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2025 AHIP FINAL EXAM
QUESTIONS WITH 100% VERIFIED CORRECT ANSWERS
"Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs, he is
considering signing up for it. What should you tell him? - CORRECT ANSWER He should
compare the benefits in his employer-sponsored retiree group health plan with the benefits in his neighbor's MA-PD plan to determine which one will provide sufficient coverage for his prescription needs." "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 received 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? - CORRECT ANSWER You can offer to review the plans appeal
process to help him ask the plan to review the coverage decision." "Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should
she be aware of when considering enrollment in a Medicare Advantage (MA) plan? - CORRECT
ANSWER She cannot enroll in an MA Medical Savings Account (MSA) plan."
"What types of tools can Medicare Part D prescription drug plans use that affect the way their
enrollees can access medications? - CORRECT ANSWER Part D plans do not have to cover all
medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-payments and step therapy." "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 activity at an event that has been
advertised as educational? - CORRECT ANSWER Yes. When an event has been advertised as
"educational," discussing plan-specific premiums is impermissible." "Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services (CMS) Communication and Marketing Guidelines to ensure he is
compliant with which type of products. - CORRECT ANSWER Medicare Advantage (MA) and
Prescription Drug (PDP) plans." "Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: "We offer Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if you would like to learn more." Which of the following best describes the obligation(s) of Winthrop
Brokerage regarding the advertisement? - CORRECT ANSWER Winthrop Brokerage does not
need to submit the advertisement to CMS for prior approval because it does not include information about the plans' benefits structures, cost-sharing, or information about measures or ranking standards." "You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in
mind? - CORRECT ANSWER You may request RSVPs, but you are not permitted to require
contact information." "You are meeting with Mrs. Hall in her home. On her scope of appointment form, she asked to discuss Medicare Advantage plans. During the meeting, she asked to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so she needs to decide before she leaves. What must happen before that additional discussion can
take place? - CORRECT ANSWER 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." "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? - CORRECT ANSWER Tell Mr. Anderson that you
cannot accept any enrollment forms until the annual election period begins." "Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his prescription drug needs. He is interested in changing plans during the upcoming MA Open
Enrollment Period. What are his options during the MA OEP? - CORRECT ANSWER He can
switch to a MA-PD plan." "Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's service area next month. She is worried that she will not be able to enroll in another plan available in her new
residence until the Annual Election Period. What should you tell her? - CORRECT ANSWER She
is eligible for a special election period (SEP) that begins either the month before her permanent
"Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor was talking about. What
could you tell her? - CORRECT ANSWER Part D covers prescription drugs and she should look
at her premiums, formulary, and cost-sharing among other factors to see if they have changed." "Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover? - CORRECT ANSWER Medicare
will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime." "Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - CORRECT ANSWER Mr. Singh can enroll in a stand-alone
prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare." "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? - CORRECT
ANSWER Most individuals who are citizens and age 65 or over 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." "Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Quinn? - CORRECT ANSWER Part B primarily covers
physician services. She will be paying a monthly premium and, except for many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible."
"What impact, if any, have recent regulatory changes had on Medigap plans? - CORRECT
ANSWER The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020."
"Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
Medicare. What can you tell her about Medigap as an option to address this concern? -
CORRECT ANSWER Medigap plans do not cover Original Medicare benefits, but they
coordinate with Original Medicare coverage." "Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are
met. What could you tell her? - CORRECT ANSWER Original Medicare covers ambulance
services." "Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services
in case she needs them. What should you tell her? - CORRECT ANSWER Medicare covers
hospice services, and they will be available for her." "Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should
you tell him? - CORRECT ANSWER Mr. Diaz will not pay any penalty because he had
continuous coverage under his employer's plan." "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? - CORRECT ANSWER You are sorry to disappoint
Anita, but a Medigap F plan is no longer available 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." "Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what
will he have to do? - CORRECT ANSWER He will have to enroll in Part B."
"Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Carolina. She is worried that without additional support, her mother will need to go into a nursing home. Mrs. Velasquez asks you if there is any Medicare plan that might allow her mother to remain in the
community rather than going into a nursing home. How should you advise Mrs. Velasquez? -
CORRECT ANSWER There are Programs of All-Inclusive Care for the Elderly (PACE) for frail
drug coverage? - CORRECT ANSWER She can enroll in the PPO, but she will not be able to
purchase a stand-alone Medicare Part D prescription drug plan." "Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be the correct description? - CORRECT ANSWER Medicare Advantage
is a way of covering all the Original Medicare benefits through private health insurance companies." "Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to obtain his drug coverage through a stand-alone
Medicare prescription drug plan. What should you tell him about this situation? - CORRECT
ANSWER He could enroll either in one of the MA plans that include prescription drug coverage
or Original Medicare with a Medigap plan and standalone Part D prescription drug coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan." "Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? - CORRECT ANSWER Medicare Advantage Plans may offer extra
benefits that Original Medicare does not offer such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on Part A and Part B services." "Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan.
