AHIP 2024-2025 Final Exam Test Questions and Answers Updated (Verified
Answers)
A client wants to give you an enrollment application on October 1 before the
beginning of the Annual Election Period because he is leaving on vacation for two
weeks and does not want to forget about turning it in. What should you tell him? -
ansYou must tell him you are not permitted to take the form. If he sends the form
directly to the plan, the plan will process the enrollment on the day the Annual
Election Period begins.
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? - ansb.
It must obtain a HIPAA compliant authorization from an enrollee that indicates the
plan or plan sponsor may use their information for marketing purposes.
Agent Daniel Webber has properly set up a sales appointment to meet with client
Edward Young at Agent Webber's office. At the agreed upon appointment time, Mr.
Young arrives with his elderly neighbor - Clara Burton, who wants to learn about her
Medicare Advantage options. What should Agent Daniel Webber do? - ans
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not
provide drug benefits. How would you advise Agent John Miller to proceed? - ansTell
prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and
asks you for advice as to whether this is possible. What should you tell her? -
ansMarketing representatives may initiate electronic contact through e-mail but an
opt-out process must be provided.
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area
that has suffered from major flooding that has been declared a major disaster by
both the Federal government and her state. As a result of dealing with the flooding
issues and being evacuated from her home, Edna missed her chance to enroll in MA
during her Initial Coverage Election Period. Felix lives in an area with a Medicare
Advantage plan with a 4-star rating that he would like to join. George dropped his
Medigap policy six months ago when he first enrolled in a Medicare Advantage plan.
He now wants to return to Original Medicare. Harriet has recently developed
diabetes and would like to enroll in a Medicare Advantage plan that focuses on care
for those with that disease. Which, if any, of these individuals would qualify for a
special election period (SEP)? - ansEdna would qualify for a SEP because government
officials have declared a major disaster for her area and she did not enroll in MA
during her ICEP due to the emergency. George would qualify for an SEP because he
,AHIP 2024-2025 Final Exam Test Questions and Answers Updated (Verified
Answers)
enrolled in Medicare Advantage (MA) plan for the first time and would now like to
return to Original Medicare within the first 12 months of his enrollment. Harriet
would also qualify for a SEP to enroll in a C-SNP because she has developed a
chronic condition. Felix would not qualify for a SEP since he seeks to enroll in a 4-
star not a 5-star MA plan.
Hector Hernandez is an independent agent. Hector sells plans on behalf of three
Medicare Advantage organizations that offer a total of 10 plans but does not
represent all Medicare Advantage organizations offering plans that are available in
his area. Which of the following statements best describes any steps Hector is
required to take? - ansDuring the first minute of a sales call, Hector must send an
email to the prospect stating that "I represent 3 plans but not every plan available in
your area. Please contact Medicare.gov to get information on all your options.
If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep
that plan, what type of Medicare health plan could the individual also enroll in,
without being automatically disenrolled from the stand-alone prescription drug plan?
- ansThe beneficiary could enroll in a private fee-for-service (PFFS) plan that does not
include prescription drug coverage; a cost plan; or a Medicare Medical Savings
Account (MSA) plan.
Juan Hernandez is turning 65 next month, Juan legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Juan has
worked at Smallcap Incorporated and contributed to the Medicare system. Juan
suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare
Advantage plan that you represent. How would you respond? - ansJuan is eligible to
enroll in a Medicare Advantage as long as he is entitled to Part A and enrolled in Part
B. Juan should go to the Social Security website to enroll in Medicare Part A and B if
he has not done so already. Once he is enrolled, he can choose a Medicare
Advantage plan.
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? - ansYou 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.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a
,AHIP 2024-2025 Final Exam Test Questions and Answers Updated (Verified
Answers)
few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the Allcare
Medicare Advantage plan. What should you say? - ansMildred may remain enrolled in
Allcare and make a hospice election. Hospice benefits will be paid for by Original
Medicare under Part A and Allcare will continue to pay for any non-hospice services.
Mr. Albert has heard about something called the Star Rating system for Medicare
Advantage plans. He asks you to explain it to him since he is interested in enrolling
in a plan that is newly available in his area. After you explain that it is the way for
consumers to judge plan performance, what else would you say? - ansNew plans and
Part D sponsors that do not have any Star Rating are not required to provide Star
Rating information until the next contract year.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess
of his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - ansYou can offer to review the plans appeal process to help him ask the plan
to review the coverage decision.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him
- ansAfter receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him? - ansHe is not eligible to enroll in a Medicare Advantage
plan until he re-enrolls in Medicare Part B.
