AHIP FWA 2023 Exam/ Questions &
Answers Updated 2025
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but
is not sure about what type of plan designs are available through this program. What
should you tell him about the types of health plans that are available through the
Medicare Advantage program? - CORRECT ANSWERS-They are Medicare health
plans such as HMOs, PPOs, PFFS, and MSAs.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him
at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him? - CORRECT ANSWERS-C-SNP
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell her
about obtaining drug coverage? - CORRECT ANSWERS-She can enroll in the PPO,
but she will not be able to purchase a stand-alone Medicare Part D prescription drug
plan.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise
her to do before she will be able to enroll in a Medicare Advantage plan? - CORRECT
ANSWERS-To join a Medicare Advantage plan, she also must enroll in Part B.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - CORRECT ANSWERS-Mrs. Radford must be
entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
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? - CORRECT
ANSWERS-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.
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? - CORRECT ANSWERS-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.
All plans must cover at least the standard Part D coverage or its actuarial equivalent.
Which of the following statements best describes some of the costs a beneficiary would
incur for prescription drugs under the standard coverage? - CORRECT ANSWERS-
,Standard Part D coverage would require payment of an annual deductible, and once
past the catastrophic coverage threshold, the beneficiary pays whichever is greater of
either the co-pays for generic and brand name drugs or coinsurance of 5%.
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.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy will be
worth the time to fill out the paperwork. What could you tell her? - CORRECT
ANSWERS-The Part D low-income subsidy could substantially lower her overall costs.
She can apply by contacting her state Medicaid office or calling the Social Security
Administration.
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.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer plan
does not cover prescription drugs, she wants to enroll in a Medicare prescription drug
plan. Will she be able to? - CORRECT ANSWERS-Yes. Mrs. Walters must be entitled
to Part A and/or enrolled in Part B to be eligible for coverage under the Medicare
prescription drug program.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription for helping to regrow his hair. They are anxious to have
their Medicare prescription drug plan cover these drug needs. What should you tell
them? - CORRECT ANSWERS-Medicare prescription drug plans are not permitted to
cover the prescription medications the Vaughns are interested in under Part D
coverage, however, plans may cover them as supplemental benefits and the Vaughn's
could look into that possibility.
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
Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary
but also in some instances drug manufacturer discounts.
, Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be
extra help paying for Part D prescription drugs for Medicare beneficiaries with limited
income. He wants to know whether he might qualify. What should you tell him? -
CORRECT ANSWERS-The extra help is available to beneficiaries whose income and
assets do not exceed annual limits specified by the government.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met? What could you tell her? - CORRECT ANSWERS-Original
Medicare covers ambulance services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? - CORRECT ANSWERS-Mr. Singh can
enroll in a stand-alone prescription drug plan and continue to be covered for Part A and
Part B services through Original Fee-for-Service Medicare.
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? - CORRECT ANSWERS-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.
Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her? -
CORRECT ANSWERS-You should tell Madeline that she will be able to enroll in
Medicare Part A without paying monthly premiums due to her husband's long work
record and participation in the Medicare system. You should also tell Madeline that she
will pay Part B premiums at more than the standard lowest rate but less than the highest
rate due her substantial income.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - CORRECT ANSWERS-
Medicare does not cover massage therapy, or, in general, glasses or dentures.
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving
Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her
that she has been automatically enrolled in Medicare Part B. She wants to understand
what this means. What should you tell Mrs. Quinn? - CORRECT ANSWERS-Part B
primarily covers physician services. She will be paying a monthly premium and, with the
Answers Updated 2025
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but
is not sure about what type of plan designs are available through this program. What
should you tell him about the types of health plans that are available through the
Medicare Advantage program? - CORRECT ANSWERS-They are Medicare health
plans such as HMOs, PPOs, PFFS, and MSAs.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him
at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him? - CORRECT ANSWERS-C-SNP
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell her
about obtaining drug coverage? - CORRECT ANSWERS-She can enroll in the PPO,
but she will not be able to purchase a stand-alone Medicare Part D prescription drug
plan.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise
her to do before she will be able to enroll in a Medicare Advantage plan? - CORRECT
ANSWERS-To join a Medicare Advantage plan, she also must enroll in Part B.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - CORRECT ANSWERS-Mrs. Radford must be
entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
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? - CORRECT
ANSWERS-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.
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? - CORRECT ANSWERS-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.
All plans must cover at least the standard Part D coverage or its actuarial equivalent.
Which of the following statements best describes some of the costs a beneficiary would
incur for prescription drugs under the standard coverage? - CORRECT ANSWERS-
,Standard Part D coverage would require payment of an annual deductible, and once
past the catastrophic coverage threshold, the beneficiary pays whichever is greater of
either the co-pays for generic and brand name drugs or coinsurance of 5%.
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.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy will be
worth the time to fill out the paperwork. What could you tell her? - CORRECT
ANSWERS-The Part D low-income subsidy could substantially lower her overall costs.
She can apply by contacting her state Medicaid office or calling the Social Security
Administration.
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.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer plan
does not cover prescription drugs, she wants to enroll in a Medicare prescription drug
plan. Will she be able to? - CORRECT ANSWERS-Yes. Mrs. Walters must be entitled
to Part A and/or enrolled in Part B to be eligible for coverage under the Medicare
prescription drug program.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription for helping to regrow his hair. They are anxious to have
their Medicare prescription drug plan cover these drug needs. What should you tell
them? - CORRECT ANSWERS-Medicare prescription drug plans are not permitted to
cover the prescription medications the Vaughns are interested in under Part D
coverage, however, plans may cover them as supplemental benefits and the Vaughn's
could look into that possibility.
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
Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary
but also in some instances drug manufacturer discounts.
, Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be
extra help paying for Part D prescription drugs for Medicare beneficiaries with limited
income. He wants to know whether he might qualify. What should you tell him? -
CORRECT ANSWERS-The extra help is available to beneficiaries whose income and
assets do not exceed annual limits specified by the government.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met? What could you tell her? - CORRECT ANSWERS-Original
Medicare covers ambulance services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? - CORRECT ANSWERS-Mr. Singh can
enroll in a stand-alone prescription drug plan and continue to be covered for Part A and
Part B services through Original Fee-for-Service Medicare.
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? - CORRECT ANSWERS-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.
Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her? -
CORRECT ANSWERS-You should tell Madeline that she will be able to enroll in
Medicare Part A without paying monthly premiums due to her husband's long work
record and participation in the Medicare system. You should also tell Madeline that she
will pay Part B premiums at more than the standard lowest rate but less than the highest
rate due her substantial income.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - CORRECT ANSWERS-
Medicare does not cover massage therapy, or, in general, glasses or dentures.
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving
Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her
that she has been automatically enrolled in Medicare Part B. She wants to understand
what this means. What should you tell Mrs. Quinn? - CORRECT ANSWERS-Part B
primarily covers physician services. She will be paying a monthly premium and, with the
