AHIP Final Exam MR WEST Test Questions /GUARATEENED KPASSAHIP Final Exam Test Questions

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Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
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K acupuncture. She is concerned about whether or not Medicare will cover these items and services. What
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K should you tell her? - Medicare does not cover acupuncture, or, in general, glasses or dentures.
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Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D
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K Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his
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K considerable drug costs. What should you tell him? - He could check with the manufacturers of his
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K medications to see if they offer an assistance program to help people with limited means obtain the
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K medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance
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K program to help him with his expenses.
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Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of
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K three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include
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K drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug
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K coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan.
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K What should you tell him about this situation? - He could enroll in one of the MA plans that include
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K prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll
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K in the MA-only PPO plan and a stand-alone prescription drug plan.
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Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an
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K automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums
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K withheld from his Social Security check. What should you tell him? - In general, he must select a single Part D
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K premium payment mechanism that will be used throughout the year.
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Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings
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K distributes materials that are solely educational in nature. However, she gives a brief presentation that
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K mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as
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K educational? - Yes. When an event has been advertised as "educational," discussing plan-specific premiums is
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K impermissible.

Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug
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K plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you
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K tell her? - Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare
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K prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B
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K before enrolling in a prescription drug plan.
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Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when
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K he looks at information on various plans available in his area, he sees a wide range in what they charge for
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K deductibles, premiums and cost sharing. How can you explain this to him? - Medicare Part D drug plans may
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K have different benefit structures, but on average, they must all be at least as good as the standard model
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K established by the government. K K K




Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have
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, K considerable income when she retires. She is concerned that her income will make it impossible for her to
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K qualify for Medicare. What could you tell her to address her concern? - Medicare is a program for people age
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K 65 or older and those under age 65 with certain disabilities, end stage renal disease or Lou Gehrig's disease, so
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K she will be eligible for Medicare.
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Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a K K K K K K K K K K K K K K K




K Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing
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K the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more
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K information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What
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K statement best describes the marketing and compliance rules that apply to Agent Armstrong? - Agent
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K Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC
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K MA plans are located.
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Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-
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for-Service (FFS) Medicare? What could you tell him? - Part A, which covers hospital, skilled nursing facility,
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hospice and home health services and Part B, which covers professional services such as those provided by a
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doctor are covered under Original Medicare.
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You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in
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K your state. You have completed the required training for each plan, but you did not achieve a passing score on
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K the tests that came after the training. What can you do in this situation? - You will not be able to represent any
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K Medicare Advantage or Part D plan until you complete the training and achieve an adequate score, although
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K you will not have to take a test if you exclusively market employer/union group plans and the companies do
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K not require testing.
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Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to
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K know his options since he has decided to drop his retiree coverage and is eligible for Medicare. What should
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K you tell him? - Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage
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K or Part D plan within 2 months of his disenrollment, but he should revaluate if he really wants to drop his
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K employer coverage. K




Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will
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K soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? - He
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K may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis
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K treatments start. K




Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy. How
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K does that affect his ability to enroll or disenroll in a Part D plan? - He qualifies for a special election period and
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K can enroll in or disenroll from a Part D plan once during that period.
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Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug plan
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K you represent and simply give you a check to cover his premiums for the entire year. What should you tell
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K him? - Enrollees should pay using automatic withdrawal from a bank account or credit or debit card, direct
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K monthly billing from the plan, or deductions from their Social Security check.
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You have approached a hospital administrator about marketing in her facility. The administrator is
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K uncomfortable with the suggestion. How could you address her concerns? - Tell her that Medicare guidelines K K K K K K K K K K K K K K K




K allow you to conduct marketing activities in common areas of a provider's facility.
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You have come to Mrs. Midler's home for a sales presentation. At the beginning of the presentation,
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K Mrs. Midler tells you that she has a copy of her medical record available because she thinks this will help you
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K understand her needs. She suggests that you will know which questions to ask her about her health status in
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K order to best assist her in selecting a plan. What should you do? - You can only ask Mrs. Midler questions
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