AHIP Final Exam Test Questions & Answers
(Latest )
Mr. and Mrs. Nunez attended one of your sales presentations.
They've asked you to come to their home to clear up a few questions.
During the presentation, Mrs. Nunez feels tired and tells you that her
husband can finish things up. She goes to bed. At the end of your
discussion, Mr. Nunez says that he wants to enroll both himself and
his wife. What should you do? - ANSWER ✔✔- As long as she is able
to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez
will have to wake up to sign her form or do so at another time.
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? - ANSWER ✔✔- He should
know that Medicaid will pay cost sharing only for services provided by
Medicaid participating providers.
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 a number of services and items he
thought would be fully covered. He called you to ask what he could
do? What could you tell him? - ANSWER ✔✔- You can offer to review
the plans appeal process to help him ask the plan to review the
coverage decision.
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, Mr. Zachow has a condition for which three drugs are available. He
has tried two, but had an allergic reaction to them. Only the third
drug works for him and it is not on his Part D plan's formulary. What
could you tell him to do? - ANSWER ✔✔- Mr. Zachow has a right to
request a formulary exception to obtain coverage for his Part D drug.
He or his physician could obtain the standardized request form on
the plan's website, fill it out, and submit it to his plan.
Mr. Patel is in good health and is preparing a budget in anticipation
of his retirement when he turns 66. He wants to understand the
health care costs he might be exposed to under Medicare if he were
to require hospitalization as a result of an illness. In general terms,
what could you tell him about his costs for inpatient hospital services
under Original Medicare? - ANSWER ✔✔- Under Original Medicare,
there is a single deductible amount due for the first 60 days of any
inpatient
hospital stay, after which it converts into a per-day amount through
day 90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be
responsible for all costs
Mrs. West wears glasses and dentures and has enjoyed considerable
pain relief from arthritis through acupuncture. She is concerned
about whether or not Medicare will cover these items and services.
What should you tell her? - ANSWER ✔✔- Medicare does not cover
acupuncture, or, in general, glasses or dentures.
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(Latest )
Mr. and Mrs. Nunez attended one of your sales presentations.
They've asked you to come to their home to clear up a few questions.
During the presentation, Mrs. Nunez feels tired and tells you that her
husband can finish things up. She goes to bed. At the end of your
discussion, Mr. Nunez says that he wants to enroll both himself and
his wife. What should you do? - ANSWER ✔✔- As long as she is able
to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez
will have to wake up to sign her form or do so at another time.
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? - ANSWER ✔✔- He should
know that Medicaid will pay cost sharing only for services provided by
Medicaid participating providers.
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 a number of services and items he
thought would be fully covered. He called you to ask what he could
do? What could you tell him? - ANSWER ✔✔- You can offer to review
the plans appeal process to help him ask the plan to review the
coverage decision.
1|Page
, Mr. Zachow has a condition for which three drugs are available. He
has tried two, but had an allergic reaction to them. Only the third
drug works for him and it is not on his Part D plan's formulary. What
could you tell him to do? - ANSWER ✔✔- Mr. Zachow has a right to
request a formulary exception to obtain coverage for his Part D drug.
He or his physician could obtain the standardized request form on
the plan's website, fill it out, and submit it to his plan.
Mr. Patel is in good health and is preparing a budget in anticipation
of his retirement when he turns 66. He wants to understand the
health care costs he might be exposed to under Medicare if he were
to require hospitalization as a result of an illness. In general terms,
what could you tell him about his costs for inpatient hospital services
under Original Medicare? - ANSWER ✔✔- Under Original Medicare,
there is a single deductible amount due for the first 60 days of any
inpatient
hospital stay, after which it converts into a per-day amount through
day 90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be
responsible for all costs
Mrs. West wears glasses and dentures and has enjoyed considerable
pain relief from arthritis through acupuncture. She is concerned
about whether or not Medicare will cover these items and services.
What should you tell her? - ANSWER ✔✔- Medicare does not cover
acupuncture, or, in general, glasses or dentures.
2|Page
