AHIP Final Exam Test Questions and Answers (2022/2023)
(Verified Answers) latest updated
Lexington) for several years. Recently, Mr. Wilcox decided to spend time with his children who live
in
another state that is not in Lexington's service area. In the future, he may relocate near his
children
permanently. How does this move to another service area impact his PFFS MA coverage?correct
answersLexington can allow for Mr. Wilcox's continued enrollment for up to 12 months whether
or
is in a visitor/traveler (V/T) program since it is a PFFS plan.
Mr. Wilcox has been enrolled in Lexington Private Fee-for-Service (PFFS) Medicare Advantage Health
Plan
(
not he
Miles is a licensed agent who represents Colgate Health and its Medicare Advantage (MA) plans. Miles
has several clients who have recently come to him for help. They are in their initial coverage periods)
(ICEP) and are interested in enrolling in one of Colgate Health's MA plans. Adam will soon turn 68 and
has decided to retire. Betty is about to turn 65 and has also decided to retire. Adam and Betty both
currently have coverage through Colgate Health. Charles had health coverage through Colgate but
dropped the coverage when he retired early to travel to Europe. Charles has just turned age 65 and is
now back in the United States. Diedre, who will turn 65 next month, currently has coverage through
Ditmas Health - a company that Miles also represents. Who qualifies for the opt-in simplified
enrollment mechanism?correct answersAdam and Betty because each of them will not have a break
between their non-Medicare and Medicare coverage through Colgate Health Plan.
Mr. Fitzgerald is selling his home to permanently move into a retirement facility near his daughter in a
neighboring state before the Annual Election Period. He has a stand- alone prescription drug plan and
has learned it is not available where he is moving. He doesn't know what he should do. What can you
tell him?correct answersBecause he is moving outside of the service area, the plan must automatically
disenroll him. He will have a special election period to select a new plan.
Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She has recently also become eligible for
,AHIP Final Exam Test Questions and Answers (Verified
Answers) latest updated
Medicaid and would like to enroll in a MA-PD plan. Since this is her first experience with Medicare
Advantage, she is concerned that she will be locked into a plan and unable to make any coverage
changes for at least a year if not longer. What should you tell her?correct answersSince Mrs. Jenkins
has Medicare Part A and Part B and receives Medicaid, she has a special election period (SEP) that will
allow her to enroll or disenroll from an MA or MA-PD plan during the first 9 months of each calendar
year.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his prescription
drug needs. He is interested in changing plans during the upcoming MA Open Enrollment Period. What
are his options during the MA OEP?correct answersHe can switch to a MA-PD plan.
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 answersII and III
only
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On
December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-
PD plan. What enrollment rules would apply in this case?correct answersHe can make as many
enrollment changes as he likes during the Annual Election Period and the last choice made prior to the
end of the period will be the effective one as of January 1.
Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare Part A and
did not enroll for Part B when first eligible because she has insurance through her employer - Coffee
Brew, Inc. She also did not enroll in Part D because she had creditable coverage. She would like to retire
in June and enroll in a
,AHIP Final Exam Test Questions and Answers (Verified
Answers) latest updated
Medicare Advantage plan. She has been informed that her group coverage will end on her retirement
effective date. How would you advise Ms. Thomas?correct answersMs.
Thomas can enroll in Part B without a late penalty at any time she is still covered by her employer
group and 8 months after her last month of employer group coverage without a penalty. However,
because she wants to enroll in a MA plan after retirement, she should make sure her Part B coverage is
effective in time to use the Medicare Advantage/Part D special election period for individuals changing
from employer group coverage to enroll in a MA plan or MA-PD. The SEP begins while she has employer
group coverage and will last until 2 months after the month after the month her employer coverage
ends. If she wants Part D coverage she should enroll in an MA-PD or a PDP (depending on how she
decides to receive her Part A and B benefits) during this time.
Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his first Medicare
eligibility date will be by June 1. Mr. Liu's ICEP and Part D IEP begin March 1 and end on September 30.
He wants prescription drug coverage with his Part A and Part B benefits. What advice can you provide
him?correct answersHe can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A.
