AHIP EXAM QUESTIONS WITH COMPLETE
SOLUTIONS.
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 Medicare and does not want to sign up
for an MA product, but he also wants prescription drug coverage. What should
you tell him?
Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription
drug plan through a private company that has contracted with the government to
provide only such drug coverage to eligible Medicare beneficiaries.
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 of a 4-star, which of the following would be the correct
statement to say to her?
The Medicare Advantage plan received a 5-star rating in customer service and care
coordination with an overall performance rating of 4-stars
Mrs. Pena is 66 years old, has coverage under an employer plan and will retire
next year. She heard she must enroll in Part B at the beginning of the year to
ensure no gap in coverage. What can you tell her?
She may enroll at any time while she is covered under her employer plan, but she will
have a special eight-month enrollment period that differs from the standard general
enrollment period, during which she may enroll in Medicare Part B
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 him?
He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses.
Alice is a marketing representative employed by a health plan. Betty is a captive
agent of a health plan who markets to multiple plans and sponsors. Carl is a
captive agent who markets to only one plan/sponsor. Denise is an independent
agent who markets to different types of groups. Edward is an independent agent
who markets only to employer and union groups. CMS marketing representative
compensation rules generally apply to:
Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions
apply).
Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no
longer meeting her needs, but it is now mid-year and past the annual election
period (AEP). What would you say to Mrs. Valentino regarding her options?
, Mrs. Valentino can submit a written request to Medicare to be disenrolled from the Cost
plan and enroll in Original Medicare.
When Myra first became eligible for Medicare, she enrolled in Original Medicare
(Parts A and B). She is now 67 and will turn 68 on July 1. She would now like to
enroll in a Medicare Advantage (MA) plan and approaches you about her options.
What advice would you give her?
She should remain in Original Medicare until the annual election period running from
October 15 to December 7, during which she can select an MA plan.
Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point of
service options. This allows Mrs. Tanner to do which of the following?
Mrs. Tanner can go to non-plan doctors for certain services without receiving prior
approval
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?
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.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concerned
that she will not qualify for coverage under part A because she was not born in
the United States. What should you tell her?
Most individuals who are citizens and over age 65 are covered under Part A by virtue of
having paid Medicare taxes while working, though some may be covered as a result of
paying monthly premiums.
Mr. Katz reached the Part D coverage gap in August last year. His prescriptions
have not been changed, he is keeping the same Part D plan and the benefits,
cost-sharing, and coverage of his drugs are all the same as last year. He asked
what to expect for this year about his out-of-pocket costs. What could you tell
him?
Because he reached the coverage gap last year, he will probably reah it again this year
close to the same time.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its
enrollees' protected health information to market non-health related products
such as life insurance and annuities. To do so it must obtain authorization from
the enrollees. Which statement best describes the authorization process?
Authorization may be obtained by directing a beneficiary to a website to provide consent
Mrs. Henderson believes that she will qualify for Medicare coverage when she
turns 65, without paying any premiums, because she has been working for 40
years and paying Medicare taxes. What should you tell her?
In order to obtain Part B coverage, she must pay a standard monthly premium, though it
is higher for individuals with higher incomes.
Mr. Buck has several family members who died from different cancers. He wants
to know if Medicare covers cancer screening. What should you tell him?
SOLUTIONS.
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 Medicare and does not want to sign up
for an MA product, but he also wants prescription drug coverage. What should
you tell him?
Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription
drug plan through a private company that has contracted with the government to
provide only such drug coverage to eligible Medicare beneficiaries.
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 of a 4-star, which of the following would be the correct
statement to say to her?
The Medicare Advantage plan received a 5-star rating in customer service and care
coordination with an overall performance rating of 4-stars
Mrs. Pena is 66 years old, has coverage under an employer plan and will retire
next year. She heard she must enroll in Part B at the beginning of the year to
ensure no gap in coverage. What can you tell her?
She may enroll at any time while she is covered under her employer plan, but she will
have a special eight-month enrollment period that differs from the standard general
enrollment period, during which she may enroll in Medicare Part B
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 him?
He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses.
Alice is a marketing representative employed by a health plan. Betty is a captive
agent of a health plan who markets to multiple plans and sponsors. Carl is a
captive agent who markets to only one plan/sponsor. Denise is an independent
agent who markets to different types of groups. Edward is an independent agent
who markets only to employer and union groups. CMS marketing representative
compensation rules generally apply to:
Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions
apply).
Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no
longer meeting her needs, but it is now mid-year and past the annual election
period (AEP). What would you say to Mrs. Valentino regarding her options?
, Mrs. Valentino can submit a written request to Medicare to be disenrolled from the Cost
plan and enroll in Original Medicare.
When Myra first became eligible for Medicare, she enrolled in Original Medicare
(Parts A and B). She is now 67 and will turn 68 on July 1. She would now like to
enroll in a Medicare Advantage (MA) plan and approaches you about her options.
What advice would you give her?
She should remain in Original Medicare until the annual election period running from
October 15 to December 7, during which she can select an MA plan.
Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point of
service options. This allows Mrs. Tanner to do which of the following?
Mrs. Tanner can go to non-plan doctors for certain services without receiving prior
approval
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?
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.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concerned
that she will not qualify for coverage under part A because she was not born in
the United States. What should you tell her?
Most individuals who are citizens and over age 65 are covered under Part A by virtue of
having paid Medicare taxes while working, though some may be covered as a result of
paying monthly premiums.
Mr. Katz reached the Part D coverage gap in August last year. His prescriptions
have not been changed, he is keeping the same Part D plan and the benefits,
cost-sharing, and coverage of his drugs are all the same as last year. He asked
what to expect for this year about his out-of-pocket costs. What could you tell
him?
Because he reached the coverage gap last year, he will probably reah it again this year
close to the same time.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its
enrollees' protected health information to market non-health related products
such as life insurance and annuities. To do so it must obtain authorization from
the enrollees. Which statement best describes the authorization process?
Authorization may be obtained by directing a beneficiary to a website to provide consent
Mrs. Henderson believes that she will qualify for Medicare coverage when she
turns 65, without paying any premiums, because she has been working for 40
years and paying Medicare taxes. What should you tell her?
In order to obtain Part B coverage, she must pay a standard monthly premium, though it
is higher for individuals with higher incomes.
Mr. Buck has several family members who died from different cancers. He wants
to know if Medicare covers cancer screening. What should you tell him?