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much
he will have to pay. What should you tell him? - ansThe penalty will be a permanent
10% increase in his Part B premium for every 12-month period that passed during
which he could have enrolled and did not.
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What
action could you help him take during this time? - ansHe will have one opportunity to
enroll in a Medicare Advantage plan
, AHIP 2024-2025 Final Exam Test Questions and Answers Updated (Verified
Answers)
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has
an attractive premium. He wants to know if he must use doctors in a network as his
current HMO plan requires him to do. What should you tell him? - ansHe may receive
health care services from any doctor allowed to bill Medicare, as long as he shows
the doctor the plan's identification card and the doctor agrees to accept the PFFS
plan's payment terms and conditions, which could include balance billing.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does not enroll in a Medicare
prescription drug plan, but does not want to purchase extra coverage that he will not
need. What should you tell him? - ansHe will need to enroll in a Medicare prescription
drug plan upon becoming eligible for the program in order to avoid a premium
penalty. To reduce his expenses, he should look for a plan with a zero premium.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility? -
ansYou would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he
lives in the PFFS plan's service area.
Mr. Lee was intending to enroll in MaxCare's Medicare Advantage plan this year.
However, due to his current medical condition, his daughter Debbie has been
appointed as his legal representative over both health and financial matters. Debbie
would like to ensure that her father is still able to enroll in MaxCare's plan, but she is
unsure what her role is to help with his enrollment request. What advice can you give
her? - ansDebbie can submit an telephonic enrollment request on Mr. Lee's behalf as
long as she attests that she has the legal authority to do so
Mr. Roberts is enrolled in an MA plan. He recently suffered complications following
hip replacement surgery. As a result, he has spent the last three months in
Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What
advice would you give him regarding his health coverage options? - ansHis open
enrollment period as an institutionalized individual will continue for two months after
the month he moves out of the facility.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to
work and is covered by an employer health plan, he has not enrolled in Part B or Part
D. He receives a notice on June 1 that his employer is cutting back on prescription
drug benefits and that as of July 1 his coverage will no longer be creditable. He has
come to you for advice. What advice would you give Mr. Rockwell about special
election periods (SEPs)? - ansMr. Rockwell is eligible for a SEP due to his involuntary
loss of creditable drug coverage; the SEP begins in June and ends September 1 - two
months after the loss of creditable coverage.
Answers)
A client wants to give you an enrollment application on October 1 before the
beginning of the Annual Election Period because he is leaving on vacation for two
weeks and does not want to forget about turning it in. What should you tell him? -
ansYou must tell him you are not permitted to take the form. If he sends the form
directly to the plan, the plan will process the enrollment on the day the Annual
Election Period begins.
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? - ansb.
It must obtain a HIPAA compliant authorization from an enrollee that indicates the
plan or plan sponsor may use their information for marketing purposes.
Agent Daniel Webber has properly set up a sales appointment to meet with client
Edward Young at Agent Webber's office. At the agreed upon appointment time, Mr.
Young arrives with his elderly neighbor - Clara Burton, who wants to learn about her
Medicare Advantage options. What should Agent Daniel Webber do? - ans
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not
provide drug benefits. How would you advise Agent John Miller to proceed? - ansTell
prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and
asks you for advice as to whether this is possible. What should you tell her? -
ansMarketing representatives may initiate electronic contact through e-mail but an
opt-out process must be provided.
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area
that has suffered from major flooding that has been declared a major disaster by
both the Federal government and her state. As a result of dealing with the flooding
issues and being evacuated from her home, Edna missed her chance to enroll in MA
during her Initial Coverage Election Period. Felix lives in an area with a Medicare
Advantage plan with a 4-star rating that he would like to join. George dropped his
Medigap policy six months ago when he first enrolled in a Medicare Advantage plan.
He now wants to return to Original Medicare. Harriet has recently developed
diabetes and would like to enroll in a Medicare Advantage plan that focuses on care
for those with that disease. Which, if any, of these individuals would qualify for a
special election period (SEP)? - ansEdna would qualify for a SEP because government
officials have declared a major disaster for her area and she did not enroll in MA
during her ICEP due to the emergency. George would qualify for an SEP because he
,AHIP 2024-2025 Final Exam Test Questions and Answers Updated (Verified
Answers)
enrolled in Medicare Advantage (MA) plan for the first time and would now like to
return to Original Medicare within the first 12 months of his enrollment. Harriet
would also qualify for a SEP to enroll in a C-SNP because she has developed a
chronic condition. Felix would not qualify for a SEP since he seeks to enroll in a 4-
star not a 5-star MA plan.
