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AHIP FINAL EXAM TEST QUESTIONS
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"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. 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." "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 part of the PPO network." "Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting that he and Mrs. Young complete the application together before she leaves. He will then submit the paper application prior the start of the annual enrollment period (AEP). What would you say If you were
advising Agent Adams? - CORRECT ANSWER This is a bad idea. Agents are generally prohibited
from soliciting or accepting an enrollment form prior to the start of the AEP." "During a sales presentation, your client asks you whether the Medicare agency recommends
that she sign up for your plan or stay in Original Medicare. What should you tell her? - CORRECT
ANSWER Tell her that the Medicare agency does not endorse or recommend any plan."
"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. 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? - CORRECT ANSWER 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." "Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What should you tell him? -
CORRECT ANSWER In general, he must select a single Part D premium payment mechanism
that will be used throughout the year." "Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational in nature. 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. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what
they charge for deductibles, premiums and cost sharing. How can you explain this to him? -
CORRECT ANSWER Medicare Part D drug plans may have different benefit structures, but on
average, they must all be at least as good as the standard model established by the government." "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 or Lou Gehrig's disease, so she will be eligible for Medicare." "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."
"Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and wonders what her options are for continuing MA-PD coverage. What would you say to her in regard to a
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."
"Which of the following individuals is most likely to be eligible to enroll in a part d plan? -
CORRECT ANSWER Jose, a grandfather who was granted asylum and has worked in the United
States for many years." "Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is just about saving money, or if he will get insurance coverage for his health care expenditures as well. What
should you tell him? - CORRECT ANSWER Under the Medicare Advantage program. an MSA
plan involves the combination of high deductible health plan and savings account for health expenses. Medicare will make contributions to this savings account to help him pay his health care expenses while in the deductible." "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 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." "Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She is traveling and wishes to fill two of her prescriptions that she has lost. How would
you advise her? - CORRECT ANSWER She may fill prescriptions for covered drugs at non-
network pharmacies, but likely at a higher cost than paid at an in-network pharmacy." "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 enrollment 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."
"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 is able to 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. 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? - CORRECT
ANSWER He should know that Medicaid will pay cost sharing only for services provided by
Medicaid participating providers." "Mr. Zachow has a condition for which three drugs are available. He has tried two, but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's
formulary. What could you tell him to do? - CORRECT ANSWER 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." "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 as a result 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 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" "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 and appeal of this initial determination within 120 days of the date she received the MSN in the mail"
"Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her? - CORRECT ANSWER Marketing
representatives may initiate electronic contact through e-mail but the subject line must say "marketing" and an opt-out process must be provided." "Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific drugs. She has heard about a technique called "step therapy" and is
wondering if you can explain what that is. What should you tell her? - CORRECT ANSWER Step
therapy involves using one or more lower priced drugs before trying a more expensive drug when all are used to treat the same condition." "Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - CORRECT ANSWER Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage." "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." "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." “Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items
and services. What should you tell her? - CORRECT ANSWER Medicare does not cover
acupuncture, or, in general, glasses or dentures." "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 in one of the MA plans that include prescription drug coverage or a
Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan." "Mrs. Mulcahy 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 Everyone 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." "Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and
compliance rules that apply to Agent Armstrong? - CORRECT ANSWER Agent Armstrong
needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located." "You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this
situation? - CORRECT ANSWER You will not be able to represent any Medicare Advantage or
Part D plan until you complete the training and achieve an adequate score, although you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing." "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. 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." "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