What should you tell her? - CORRECT ANSWER She could enroll in a PFFS plan and a stand-
alone Medicare prescription drug plan." "Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program?
- CORRECT ANSWER There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs." "Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers
either one of them. What should you tell her? - CORRECT ANSWER Medicare prescription
drug plans are required to cover drugs in each therapeutic category. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs." "Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition to drugs on his plan's formulary, he takes several other medications. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit.
What should you say. - CORRECT ANSWER None of the costs of Mr. Wingate's other
medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription, not on its formulary." "Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under
Medicare Part B. What should you tell her? - CORRECT ANSWER An individual who is entitled
to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan." "Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but
does not want to purchase extra coverage that he will not need. What should you tell him? -
CORRECT ANSWER If the drug coverage he has is not expected to pay, on average, at least as
much as Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period to avoid the late enrollment penalty."
"Who is most likely to benefit from the Medicare Prescription Payment Plan? - CORRECT
ANSWER Kevin, who suffered a heart attack at the beginning of the year requiring him to take an
expensive brand name blood thinner on a daily, as well as an equally expensive injectable cholesterol medication on a bi-weekly basis for which he incurs high out-of-pocket costs." "Mr. Rice is 68, actively working, and has coverage for medical services and medications through his employer's group health plan. He is entitled to premium free Part A and thinking of enrolling in Part B and switching to an MA-PD because he is paying a very large part of his group coverage premium, and it does not provide coverage for a number of his medications. Which of the
following is NOT a consideration when making the change? - CORRECT ANSWER Mr. Rice's
CORRECT ANSWER In general, he must select a single Part D premium payment mechanism
that will be used throughout the year." "One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her
neighbors called TrOOP. She asks you to explain it. What do you say? - CORRECT ANSWER
TrOOP stands for true out-of-pocket costs that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances amounts paid by or through qualified State Pharmaceutical Assistance Programs." "Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable coverage previously available through her husband's employer. She is interested in enrolling in a
Medicare Part D prescription drug plan (PDP). What should you tell her? - CORRECT ANSWER
If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP." "Mrs. Hernandez is one of your clients. She has read that there is a new program that may help her manage prescription drug costs. What do you tell her about the Medicare Prescription
Payment Plan? - CORRECT ANSWER Part D enrollees can opt into the Medicare Prescription
Payment Plan at the beginning of the plan year or any point during the year." "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 say to her? - CORRECT ANSWER
The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4 stars." "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? - CORRECT ANSWER You must have her sign a scope of
appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion." "While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and
Part D marketing appointments? - CORRECT ANSWER You can present only health care
related lines of business but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission." "One of your colleagues argues that it is better to focus your time and energy exclusively on neighborhoods with single-family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent
compared to those living in apartment complexes. How should you respond? - CORRECT
ANSWER This could be considered discriminatory activity and a prohibited practice."
"Next week you will be participating in your first "educational event" for prospective enrollees. To be sure that you do not violate any of the applicable guidelines, in what activities should you plan
to engage? - CORRECT ANSWER You should plan to ensure that the educational event is
informative and must not conduct a sales presentation or distribute or accept enrollment forms at the event." "You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To comply with requirements for marketing Medicare Advantage and Part D
plans, what must you do about contacting potential clients to market those plansl? - CORRECT
ANSWER You will have to avoid calling any potential client unless he or she initiates contact with
you and specifically asks that you give him or her a call." "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 sure your clients know
about these pieces of information? - CORRECT 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." "You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation,
what must you do? - CORRECT ANSWER Before conducting the presentation, obtain and
document having obtained her permission to visit, along with her interest in the specific products you will present." "Your colleague works at a third-party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans
What should you tell him? - CORRECT ANSWER Mr. Chen can disenroll from his employer-
sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment." "Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his first Medicare eligibility date will be June 1. Mr. Liu's ICEP and Part D IEP begin on March 1 and end on September 30. He wants prescription drug coverage with his Part A and Part B benefits. What
advice can you provide him? - CORRECT ANSWER He can enroll in a MA-PD as long as he
enrolls in Part B and is entitled to Part A." "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 end of your discussion, Mr.
