2025 AHIP Final Exam A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do? - Answer -You must have her sign a scope of a ppointment form, indicating which products she wishes to discuss. You may then proceed with the discussion. Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do? - Answer -Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th. Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational. However, she gives a brief presentation that mentions plan -specific premiums. Is this a prohibited activit y at an event that has been advertised as educational? - Answer -Yes. When an event has been advertised as "educational," discussing plan -specific premiums is impermissible. Alice is enrolled in a MA -PD plan. She makes a permanent move across the country and wonders what her options are for continuing MA -PD coverage. What would you say to her in regard to a special enrollment period (SEP)? - Answer -She is likely to qualify for a SEP . She can choose an effective date of up to three months after the month in which the enrollment form is received by the new plan, but the effective date may not be earlier than the date of her permanent move. Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her? - Answer -You are sorry to disappoint Anita, but a Medigap F plan is no longer avai lable to those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefits package. What should you do to make s ure your clients know about these pieces of information? - Answer -You may make comparisons between plans if you can support them with studies or statistical data and such comparisons are factually based and referenced. 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? - Answer -Dr. Brennan can charge Mary Rogers no more than t he 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. During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5 -star rating in customer service and care coordination, and received an overall plan performance rating of a 4 -star, which of the following would be the best statement to sa y to her? - Answer -The Medicare Advantage plan received a 5 -star rating in customer service and care coordination with an overall performance rating of 4 stars. Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the store owner, has provided excellent health benefits to the store's workforce. William, one of the store's long -
time employees, will soon be reaching age 65 and eligible for Medicare. William is in good health. He intends to remain an active full -time employee, working several years after becoming eligible for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer William? - Answe r-Hank's can continue to offer William the same employee health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is offered to the public. If you are to comply with Medicare's guidance regarding educational events, which of the following would be acceptable activities? - Answer -You may distribute business cards to individuals who request information on how to contact you for further details o n the plan(s) you represent. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling in to a standard Medicare Part D prescription drug plan. What should you tell him? - Answer -He generally would pay a monthly premium, annual deductible, and per -prescription cost -sharing. 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 e nd 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 can 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. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription to help to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them? - 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 Vaughns could look into that possibility. 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 on January 1 next year. He is currently enrolled in Original Medicare. What should you do? - Answer -Tell Mr. Anderso n that you cannot accept any enrollment forms until the annual election period begins. 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 recei ved 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? - Answer -You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mr. Bickford did not quite qualify for the extra help low -income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell h im? - Answer -He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy as sistance program to help him with his expenses. Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand -alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA -PD plan and in addition, has a low p remium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand -alone prescription drug plan in addition to his MA -PD plan. What should you tell him? - Answer -If Mr. Block enrolls in the stand -alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original
time employees, will soon be reaching age 65 and eligible for Medicare. William is in good health. He intends to remain an active full -time employee, working several years after becoming eligible for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer William? - Answe r-Hank's can continue to offer William the same employee health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is offered to the public. If you are to comply with Medicare's guidance regarding educational events, which of the following would be acceptable activities? - Answer -You may distribute business cards to individuals who request information on how to contact you for further details o n the plan(s) you represent. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling in to a standard Medicare Part D prescription drug plan. What should you tell him? - Answer -He generally would pay a monthly premium, annual deductible, and per -prescription cost -sharing. 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 e nd 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 can 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. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription to help to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them? - 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 Vaughns could look into that possibility. 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 on January 1 next year. He is currently enrolled in Original Medicare. What should you do? - Answer -Tell Mr. Anderso n that you cannot accept any enrollment forms until the annual election period begins. 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 recei ved 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? - Answer -You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mr. Bickford did not quite qualify for the extra help low -income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell h im? - Answer -He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy as sistance program to help him with his expenses. Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand -alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA -PD plan and in addition, has a low p remium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand -alone prescription drug plan in addition to his MA -PD plan. What should you tell him? - Answer -If Mr. Block enrolls in the stand -alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original
