Download Medicare Final Exam Test Questions with Answers and more Exams Medicine in PDF only on Docsity!
AHIP FINAL EXAM TEST QUESTIONS
WITH 100% VERIFIED CORRECT ANSWERS
"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." "You have approached a hospital administrator about marketing in her facility. The administrator
is uncomfortable with the suggestion. How could you address her concerns? - CORRECT
ANSWER Tell her that Medicare guidelines allow you to conduct marketing activities in common
areas of a provider's facility." "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." "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." "Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State. What should you tell
her? - CORRECT ANSWER Medicaid may provide additional benefits, but Medicaid will
coordinate benefits only with Medicaid participating providers." "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. 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. 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." "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." "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." "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
ANSWER She should remain in Original Medicare until the annual election period running from
October 15 to December 7, during which she can select an MA plan." "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." "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. 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. 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. 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 a number of 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."
"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" "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." "Mrs. Schmidt is moving and a friend told her she might qualify for a "Special Election Period" to enroll in a new Medicare Advantage plan. She contacted you to ask what a Special Election Period
is. What could you tell her? - CORRECT ANSWER It is a time period, outside of the Annual
Election Period, when a Medicare beneficiary can select a new or different Medicare Advantage and/or Part D prescription drug plan. Typically the Special Election Period is beneficiary specific and results from events, such as when the beneficiary moves outside of the service area." "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." "Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his
wife's needs. What could you tell Mr. Moy? - CORRECT ANSWER Medicare Supplemental
Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover."
CORRECT ANSWER He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls
in Medicare Part B." "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." “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." "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." "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." "Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to know his options since he has decided to drop his retiree coverage and is eligible for Medicare.
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, but he should revaluate if he really wants to drop his employer coverage." "Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What
should you tell him? - CORRECT ANSWER He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments start." "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 MS MSA plan and remain in her
current standalone Part D prescription drug plan." "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." "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. 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."