Nunez says that he wants to enroll both himself and his wife. What should you do? - CORRECT
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. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On December 1, he calls you up and says that he has changed his mind and would like to enroll in
a MA-PD plan. What enrollment rules would apply in this case? - CORRECT ANSWER He can
make as many enrollment changes as he likes during the Annual Election Period and the last choice made before the end of the period will be the effective one as of January 1." "Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. She comes to you for advice about when she can enroll in a plan you have previously
discussed. What should you tell her? - CORRECT ANSWER 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." "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? - CORRECT ANSWER If Mr.
Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan."
"Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard certain MA plans might provide him with more specialized coverage for his diabetes and wants to know if he must wait until the next annual
open enrollment period (AEP) before enrolling in such a plan. What should you tell him? -
CORRECT ANSWER If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in
caring for individuals with diabetes, he may enroll in the SNP at any time under a special election period (SEP)." "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? - CORRECT ANSWER It means that he
qualifies for a one-time opportunity to enroll in an MA-PD or Part D prescription drug plan." "Ms. Claggett is sixty-six (66) years old. She has been covered under Original Medicare for the last six years due to her disability and has never been enrolled in a Medicare Advantage or a Part D plan before. She wants to enroll in a Part D plan. She knows that there is such a thing as the "Part D Initial Enrollment Period" (IEP) and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. What should you tell her about how
the Part D Initial Enrollment Period applies to her situation? - CORRECT ANSWER Ms. Claggett
has had two IEPs and missed them both. The first occurred three months before and three months after the month when she was first entitled to Part A OR enrolled in Part B. Because she was eligible for Medicare before age 65, Ms. Claggett had a second IEP based on turning age 65, which has also expired." "Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare Part A and did not enroll for Part B when first eligible because she has insurance through her employer
- Coffee Brew, Inc. She also did not enroll in Part D because she had creditable coverage. She would like to retire in June and enroll in a Medicare Advantage plan. She has been informed that her group coverage will end on her retirement effective date. How would you advise Ms.
Thomas? - CORRECT ANSWER Ms. Thomas can enroll in Part B without a late penalty at any
time she is still covered by her employer group and 8 months after her last month of employer group coverage without a penalty. However, because she wants to enroll in a MA plan after retirement, she should make sure her Part B coverage is effective in time to use the Medicare Advantage/Part D special election period for individuals changing from employer group coverage to enroll in a MA plan or MA-PD. The SEP begins while she has employer group coverage and will last until 2 months after the month after the month her employer coverage ends. If she wants
special enrollment period (SEP)? - CORRECT 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." "Ms. Morris will turn 65 on June 10th. She has never previously qualified for Medicare. She is entitled to Medicare Part A and intends to enroll in Part B. She wants to know if she is eligible to enroll in a Medicare Advantage plan that includes prescription drug coverage. What do you tell
her? - CORRECT ANSWER Ms. Morris can enroll in an MA-PD plan now since her initial election
period (IEP) for Part D prescription drug coverage and initial coverage period are occurring together beginning March 1st and ending September 30th." "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? - CORRECT ANSWER 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." "Mrs. Albertson has been enrolled in a Medicare Part D plan for several years. She takes several brand name drugs and is interested in learning about the Medicare Prescription Payment Plan.
What should you tell her? - CORRECT ANSWER Enrollees can opt out of the program at any
time. However, they will continue to be billed for any cost-sharing amounts still owed." “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? -
CORRECT ANSWER Medicare will cover Mrs. Shield's skilled nursing services provided during
the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days." "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 into a standard Medicare Part D
prescription drug plan. What should you tell him? - CORRECT ANSWER He generally would pay
a monthly premium, annual deductible, and per-prescription cost-sharing." "Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one of
her claims for services. What advice would you give her? - CORRECT ANSWER Mrs. Duarte
should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail." "Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi that best describes the health coverage
provided to Medicare beneficiaries? - CORRECT ANSWER Beneficiaries under Original
Medicare have no cost-sharing for most preventive services." "Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization because of an illness. In general terms, what could you tell him
about his costs for inpatient hospital services under Original Medicare? - CORRECT ANSWER
Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs." "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? - CORRECT ANSWER 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." "Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. What
could you tell her? - CORRECT ANSWER She could file a grievance with her plan to complain
about the lack of timeliness in getting an appointment." "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? - CORRECT ANSWER 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."
"You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in
this situation - CORRECT ANSWER Gift cards or gift certificates of $15 or less that can be
readily converted to cash." "When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce
enrollment in a plan? - CORRECT ANSWER You may provide gifts or prizes to all potential
enrollees during an event that does not exceed $15 in retail value."