Ms. Claggett is sixty-six (66) years old. She has been covered under Original Medicare for the last six
years due to her disability and has never been enrolled in a Medicare Advantage or a Part D plan
before. She wants to enroll in a Part D plan. She knows that there is such a thing as the "Part D Initial
Enrollment Period" (IEP) and has concluded that, since she has never enrolled in such a plan before, she
should be eligible to enroll under this period. What should you tell her about how the Part D Initial
Enrollment Period applies to her situation?correct answersMs. Claggett has had two IEPs and missed
them both. The first occurred three months before and three months after the month when she was
first entitled to Part A OR enrolled in Part B. Because she was eligible for Medicare before age 65, Ms.
Claggett had a second IEP based on turning age 65, which has also expired.
Ms. O'Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent.
She plans to switch from her old MA HMO plan to the new MA-PD plan during the Annual Election
Period. However, she wants to make sure she does not end up paying premiums for two plans. What
can you tell her?correct answersShe only needs to enroll in the new MA-PD plan and she will
automatically be disenrolled from her old MA plan.
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,
, AHIP Final Exam Test Questions and Answers (Verified
Answers) latest updated
how long does Caring Health have to notify Mrs. Garcia that her enrollment has been accepted and in
what format?correct answersThe plan has 10 calendar days to notify Mrs. Garcia in writing.
Mrs. Kendrick is in good health, has worked for many years and is six months away from turning
65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as
possible. What could you tell her?correct answersShe may enroll in an MA plan beginning three months
immediately before her first entitlement to both Medicare Part A and Part B.
Mrs. Reynolds is in her Medicare initial coverage election period (ICEP) and the date of her entitlement
to Part A and B has already occurred. Mrs. Reynolds has just signed up for a Medicare Advantage plan
on the second of the month. She is leaving for vacation in two weeks and wants to know if her new
coverage will start before she leaves. What should you tell her?correct answersTypically, her coverage
would begin on the first day of the next month, so she should not expect her coverage to begin before
she leaves.
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 answersPlan 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. 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 answersEvidence of plan membership, information on how to obtain services, and the
effective date of coverage.
Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form
on October 10 for a new plan available January 1 next year. He is currently enrolled in Original
Medicare. What should you do?correct answersTell Mr. Anderson that you cannot accept any
enrollment forms until the annual election period begins.
(Verified Answers) latest updated
Lexington) for several years. Recently, Mr. Wilcox decided to spend time with his children who live
in
another state that is not in Lexington's service area. In the future, he may relocate near his
children
permanently. How does this move to another service area impact his PFFS MA coverage?correct
answersLexington can allow for Mr. Wilcox's continued enrollment for up to 12 months whether
or
is in a visitor/traveler (V/T) program since it is a PFFS plan.
Mr. Wilcox has been enrolled in Lexington Private Fee-for-Service (PFFS) Medicare Advantage Health
Plan
(
not he
Miles is a licensed agent who represents Colgate Health and its Medicare Advantage (MA) plans. Miles
has several clients who have recently come to him for help. They are in their initial coverage periods)
(ICEP) and are interested in enrolling in one of Colgate Health's MA plans. Adam will soon turn 68 and
has decided to retire. Betty is about to turn 65 and has also decided to retire. Adam and Betty both
currently have coverage through Colgate Health. Charles had health coverage through Colgate but
dropped the coverage when he retired early to travel to Europe. Charles has just turned age 65 and is
now back in the United States. Diedre, who will turn 65 next month, currently has coverage through
Ditmas Health - a company that Miles also represents. Who qualifies for the opt-in simplified
enrollment mechanism?correct answersAdam and Betty because each of them will not have a break
between their non-Medicare and Medicare coverage through Colgate Health Plan.
Mr. Fitzgerald is selling his home to permanently move into a retirement facility near his daughter in a
neighboring state before the Annual Election Period. He has a stand- alone prescription drug plan and
has learned it is not available where he is moving. He doesn't know what he should do. What can you
tell him?correct answersBecause he is moving outside of the service area, the plan must automatically
disenroll him. He will have a special election period to select a new plan.
Mrs. Jenkins is enrolled in both Part A and Part B of Medicare. She has recently also become eligible for
,AHIP Final Exam Test Questions and Answers (Verified
Answers) latest updated
Medicaid and would like to enroll in a MA-PD plan. Since this is her first experience with Medicare
Advantage, she is concerned that she will be locked into a plan and unable to make any coverage
changes for at least a year if not longer. What should you tell her?correct answersSince Mrs. Jenkins
has Medicare Part A and Part B and receives Medicaid, she has a special election period (SEP) that will
allow her to enroll or disenroll from an MA or MA-PD plan during the first 9 months of each calendar
year.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his prescription
drug needs. He is interested in changing plans during the upcoming MA Open Enrollment Period. What
are his options during the MA OEP?correct answersHe can switch to a MA-PD plan.
