for his prescription needs.
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? - Answer-Yes. All SNPs are required to provide Part D coverage
for prescription drugs.
QUESTIONS WITH CORRECT ANSWERS
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefits package of a Medicare Advantage Plan before she starts
looking at specific plans. What could you tell her? - Answer-Medicare Advantage Plans
may offer extra benefits that Original Medicare does not offer such as vision, hearing,
and dental services and must include a maximum out-of-pocket limit on Part A and Part
B services.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after
her lengthy hospital stay she will need a month or two of nursing and rehabilitative care.
What should you tell them about Original Medicare's coverage of care in a skilled
nursing facility? - Answer-Medicare will cover Mrs. Shield's skilled nursing services
provided during the first 20 days of her stay, after which she would have a copay until
she has been in the facility for 100 days.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD
plan. He is worried that he will lose his coverage now when he needs it the most. He is
certain his plan will disenroll him because that is what happened to a friend of his in a
similar type of plan. What can you tell Mr. Robinson about his situation? - Answer-Plan
sponsors have the option to do nothing when a plan member does not pay their
premiums or disenroll the member after a grace period and notice.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - Answer-SNPs have
special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well.
Willard works as a representative focused on the senior marketplace. What would be
considered prohibited activity by Willard? - Answer-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.
Agent Harriet Walker has recently begun marketing Medicare Advantage and related
products aimed at meeting the needs of senior citizens. Client Mildred Jones has
expressed interest in a Medicare Advantage plan. It is now the beginning of September.
If you were in Agent Walker's position, what would you do? - Answer-Inquire whether
the client qualifies for a special enrollment period, and if not, solicit an enrollment
application once the annual open enrollment election period begins on October 15th.
, Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but
he did not enroll in Part B because he has employer-sponsored coverage and intends to
keep working for several more years. But he is considering enrolling in Part D
prescription drug coverage because he believes it is superior to his employer plan. How
would you advise him? - Answer-Mr. Landry is eligible for Part D since he has Part A,
and his initial enrollment period (IEP) for Part D will continue for three months after his
65th birthday.
Agent Marvin Millner wants to reach out to his current clients for referrals. What advice
would you give to Marvin? - Answer-Marvin should consult with the health plans he
represents to determine whether those plans impose requirements around beneficiary
referrals.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - Answer-
Medicare covers the periodic performance of a range of screening tests that are meant
to provide early detection of disease. Mr. Buck will need to check specific tests before
obtaining them to see if they will be covered.
If you are to comply with Medicare's guidance regarding educational events, which of
the following would be acceptable activities? - Answer-You may distribute business
cards to individuals who request information on how to contact you for further details on
the plan(s) you represent.
You market many different types of insurance and ordinarily you spend time each
evening calling potential clients. To comply with requirements for marketing Medicare
Advantage and Part D plans, what must you do about contacting potential clients to
market those plans? - Answer-You will have to avoid calling any potential client unless
he or she initiates contact with you and specifically asks that you give him or her a call.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard
about a neighbor's MA-PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should you tell him? -
Answer-He should compare the benefits in his employer-sponsored retiree group health
plan with the benefits in his neighbor's MA-PD plan to determine which one will provide
sufficient coverage for his prescription needs.
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? - Answer-Yes. All SNPs are required to provide Part D coverage
for prescription drugs.
