AHIP 2023 Final Exam/ Questions &
Correct Answers Updated 2024-2025( A+
Grade)
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - CORRECT ANSWERS-Medigap plans help beneficiaries cover Original
Medicare benefits, but they coordinate with Original Medicare coverage.
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? - CORRECT ANSWERS-Evidence of plan membership,
information on how to obtain services, and the effective date of coverage.
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? - CORRECT
ANSWERS-The plan has 10 calendar days to notify Mrs. Garcia in writing.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also
wants to have prescription drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original Medicare and a standalone
Part D plan. How would you advise Mrs. Chi? - CORRECT ANSWERS-Mrs. Chi may
enroll in a MA MSA plan and remain in her current standalone Part D prescription drug
plan.
Your colleague works at a third-party marketing organization (TMO) and she said she
did not need to take the Medicare training for brokers and agents or pass a test to
market Medicare plans since her contract is with the TMO, not the plans that have the
products she sells. What could you say to her? - CORRECT ANSWERS-You could tell
her she is wrong, and that only agents selling employer/union group plans are permitted
an exemption from testing, but some employer/union group plans may require testing to
promote agent compliance with CMS marketing requirements.
You are mailing invitations to new Medicare beneficiaries for a marketing event. You
want an idea of how many people to expect, so you would like to request RSVPs. What
should you keep in mind? - CORRECT ANSWERS-You may request RSVPs, but you
are not permitted to require contact information.
, Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
for the Part D low-income subsidy. Where might he turn for help with his prescription
drug costs? - CORRECT ANSWERS-Mr. Wu may still qualify for help in paying Part D
costs through his State Pharmaceutical Assistance Program.
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
tell him? - CORRECT ANSWERS-He should know that Medicaid will pay cost sharing
only for services provided by Medicaid participating providers.
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? - CORRECT ANSWERS-He will need to mail in
his payment with his enrollment form.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does
not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone
prescription drug plan. What should you tell her? - CORRECT ANSWERS-She could
enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify a plan that covers
all of her medications. She does not want to make an abrupt change to new drugs that
would be covered and asks what she should do. What should you tell her? - CORRECT
ANSWERS-Every Part D drug plan is required to cover a single one-month fill of her
existing medications sometime during a 90-day transition period.
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? - CORRECT
ANSWERS-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.
Mrs. Allen has a rare condition for which two different brand name drugs are the only
available treatment. She is concerned that since no generic prescription drug is
available and these drugs are very high cost, she will not be able to find a Medicare Part
D prescription drug plan that covers either one of them. What should you tell her? -
CORRECT ANSWERS-Medicare prescription drug plans are required to cover drugs in
each therapeutic category. She should be able to enroll in a Medicare prescription drug
plan that covers the medications she needs.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of
her neighbors called TrOOP. She asks you to explain it. What do you say? - CORRECT
ANSWERS-TrOOP stands for true out-of-pocket expenses that count toward the
Correct Answers Updated 2024-2025( A+
Grade)
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - CORRECT ANSWERS-Medigap plans help beneficiaries cover Original
Medicare benefits, but they coordinate with Original Medicare coverage.
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? - CORRECT ANSWERS-Evidence of plan membership,
information on how to obtain services, and the effective date of coverage.
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? - CORRECT
ANSWERS-The plan has 10 calendar days to notify Mrs. Garcia in writing.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also
wants to have prescription drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original Medicare and a standalone
Part D plan. How would you advise Mrs. Chi? - CORRECT ANSWERS-Mrs. Chi may
enroll in a MA MSA plan and remain in her current standalone Part D prescription drug
plan.
Your colleague works at a third-party marketing organization (TMO) and she said she
did not need to take the Medicare training for brokers and agents or pass a test to
market Medicare plans since her contract is with the TMO, not the plans that have the
products she sells. What could you say to her? - CORRECT ANSWERS-You could tell
her she is wrong, and that only agents selling employer/union group plans are permitted
an exemption from testing, but some employer/union group plans may require testing to
promote agent compliance with CMS marketing requirements.
You are mailing invitations to new Medicare beneficiaries for a marketing event. You
want an idea of how many people to expect, so you would like to request RSVPs. What
should you keep in mind? - CORRECT ANSWERS-You may request RSVPs, but you
are not permitted to require contact information.
, Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
for the Part D low-income subsidy. Where might he turn for help with his prescription
drug costs? - CORRECT ANSWERS-Mr. Wu may still qualify for help in paying Part D
costs through his State Pharmaceutical Assistance Program.
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
tell him? - CORRECT ANSWERS-He should know that Medicaid will pay cost sharing
only for services provided by Medicaid participating providers.
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? - CORRECT ANSWERS-He will need to mail in
his payment with his enrollment form.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does
not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone
prescription drug plan. What should you tell her? - CORRECT ANSWERS-She could
enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify a plan that covers
all of her medications. She does not want to make an abrupt change to new drugs that
would be covered and asks what she should do. What should you tell her? - CORRECT
ANSWERS-Every Part D drug plan is required to cover a single one-month fill of her
existing medications sometime during a 90-day transition period.
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? - CORRECT
ANSWERS-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.
Mrs. Allen has a rare condition for which two different brand name drugs are the only
available treatment. She is concerned that since no generic prescription drug is
available and these drugs are very high cost, she will not be able to find a Medicare Part
D prescription drug plan that covers either one of them. What should you tell her? -
CORRECT ANSWERS-Medicare prescription drug plans are required to cover drugs in
each therapeutic category. She should be able to enroll in a Medicare prescription drug
plan that covers the medications she needs.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of
her neighbors called TrOOP. She asks you to explain it. What do you say? - CORRECT
ANSWERS-TrOOP stands for true out-of-pocket expenses that count toward the