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 answersII and III
only
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On
December 1, he calls you up and says that he has changed his mind and would like to enroll into a MA-
PD plan. What enrollment rules would apply in this case?correct answersHe can make as many
enrollment changes as he likes during the Annual Election Period and the last choice made prior to the
end of the period will be the effective one as of January 1.
Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare Part A and
did not enroll for Part B when first eligible because she has insurance through her employer - Coffee
Brew, Inc. She also did not enroll in Part D because she had creditable coverage. She would like to retire
in June and enroll in a
,AHIP Final Exam Test Questions and Answers (Verified
Answers) latest updated
Medicare Advantage plan. She has been informed that her group coverage will end on her retirement
effective date. How would you advise Ms. Thomas?correct answersMs.
Thomas can enroll in Part B without a late penalty at any time she is still covered by her employer
group and 8 months after her last month of employer group coverage without a penalty. However,
because she wants to enroll in a MA plan after retirement, she should make sure her Part B coverage is
effective in time to use the Medicare Advantage/Part D special election period for individuals changing
from employer group coverage to enroll in a MA plan or MA-PD. The SEP begins while she has employer
group coverage and will last until 2 months after the month after the month her employer coverage
ends. If she wants Part D coverage she should enroll in an MA-PD or a PDP (depending on how she
decides to receive her Part A and B benefits) during this time.
Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his first Medicare
eligibility date will be by June 1. Mr. Liu's ICEP and Part D IEP begin March 1 and end on September 30.
He wants prescription drug coverage with his Part A and Part B benefits. What advice can you provide
him?correct answersHe can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A.
Ms. Claggett is sixty-six (66) years old. She has been covered under Original Medicare for the last six
years due to her disability and has never been enrolled in a Medicare Advantage or a Part D plan
before. She wants to enroll in a Part D plan. She knows that there is such a thing as the "Part D Initial
Enrollment Period" (IEP) and has concluded that, since she has never enrolled in such a plan before, she
should be eligible to enroll under this period. What should you tell her about how the Part D Initial
Enrollment Period applies to her situation?correct answersMs. Claggett has had two IEPs and missed
them both. The first occurred three months before and three months after the month when she was
first entitled to Part A OR enrolled in Part B. Because she was eligible for Medicare before age 65, Ms.
Claggett had a second IEP based on turning age 65, which has also expired.
Ms. O'Donnell learned about a new MA-PD plan that her neighbor suggested and that you represent.
She plans to switch from her old MA HMO plan to the new MA-PD plan during the Annual Election
Period. However, she wants to make sure she does not end up paying premiums for two plans. What
can you tell her?correct answersShe only needs to enroll in the new MA-PD plan and she will
automatically be disenrolled from her old MA plan.
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,
, AHIP Final Exam Test Questions and Answers (Verified
Answers) latest updated
how long does Caring Health have to notify Mrs. Garcia that her enrollment has been accepted and in
what format?correct answersThe plan has 10 calendar days to notify Mrs. Garcia in writing.
Mrs. Kendrick is in good health, has worked for many years and is six months away from turning
65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as
possible. What could you tell her?correct answersShe may enroll in an MA plan beginning three months
immediately before her first entitlement to both Medicare Part A and Part B.
Mrs. Reynolds is in her Medicare initial coverage election period (ICEP) and the date of her entitlement
to Part A and B has already occurred. Mrs. Reynolds has just signed up for a Medicare Advantage plan
on the second of the month. She is leaving for vacation in two weeks and wants to know if her new
coverage will start before she leaves. What should you tell her?correct answersTypically, her coverage
would begin on the first day of the next month, so she should not expect her coverage to begin before
she leaves.
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 answersPlan 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. 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 answersEvidence of plan membership, information on how to obtain services, and the
effective date of coverage.
Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form
on October 10 for a new plan available January 1 next year. He is currently enrolled in Original
Medicare. What should you do?correct answersTell Mr. Anderson that you cannot accept any
enrollment forms until the annual election period begins.
