AHIP Test 2 & Test 3 (100% Correct Tests)
AHIP Test 2
Question 1.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug
coverage?
a. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part
D prescription drug plan - Correct.
b. b. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare
Part D prescription drug plan.
c. c. She can enroll in the PPO and purchase drug coverage through a Medigap plan.
d. d. She can enroll in the PPO and if she decides that she wants drug coverage, she will be
able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such
drug coverage
Question 2.
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?
a. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he receives
his Medicare-covered services.
b. He should know that Medicaid will pay cost sharing only for services provided by Medicaid
participating providers-
Correct.
c. For Medicaid beneficiaries, Medicare reduces its cost-sharing amounts to match those charged
by the state Medicaid program so there will be no change in his cost-sharing amounts.d. Medicaid
will no longer pay any cost sharing once he is eligible for Medicare, so he will need to rely only on
Medicare providers
Question 3.
You have decided to focus on doing in-home presentations to market the Medicare Advantage
(MA) plans you represent. Before you conduct such sales presentations, what must you do?
a. You must receive an invitation from the beneficiary and document the specific types of
products the beneficiary wants to discuss prior to making an in-home
presentation.
b. b. There is no special action that you must take. If they choose, you may go to an
individual’s house to provide presentations and offer assistance with enrolling in a plan.
, c. c. You must first contact the Medicare agency to ensure that the individual is actually a
Medicare beneficiary.
d. d. A proper introduction at the door that includes a disclaimer regarding your relationship
with the plan you represent is the only required action you must take, prior to entering the
beneficiary’s home.
Question 4.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both
Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he
sees an out-of-network doctor to receive a Medicare covered service. How much may the doctor
collect from Mr. Rivera?
a. The doctor may only collect the amount allowable under Medicare plus 25 percent balance
billing.
b. The doctor may only collect the amount allowable under Medicare Advantage (MA) PPO plan
cost sharing for non-QMB enrollees.
c. The doctor may only collect the amount allowable under Medicare plus 15 percent balance
billing.
d. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s
Medicaid program
Question 5
B Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her lengthy
hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell
them about Original Medicare’s coverage of care in a skilled nursing facility?
a. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term
care costs.
b. b. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a
physician certifies that such care is needed.
c. c. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered
d. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days
of her stay, after which she would have a coinsurance until she has been in the facility for
100
days
because Medicare does not provide such a benefit. d.
,Question 6.
You are working with a number of plans and community organizations to sponsor an educational
event. When putting together advertisements for this event, what should you do?
a. You must ensure that the advertisements indicate it is an educational event, otherwise it will
be
considered a marketing
event.
b. Plans may not participate in advertising such an event. All advertising must be done by
community organizations.
c. You must state in the advertisement that it will be an educational event and that the education
willconsist of specific information about the participating plans.
d. You must only ensure that the advertisement is factually accurate.
Question 7.
You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer’s and is
incapable of understanding the implications of choosing a Medicare Advantage or prescription
drug plan. Can his daughter fill out the enrollment form and sign it for him?
a. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out
and signing the form.b
b. . Mr. Tully’s daughter can do so because she is an immediate family member who has taken
responsibility for her father’s care.
c. c. Mr. Tully’s daughter can do so only, if she is authorized under state law as a
courtappointed legal guardian, has a durable power of attorney for health care decisions, or
is authorized under state surrogate consent laws to make health decisions.
d. d. If the enrollment form is countersigned by one of Mr. Tully’s treating physicians, she can
sign it for him.
Question 8.
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?
a. All individuals who are citizens and over age 65 will be covered under Part A.
b. Most individuals who are citizens and over age 65 and are covered under Part A must pay a
monthly premium for that coverage.
c. Most individuals who are citizens and over age 65 and wish to be covered under Part A must
enroll in a Medicare Health Plan.
d. 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.
, Question 9.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug
plan you represent and simply give you a check to cover his premiums for the entire year. What
should you tell him?
a. He will need to mail in his payment with his enrollment form
b. You can take his first payment, but after that, he will need to make arrangements to send
his monthly premium payment to the plan.
c. This is perfectly acceptable. You will be happy to forward his payment to the plan.d.
Enrollees should pay using automatic withdrawal from a bank account or credit or debit
card, direct monthly billing from the plan, or deductions from their Social Security check.
d. Enrollees should pay using automatic withdrawal from a bank account or credit or debit
card, direct monthly billing from the plan, or deductions from their Social Security check
Question 10.
Mrs. Patterson is a new enrollee in the HealthBest Medicare Advantage (MA-PD) plan. She is new
to this type of coverage and asks you what materials, if any, she should expect to receive. How
would you reply?
a. She should expect to receive Evidence of Coverage (EOC) within 21 days of confirmation of
enrollment.
b. She should expect to receive hard copies of both the provider and pharmacy directories
automatically within 30 days of confirmation of enrollment.
c. She should expect to receive a hard copy of the provider directory in and a separate notice
describing where she can find monthly periodic updates online and how to request hardcopies.
d. She should expect either the pharmacy directory in hard copy or a distinct and separate
notice (in hard copy) describing where she can find the pharmacy directory online and how to
request a hard copy.
Question 11.
During a sales presentation in Ms. Sullivan’s home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans?
a. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage
she wants, she may enroll in one if it is available in her area.
b. A PFFS plan is one of the various types of Medicare Advantage plans offered by private
entities and she may enroll in one if it is available in her area.
c. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available
in her area.
d. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she
AHIP Test 2
Question 1.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug
coverage?
a. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part
D prescription drug plan - Correct.
b. b. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare
Part D prescription drug plan.
c. c. She can enroll in the PPO and purchase drug coverage through a Medigap plan.
d. d. She can enroll in the PPO and if she decides that she wants drug coverage, she will be
able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such
drug coverage
Question 2.