Hector Hernandez is an independent agent. Hector sells plans on behalf of three
Medicare Advantage organizations that offer a total of 10 plans but does not
represent all Medicare Advantage organizations offering plans that are available in
his area. Which of the following statements best describes any steps Hector is
required to take? - ansDuring the first minute of a sales call, Hector must send an
email to the prospect stating that "I represent 3 plans but not every plan available in
your area. Please contact Medicare.gov to get information on all your options.
If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep
that plan, what type of Medicare health plan could the individual also enroll in,
without being automatically disenrolled from the stand-alone prescription drug plan?
- ansThe beneficiary could enroll in a private fee-for-service (PFFS) plan that does not
include prescription drug coverage; a cost plan; or a Medicare Medical Savings
Account (MSA) plan.
Juan Hernandez is turning 65 next month, Juan legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Juan has
worked at Smallcap Incorporated and contributed to the Medicare system. Juan
suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare
Advantage plan that you represent. How would you respond? - ansJuan is eligible to
enroll in a Medicare Advantage as long as he is entitled to Part A and enrolled in Part
B. Juan should go to the Social Security website to enroll in Medicare Part A and B if
he has not done so already. Once he is enrolled, he can choose a Medicare
Advantage plan.
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? - ansYou 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.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a
,AHIP 2024-2025 Final Exam Test Questions and Answers Updated (Verified
Answers)
few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the Allcare
Medicare Advantage plan. What should you say? - ansMildred may remain enrolled in
Allcare and make a hospice election. Hospice benefits will be paid for by Original
Medicare under Part A and Allcare will continue to pay for any non-hospice services.
Mr. Albert has heard about something called the Star Rating system for Medicare
Advantage plans. He asks you to explain it to him since he is interested in enrolling
in a plan that is newly available in his area. After you explain that it is the way for
consumers to judge plan performance, what else would you say? - ansNew plans and
Part D sponsors that do not have any Star Rating are not required to provide Star
Rating information until the next contract year.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess
of his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - ansYou can offer to review the plans appeal process to help him ask the plan
to review the coverage decision.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him
- ansAfter receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him? - ansHe is not eligible to enroll in a Medicare Advantage
plan until he re-enrolls in Medicare Part B.
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much
he will have to pay. What should you tell him? - ansThe penalty will be a permanent
10% increase in his Part B premium for every 12-month period that passed during
which he could have enrolled and did not.
Mr. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What
action could you help him take during this time? - ansHe will have one opportunity to
enroll in a Medicare Advantage plan
, AHIP 2024-2025 Final Exam Test Questions and Answers Updated (Verified
Answers)
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has
an attractive premium. He wants to know if he must use doctors in a network as his
current HMO plan requires him to do. What should you tell him? - ansHe may receive
health care services from any doctor allowed to bill Medicare, as long as he shows
the doctor the plan's identification card and the doctor agrees to accept the PFFS
plan's payment terms and conditions, which could include balance billing.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does not enroll in a Medicare
prescription drug plan, but does not want to purchase extra coverage that he will not
need. What should you tell him? - ansHe will need to enroll in a Medicare prescription
drug plan upon becoming eligible for the program in order to avoid a premium
penalty. To reduce his expenses, he should look for a plan with a zero premium.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility? -
ansYou would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he
lives in the PFFS plan's service area.
Mr. Lee was intending to enroll in MaxCare's Medicare Advantage plan this year.
However, due to his current medical condition, his daughter Debbie has been
appointed as his legal representative over both health and financial matters. Debbie
would like to ensure that her father is still able to enroll in MaxCare's plan, but she is
unsure what her role is to help with his enrollment request. What advice can you give
her? - ansDebbie can submit an telephonic enrollment request on Mr. Lee's behalf as
long as she attests that she has the legal authority to do so
Mr. Roberts is enrolled in an MA plan. He recently suffered complications following
hip replacement surgery. As a result, he has spent the last three months in
Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What
advice would you give him regarding his health coverage options? - ansHis open
enrollment period as an institutionalized individual will continue for two months after
the month he moves out of the facility.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to
work and is covered by an employer health plan, he has not enrolled in Part B or Part
D. He receives a notice on June 1 that his employer is cutting back on prescription
drug benefits and that as of July 1 his coverage will no longer be creditable. He has
come to you for advice. What advice would you give Mr. Rockwell about special
election periods (SEPs)? - ansMr. Rockwell is eligible for a SEP due to his involuntary
loss of creditable drug coverage; the SEP begins in June and ends September 1 - two
months after the loss of creditable coverage.
