AHIP 2022 QUESTIONS & 100%
VERIFIED ANSWERS / LATEST UPDATE /
ALREADY GRADED A+
mMr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to
know his options since he has decided to drop his retiree coverage and is eligible for Medicare. What
should you tell him? - Correct answer.Mr. Chen can disenroll from his employer-sponsored coverage to
elect a Medicare Advantage or Part D plan within 2 months of his disenrollment.
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 (except in an emergency
or where care is unavailable within the network).
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to market
non-health related products such as life insurance and annuities. Which statement best describes ABC's
obligation to its enrollees regarding marketing such products? - Correct answer.XXXIt must obtain a
HIPAA complaint authorization from an enrollee that indicates the plan or plan sponsor may use their
information for marketing purposes.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was
offered to company retirees. The company told Mr. Yoo that, because he was affected by this change, he
would qualify for a Special election period. Mr. Yoo contacted you to find out more about what this
means. What can you tell him? - Correct answer.It means that he qualifies for a one-time opportunity to
enroll in an MA-PD or Part D prescription drug plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and
conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan
charge? - Correct answer.Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in
the PFFS plan's terms and condition of payment which may include balance billing up to 15% of the
Medicare rate.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized.
What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric
,hospital stay that Medicare will cover? - Correct answer.Medicare will cover a total of 190 days of
inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans
that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should
Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees
who attend the sales presentation? - Correct answer.A meal cannot be provided, but light snacks would
be permitted.
You have approached a hospital administrator about marketing in her facility. The administrator is
uncomfortable with the suggestion. How could you address her concerns? - Correct answer.Tell her that
Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility.
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 answer.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.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and
also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?
- Correct answer.If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not
offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
Which of the following is/are most likely to be characterized as an involuntary disenrollment from a
Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to substantially improved health.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment period. - Correct answer.I, II,
and III only
Ms. Brooks has an aggressive cancer and would like to k - Correct answer.Medicare covers hospice
services and they will be available for her.
, You are working several plans and community organizations to sponsor an educational event. When
putting together advertisements for this event, what should you do? - Correct answer.You must ensure
that the advertisements indicate it is an educational event, otherwise it will be considered a marketing
event.
Which of the following statement is/are correct about a Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed
for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as
payment in full. - Correct answer.I and II, only
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 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.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
Medicare beneficiaries? - Correct answer..
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans? - Correct answer.A PFFS plan is one of the
various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is
available in her area.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the presentation, Mrs.
Midler tells you that she has a copy of her medical records available because she thinks this will help you
VERIFIED ANSWERS / LATEST UPDATE /
ALREADY GRADED A+
mMr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to
know his options since he has decided to drop his retiree coverage and is eligible for Medicare. What
should you tell him? - Correct answer.Mr. Chen can disenroll from his employer-sponsored coverage to
elect a Medicare Advantage or Part D plan within 2 months of his disenrollment.
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 (except in an emergency
or where care is unavailable within the network).
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to market
non-health related products such as life insurance and annuities. Which statement best describes ABC's
obligation to its enrollees regarding marketing such products? - Correct answer.XXXIt must obtain a
HIPAA complaint authorization from an enrollee that indicates the plan or plan sponsor may use their
information for marketing purposes.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was
offered to company retirees. The company told Mr. Yoo that, because he was affected by this change, he
would qualify for a Special election period. Mr. Yoo contacted you to find out more about what this
means. What can you tell him? - Correct answer.It means that he qualifies for a one-time opportunity to
enroll in an MA-PD or Part D prescription drug plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and
conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan
charge? - Correct answer.Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in
the PFFS plan's terms and condition of payment which may include balance billing up to 15% of the
Medicare rate.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized.
What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric
,hospital stay that Medicare will cover? - Correct answer.Medicare will cover a total of 190 days of
inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans
that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should
Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees
who attend the sales presentation? - Correct answer.A meal cannot be provided, but light snacks would
be permitted.
You have approached a hospital administrator about marketing in her facility. The administrator is
uncomfortable with the suggestion. How could you address her concerns? - Correct answer.Tell her that
Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility.
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 answer.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.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and
also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?
- Correct answer.If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not
offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
Which of the following is/are most likely to be characterized as an involuntary disenrollment from a
Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to substantially improved health.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment period. - Correct answer.I, II,
and III only
Ms. Brooks has an aggressive cancer and would like to k - Correct answer.Medicare covers hospice
services and they will be available for her.
, You are working several plans and community organizations to sponsor an educational event. When
putting together advertisements for this event, what should you do? - Correct answer.You must ensure
that the advertisements indicate it is an educational event, otherwise it will be considered a marketing
event.
Which of the following statement is/are correct about a Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed
for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as
payment in full. - Correct answer.I and II, only
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 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.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
Medicare beneficiaries? - Correct answer..
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans? - Correct answer.A PFFS plan is one of the
various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is
available in her area.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the presentation, Mrs.
Midler tells you that she has a copy of her medical records available because she thinks this will help you
