2024 AHIP FINAL EXAM LATEST VESION
UPDATED QUESTIONS AND ANSWERS ALEADY
GRADED A+
Mr. Schmidt would like to plan for retirement and has asked you
what is covered under Original Fee-for-Service (FFS) Medicare.
What could you tell him? - correct answer✔✔Part A, which covers
hospital, skilled nursing facility, hospice, and home health
services and Part B, which covers professional services such as
those provided by a doctor are covered under Original Medicare.
Mr. Wu is eligible for Medicare. He has limited financial resources
but failed to qualify for the Part D low-income subsidy. Where
might he turn for help with his prescription drug costs? - correct
answer✔✔Mr. Wu may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program.
Shirly Thomas was enrolled in Medicaid during the Public Health
Emergency (PHE). This coverage has recently been terminated
due to the end of the PHE. While Shirley was enrolled in
Medicaid, she missed an opportunity to enroll in Medicare and
now wants Part B. Which of the following statements best
describes Shirley's ability to now enroll in Medicare Part B? -
correct answer✔✔Shirley is eligible for a Special Enrollment
Period (SEP) for up to six months after the termination of her
Medicaid coverage. Under this SEP, Shirley can choose
retroactive coverage back to the date of termination from
Medicaid or coverage beginning the month after the month of
enrollment.
,Anthony Boniface turned 65 in 2023. He was not receiving Social
Security or Railroad Retirement Benefits on his 65th birthday. He
was interested in obtaining Medicare coverage and is eligible for
premium-free Part A. Before he could enroll in Medicare, his
entire area was impacted by a hurricane causing massive flooding
and severe wind damage. The Federal government declared this
to be a natural disaster which has recently ended. During this
period Anthony's initial enrollment period expired. Anthony asks
you how he can now obtain Medicare coverage. What should you
say? - correct answer✔✔Anthony is eligible for a special
enrollment period (SEP) because he missed an enrollment period
due to the impact of the Federally declared disaster. This SEP will
allow Anthony to enroll in Part B up to six months after the end of
the emergency declaration. Anthony may enroll in premium-free
Part A at any time and his Part A coverage will be retroactive for
up to 6 months.
Mrs. Lyons is in good health, uses a single prescription, and lives
independently in her own home. She is attracted by the idea of
maintaining control over a Medical Savings Account (MSA) but is
not sure if the plan associated with the account will fit her needs.
What specific piece of information about a Medicare MSA plan
would it be important for her to know, prior to enrolling in such a
plan? - correct answer✔✔All MSAs cover Part A and Part B
benefits, but not Part D prescription drug benefits, which could be
obtained by also enrolling in a separate prescription drug plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care.
What should you tell her? - correct answer✔✔Mrs. Ramos can
obtain care from any provider who participates in Original
Medicare, but generally will have a higher cost-sharing amount if
she sees a provider who/that is not a part of the PPO network.
,Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug
coverage with nominal copays. He heard about a neighbor's MA-
PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should
you tell him? - correct answer✔✔He should compare the benefits
in his employer-sponsored retiree group health plan with the
benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
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.
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. 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? - correct
answer✔✔He 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.
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? - correct answer✔✔Juan 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.
Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her? -
correct answer✔✔Mrs. Radford must be entitled to Part A and
enrolled in Part B to enroll in Medicare Advantage.
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? - correct
answer✔✔You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
Mrs. Burton is a retiree with substantial income. She is enrolled in
an MA-PD plan and was disappointed with the service she
received from her primary care physician because she was told
UPDATED QUESTIONS AND ANSWERS ALEADY
GRADED A+
Mr. Schmidt would like to plan for retirement and has asked you
what is covered under Original Fee-for-Service (FFS) Medicare.
What could you tell him? - correct answer✔✔Part A, which covers
hospital, skilled nursing facility, hospice, and home health
services and Part B, which covers professional services such as
those provided by a doctor are covered under Original Medicare.
Mr. Wu is eligible for Medicare. He has limited financial resources
but failed to qualify for the Part D low-income subsidy. Where
might he turn for help with his prescription drug costs? - correct
answer✔✔Mr. Wu may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program.
Shirly Thomas was enrolled in Medicaid during the Public Health
Emergency (PHE). This coverage has recently been terminated
due to the end of the PHE. While Shirley was enrolled in
Medicaid, she missed an opportunity to enroll in Medicare and
now wants Part B. Which of the following statements best
describes Shirley's ability to now enroll in Medicare Part B? -
correct answer✔✔Shirley is eligible for a Special Enrollment
Period (SEP) for up to six months after the termination of her
Medicaid coverage. Under this SEP, Shirley can choose
retroactive coverage back to the date of termination from
Medicaid or coverage beginning the month after the month of
enrollment.
,Anthony Boniface turned 65 in 2023. He was not receiving Social
Security or Railroad Retirement Benefits on his 65th birthday. He
was interested in obtaining Medicare coverage and is eligible for
premium-free Part A. Before he could enroll in Medicare, his
entire area was impacted by a hurricane causing massive flooding
and severe wind damage. The Federal government declared this
to be a natural disaster which has recently ended. During this
period Anthony's initial enrollment period expired. Anthony asks
you how he can now obtain Medicare coverage. What should you
say? - correct answer✔✔Anthony is eligible for a special
enrollment period (SEP) because he missed an enrollment period
due to the impact of the Federally declared disaster. This SEP will
allow Anthony to enroll in Part B up to six months after the end of
the emergency declaration. Anthony may enroll in premium-free
Part A at any time and his Part A coverage will be retroactive for
up to 6 months.
Mrs. Lyons is in good health, uses a single prescription, and lives
independently in her own home. She is attracted by the idea of
maintaining control over a Medical Savings Account (MSA) but is
not sure if the plan associated with the account will fit her needs.
What specific piece of information about a Medicare MSA plan
would it be important for her to know, prior to enrolling in such a
plan? - correct answer✔✔All MSAs cover Part A and Part B
benefits, but not Part D prescription drug benefits, which could be
obtained by also enrolling in a separate prescription drug plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care.
What should you tell her? - correct answer✔✔Mrs. Ramos can
obtain care from any provider who participates in Original
Medicare, but generally will have a higher cost-sharing amount if
she sees a provider who/that is not a part of the PPO network.
,Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug
coverage with nominal copays. He heard about a neighbor's MA-
PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should
you tell him? - correct answer✔✔He should compare the benefits
in his employer-sponsored retiree group health plan with the
benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
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.
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. 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? - correct
answer✔✔He 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.
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? - correct answer✔✔Juan 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.
Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her? -
correct answer✔✔Mrs. Radford must be entitled to Part A and
enrolled in Part B to enroll in Medicare Advantage.
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? - correct
answer✔✔You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
Mrs. Burton is a retiree with substantial income. She is enrolled in
an MA-PD plan and was disappointed with the service she
received from her primary care physician because she was told