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?
a. Medicaid will cover his cost-sharing, regardless of from which physician or hospital he receives
his Medicare-covered services.
b. He should know that Medicaid will pay cost sharing only for services provided by Medicaid
participating providers-
Correct.
c. For Medicaid beneficiaries, Medicare reduces its cost-sharing amounts to match those charged
by the state Medicaid program so there will be no change in his cost-sharing amounts.d. Medicaid
will no longer pay any cost sharing once he is eligible for Medicare, so he will need to rely only on
Medicare providers
Question 3.
You have decided to focus on doing in-home presentations to market the Medicare Advantage
(MA) plans you represent. Before you conduct such sales presentations, what must you do?
a. You must receive an invitation from the beneficiary and document the specific types of
products the beneficiary wants to discuss prior to making an in-home
presentation.
b. b. There is no special action that you must take. If they choose, you may go to an
individual’s house to provide presentations and offer assistance with enrolling in a plan.
, c. c. You must first contact the Medicare agency to ensure that the individual is actually a
Medicare beneficiary.
d. d. A proper introduction at the door that includes a disclaimer regarding your relationship
with the plan you represent is the only required action you must take, prior to entering the
beneficiary’s home.
Question 4.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both
Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he
sees an out-of-network doctor to receive a Medicare covered service. How much may the doctor
collect from Mr. Rivera?
a. The doctor may only collect the amount allowable under Medicare plus 25 percent balance
billing.
b. The doctor may only collect the amount allowable under Medicare Advantage (MA) PPO plan
cost sharing for non-QMB enrollees.
c. The doctor may only collect the amount allowable under Medicare plus 15 percent balance
billing.
d. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s
Medicaid program
Question 5
B Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her lengthy
hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell
them about Original Medicare’s coverage of care in a skilled nursing facility?
a. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term
care costs.
b. b. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a
physician certifies that such care is needed.
c. c. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered
d. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days
of her stay, after which she would have a coinsurance until she has been in the facility for
100
days
because Medicare does not provide such a benefit. d.
,Question 6.
You are working with a number of plans and community organizations to sponsor an educational
event. When putting together advertisements for this event, what should you do?
a. You must ensure that the advertisements indicate it is an educational event, otherwise it will
be
considered a marketing
event.
b. Plans may not participate in advertising such an event. All advertising must be done by
community organizations.
c. You must state in the advertisement that it will be an educational event and that the education
willconsist of specific information about the participating plans.
d. You must only ensure that the advertisement is factually accurate.
Question 7.
You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer’s and is
incapable of understanding the implications of choosing a Medicare Advantage or prescription
drug plan. Can his daughter fill out the enrollment form and sign it for him?
a. A signature is not necessary since Mr. Tully is not physically or mentally capable of filling out
and signing the form.b
b. . Mr. Tully’s daughter can do so because she is an immediate family member who has taken
responsibility for her father’s care.
c. c. Mr. Tully’s daughter can do so only, if she is authorized under state law as a
courtappointed legal guardian, has a durable power of attorney for health care decisions, or
is authorized under state surrogate consent laws to make health decisions.
d. d. If the enrollment form is countersigned by one of Mr. Tully’s treating physicians, she can
sign it for him.
Question 8.
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?
a. All individuals who are citizens and over age 65 will be covered under Part A.
b. Most individuals who are citizens and over age 65 and are covered under Part A must pay a
monthly premium for that coverage.
c. Most individuals who are citizens and over age 65 and wish to be covered under Part A must
enroll in a Medicare Health Plan.
d. 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.
, Question 9.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug
plan you represent and simply give you a check to cover his premiums for the entire year. What
should you tell him?
a. He will need to mail in his payment with his enrollment form
b. You can take his first payment, but after that, he will need to make arrangements to send
his monthly premium payment to the plan.
c. This is perfectly acceptable. You will be happy to forward his payment to the plan.d.
Enrollees should pay using automatic withdrawal from a bank account or credit or debit
card, direct monthly billing from the plan, or deductions from their Social Security check.
d. Enrollees should pay using automatic withdrawal from a bank account or credit or debit
card, direct monthly billing from the plan, or deductions from their Social Security check
Question 10.
Mrs. Patterson is a new enrollee in the HealthBest Medicare Advantage (MA-PD) plan. She is new
to this type of coverage and asks you what materials, if any, she should expect to receive. How
would you reply?
a. She should expect to receive Evidence of Coverage (EOC) within 21 days of confirmation of
enrollment.
b. She should expect to receive hard copies of both the provider and pharmacy directories
automatically within 30 days of confirmation of enrollment.
c. She should expect to receive a hard copy of the provider directory in and a separate notice
describing where she can find monthly periodic updates online and how to request hardcopies.
d. She should expect either the pharmacy directory in hard copy or a distinct and separate
notice (in hard copy) describing where she can find the pharmacy directory online and how to
request a hard copy.
Question 11.
During a sales presentation in Ms. Sullivan’s home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans?
a. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage
she wants, she may enroll in one if it is available in her area.
b. A PFFS plan is one of the various types of Medicare Advantage plans offered by private
entities and she may enroll in one if it is available in her area.
c. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available
in her area.
d. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she
