AHIP Final Exam 50 Questions With Correct Answers
Correct
Incorrect
Questions & Answers
1 of 50
Term
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?
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Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug.
He or his physician could obtain the standardized request form on the plan's website, fill it out,
and submit it to his plan.
Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan
year or any point during the year.
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.
Enrollment in Cost plans offering Part D coverage is available only during enrollment periods
under the Part D program, and Cost plans must accept enrollments during these periods.
2 of 50
Term
Mr. Yoo's employer has recently dropped comprehensive creditable prescription
drug coverage that was offered to company retirees. The company told Mr. Yoo
that, because he was affected by this change, he would qualify for a special
election period. Mr. Yoo contacted you to find out more about what this means.
What can you tell him?
Give this one a try later!
If Mr. Block enrolls in the stand-alone
You would need to ask Mr. Kelly if he is
Medicare prescription drug plan, he will Be
entitled to Part A, enrolled in Part B, and if
disenrolled From The Medicare Advantage
he lives in the PFFS plan's service area.
plan.
If the SEP is for MA coverage, he will It means that he qualifies for a one-
generally have one opportunity to change time opportunity to enroll in an MA-PD
his MA coverage. or Part D prescription drug plan.
3 of 50
Term
You would like to offer gifts of nominal value to potential enrollees who call for
more information about a plan you represent. You would then like to offer
additional gifts if they come to a marketing event. Each of the gifts meets the CMS
,definition of nominal value, but together, the gifts are more than the nominal
value. Is this permissible?
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Yes, as long as each of the gifts is $10 or less in value, and the total value of all gifts given to
an enrollee in a year does not exceed $20.
You may make comparisons between plans if you can support them with studies or statistical data
and such comparisons are factually based and referenced.
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.
Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as
long as she signs a new scope of appointment form first, indicating that she wants to discuss the
Part D plan.
4 of 50
Term
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
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Mrs. Radford must be entitled to Part A and
Mrs. Radford must be enrolled in Part C to
enrolled in Part D to enroll in Medicare
enroll in Medicare Advantage.
Advantage.
Mrs. Radford must be entitled to Part B and Mrs. Radford must be entitled to Part A
enrolled in Part D to enroll in Medicare and enrolled in Part B to enroll in
Advantage. Medicare Advantage.
, 5 of 50
Term
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 premium. 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?
Give this one a try later!
He Can Enroll in a MA-PD as Long as he
He can switch to a MA-PD plan.
enrolls in Part B and is entitled To Part A.
If Mr. Block enrolls in the stand-alone
If the SEP is for MA coverage, he will
Medicare prescription drug plan, he
generally have one opportunity to change
will be disenrolled from the Medicare
his MA coverage.
Advantage plan.
6 of 50
Term
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his
eligibility?
Give this one a try later!
Correct
Incorrect
Questions & Answers
1 of 50
Term
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?
Give this one a try later!
Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug.
He or his physician could obtain the standardized request form on the plan's website, fill it out,
and submit it to his plan.
Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan
year or any point during the year.
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.
Enrollment in Cost plans offering Part D coverage is available only during enrollment periods
under the Part D program, and Cost plans must accept enrollments during these periods.
2 of 50
Term
Mr. Yoo's employer has recently dropped comprehensive creditable prescription
drug coverage that was offered to company retirees. The company told Mr. Yoo
that, because he was affected by this change, he would qualify for a special
election period. Mr. Yoo contacted you to find out more about what this means.
What can you tell him?
Give this one a try later!
If Mr. Block enrolls in the stand-alone
You would need to ask Mr. Kelly if he is
Medicare prescription drug plan, he will Be
entitled to Part A, enrolled in Part B, and if
disenrolled From The Medicare Advantage
he lives in the PFFS plan's service area.
plan.
If the SEP is for MA coverage, he will It means that he qualifies for a one-
generally have one opportunity to change time opportunity to enroll in an MA-PD
his MA coverage. or Part D prescription drug plan.
3 of 50
Term
You would like to offer gifts of nominal value to potential enrollees who call for
more information about a plan you represent. You would then like to offer
additional gifts if they come to a marketing event. Each of the gifts meets the CMS
,definition of nominal value, but together, the gifts are more than the nominal
value. Is this permissible?
Give this one a try later!
Yes, as long as each of the gifts is $10 or less in value, and the total value of all gifts given to
an enrollee in a year does not exceed $20.
You may make comparisons between plans if you can support them with studies or statistical data
and such comparisons are factually based and referenced.
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.
Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as
long as she signs a new scope of appointment form first, indicating that she wants to discuss the
Part D plan.
4 of 50
Term
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
Give this one a try later!
Mrs. Radford must be entitled to Part A and
Mrs. Radford must be enrolled in Part C to
enrolled in Part D to enroll in Medicare
enroll in Medicare Advantage.
Advantage.
Mrs. Radford must be entitled to Part B and Mrs. Radford must be entitled to Part A
enrolled in Part D to enroll in Medicare and enrolled in Part B to enroll in
Advantage. Medicare Advantage.
, 5 of 50
Term
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 premium. 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?
Give this one a try later!
He Can Enroll in a MA-PD as Long as he
He can switch to a MA-PD plan.
enrolls in Part B and is entitled To Part A.
If Mr. Block enrolls in the stand-alone
If the SEP is for MA coverage, he will
Medicare prescription drug plan, he
generally have one opportunity to change
will be disenrolled from the Medicare
his MA coverage.
Advantage plan.
6 of 50
Term
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his
eligibility?
Give this one a try later!
