Download AHIP 2024 FINAL EXAM ALREADY GRADED A+ and more Exams Medicine in PDF only on Docsity!
AHIP 2024 FINAL EXAM
ALREADY GRADED A+
"Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare? What could you tell him? - CORRECT ANSWER Part A, which
covers hospital, skilled nursing facility, hospice and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare." "Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in
a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? -
CORRECT ANSWER He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls
in Medicare Part B." "Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He
wants to know whether he might qualify. What should you tell him? - CORRECT ANSWER The
extra help is available to beneficiaries whose income and assets do not exceed annual limits specified by the government." "ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to market non-health related products such as life insurance and annuities. Which statement best
describes ABC's obligation to its enrollees regarding marketing such products? - CORRECT
ANSWER b.
It must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan sponsor may use their information for marketing purposes." "Your friend's mother just moved to an assisted living facility and he asked if you could present a
program for the residents about the MA-PD plans you market. What could you tell him? -
CORRECT ANSWER You appreciate the opportunity and would be happy to schedule an
appointment with anyone at their request." "Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice
on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his coverage will no longer be creditable. He has come to you for advice. What advice would you give
Mr. Rockwell about special election periods (SEPs)? - CORRECT ANSWER Mr. Rockwell is
eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins in June and ends September 1 - two months after the loss of creditable coverage." "If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type of Medicare health plan could the individual also enroll in, without being automatically
disenrolled from the stand-alone prescription drug plan? - CORRECT ANSWER The beneficiary
could enroll in a private fee-for-service (PFFS) plan that does not include prescription drug coverage; a cost plan; or a Medicare Medical Savings Account (MSA) plan." "Ms. Brooks has an 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." "Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to
you for advice. What should you tell her? - CORRECT ANSWER You should tell Madeline that
she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband's long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income." "Mrs. Peňa 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? - CORRECT ANSWER 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. 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 The penalty will be a permanent 10% increase in his Part B
premium for every 12-month period that passed during which he could have enrolled and did not."
"Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the
time to fill out the paperwork. What could you tell her? - CORRECT ANSWER The Part D low
income subsidy could substantially lower her overall costs. She can apply by contacting her state Medicaid office, or calling the Social Security Administration." "Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. She currently does not have creditable coverage. What could you tell her
about the implications of such a decision? - CORRECT ANSWER If she does not sign up for a
Medicare prescription drug plan as soon as she is eligible to do so, if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered."
"Which of the following statements about Medicare Part D are correct? - CORRECT ANSWER I,
II, and III only -I. Part D plans must enroll any eligible beneficiary who applies regardless of health status except in limited circumstances. II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to have one. III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only obtain Part D benefits through a standalone PDP." "Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider
before selecting a PFFS plan? - CORRECT ANSWER A Medicare Advantage Prescription Drug
(MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone prescription drug plan." "Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you on October
15. During the appointment, what are you permitted to do? - CORRECT ANSWER You may
provide her with the required enrollment materials and take her completed enrollment application."
"Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which
statement best describes how Agent Chan may be compensated under CMS rules? - CORRECT
ANSWER FeelBetter will pay Agent Chan initial year compensation for the months July through
December. Renewal amounts will be paid starting in January if Ms. Park remains enrolled the following year." "You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in
a health care facility. What should you tell them? - CORRECT ANSWER Marketing in health
care facilities is an acceptable practice, as long as it takes place in common areas where patients are not receiving or waiting to receive health care and as long as the hospital displays materials for all plans that provide them to the hospital." "Hector Hernandez is an independent agent. Hector sells plans on behalf of three Medicare Advantage organizations that offer a total of 10 plans but does not represent all Medicare Advantage organizations offering plans that are available in his area. Which of the following
statements best describes any steps Hector is required to take? - CORRECT ANSWER During
the first minute of a sales call, Hector must send an email to the prospect stating that "I represent 3 plans but not every plan available in your area. Please contact Medicare.gov to get information on all your options." "Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial Coverage
Election Period (ICEP) has just begun. Which of the following can she not do during the ICEP? -
CORRECT ANSWER She can enroll in a Medigap plan to supplement the benefits of the MA
plan that she's also enrolling in." "Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that has suffered from major flooding that has been declared a major disaster by both the Federal government and her state. As a result of dealing with the flooding issues and being evacuated from her home, Edna missed her chance to enroll in MA during her Initial Coverage Election Period. Felix lives in an area with a Medicare Advantage plan with a 4-star rating that he would like to join. George dropped his Medigap policy six months ago when he first enrolled in a Medicare Advantage plan. He now wants to return to Original Medicare. Harriet has recently developed diabetes and would like to enroll in a Medicare Advantage plan that focuses on care for those with that disease. Which, if any, of these individuals would qualify for a special election
period (SEP)? - CORRECT ANSWER Edna would qualify for a SEP because government officials
"creditable." She wants to know what this means. What should you tell her? - CORRECT
ANSWER The letter is to inform her that the drug coverage offered through her Medigap plan
does not offer drug coverage that is at least comparable to that provided under the Medicare Part D prescription drug program. If she does not have such creditable coverage during periods when she is first eligible for the Part D program, she will face a premium penalty if she enrolls in a Part D plan at a later date." "Mr. Albert has heard about something called the Star Rating system for Medicare Advantage plans. He asks you to explain it to him since he is interested in enrolling in a plan that is newly available in his area. After you explain that it is the way for consumers to judge plan performance,
what else would you say? - CORRECT ANSWER New plans and Part D sponsors that do not
have any Star Rating are not required to provide Star Rating information until the next contract year." "Mr. Lee was intending to enroll in MaxCare's Medicare Advantage plan this year. However, due to his current medical condition, his daughter Debbie has been appointed as his legal representative over both health and financial matters. Debbie would like to ensure that her father is still able to enroll in MaxCare's plan, but she is unsure what her role is to help with his
enrollment request. What advice can you give her? - CORRECT ANSWER Debbie can submit an
telephonic enrollment request on Mr. Lee's behalf as long as she attests that she has the legal authority to do so" “Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance? - CORRECT ANSWER She should contact her state Medicaid
agency to see if she qualifies for programs that can help with Medicare costs for which she is responsible." "Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he
can obtain coverage under Medicare. What should you tell him - CORRECT ANSWER After
receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age." "Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - CORRECT ANSWER Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present coverage." "Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
CORRECT ANSWER Medicare is a program for people age 65 or older and those under age 65
with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare." "Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires
him to do. What should you tell him? - CORRECT ANSWER He may receive health care services
from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing." "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. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi? - CORRECT ANSWER Mrs. Chi may enroll in a MA MSA plan and remain in her
current standalone Part D prescription drug plan." "Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers
she can go to for her health care. What should you tell her? - CORRECT ANSWER Mrs. Ramos
can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network." "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 He will need to enroll in a Medicare prescription drug plan upon becoming
"You are doing a sales presentation for Mrs. Pearson. You know that Medicare marketing guidelines prohibit certain types of statements. Apply those guidelines to the following
statements and identify which would be prohibited. - CORRECT ANSWER "If you're not in very
good health, you will probably do better with a different product.""
