AHIP Final Exam questions /verified answers graded A+/LATEST 2024=2025, Exams of Nursing

Download AHIP Final Exam questions /verified answers graded A+/LATEST 2024=2025 and more Exams Nursing in PDF only on Docsity! AHIP Final Exam questions /verified answers graded A+/LATEST 2024=2025 1.Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs?: Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. 2.Mr. Bauer is 49 years old, but eighteen months ago he was declared dis- abled 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?: After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. 3.Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently learned that she is suffering from inoperable cancer and has just a few months to live. She would like to spend these final months in hospice care. Mildred's family asks you whether hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you say?: Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid for by Original Medicare under Part A and Allcare will continue to pay for any non-hospice services. 4.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?: 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. 5.Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur- rently 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?: Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. 6.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?: He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. 7.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?: Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. 8. Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substan- tial estate which provides Shirley is eli- gible for a Special Enrollment Period (SEP) for up to six months after the termination of her Medicaid coverage. Under this SEP, Shirley can choose retroactive coverage back to the date of termination from Medicaid or coverage beginning the month after the month of enrollment. 15.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?: 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. 16.Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her?: Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. 17.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?: 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. 18.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?: Ben- eficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. 19. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under- stand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr. Moy?: Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. 20.Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and severe wind damage. The Federal government declared this to be a natural disaster which has recently ended. During this period Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare coverage. What should you say?: Anthony is eligible for a special enrollment period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration. Anthony may enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months. 21.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?: You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. 22.Mr. Romero is 64, retiring soon, and considering enrollment in his em- ployer-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?: He should compare the benefits in his em- ployer-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. 23.Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems func- tioning. Which type of SNP is likely to be most appropriate for him?: C-SNP timeliness in getting an appointment. 28.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?: He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. 29.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 deter- mine his eligibility?: You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area. 30.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?: 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. 31.Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage?: She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. 32.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?: 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. 33.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?: 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. 34.Mrs. Lyons is in good health, uses a single prescription, and lives indepen- dently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan?: 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. 35.Which of the following statement(s) is/are correct about a Medicare Sav- ings Account (MSA) Plans?: MSAs may have either a partial network, full network, or no network of providers. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full. 36.Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. 37. 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?- : Medicare Advantage Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services but must include a maximum out-of-pocket limit. account until it is exhausted, and then have his premiums withheld from his Social Security check. What should you tell him?: In general, he must select a single Part D premium payment mechanism that will be used throughout the year. 45.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?: He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means to 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. 46.Charles McCarthy is a Medicare beneficiary who suffers from diabetes. Mr. McCarthy is considering enrollment in a MA-PD plan that you represent. He asks you whether his insulin costs will be covered. What should you say?: Mr. McCarthy's insulin costs for a one-month supply cannot be more than $35 in any coverage phase under the prescription drug plan beginning in 2023. 47.Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?: Jose, a grandfather who was granted asylum and has worked in the United States for many years. 48.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?: If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. 49.Mr. Schultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Schultz has lost his employer group coverage within the last two weeks. How would you advise him?: Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. 50.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?: 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. 51.Mr. Jacob understands that there is a standard Medicare Part D prescrip- tion 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, premi- ums, and cost sharing. How can you explain this to him?: 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. 52.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?: 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. 53.Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?: If the Medicare Advan- tage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this. 54.Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen to her drug coverage?: Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area. 55.Mrs. Cantwell is enrolled in a prescription drug plan. She has heard about something called True-Out-Pocket costs or "TrOOP" and asks you if any of the following count toward reaching the catastrophic coverage phase. What do you say?: Her annual PDP deductible, A drug manufacturer's discount for brand name drugs after her initial coverage period 56.Mr. Carlini has heard that Medicare prescription drug plans are only offered through like to use the power of social media to reach potential prospects. What advice would you give her?: As soon as CMS approves Best Care's social media posts, Agent Meadows could post a tweet stating that "Best Care offers an array of Medicare Advantage benefit packages. One might be right for you. Call me to find out more!" 63. 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?: You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score. However, you will not have to take a test if you exclusively market employer/union group plans and the companies do not require testing. 64.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?: During the first minute of a sales call, Hector must use a disclaimer that says "I do not represent every plan available in your area. I represent 3 organizations that offer 10 plans in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options." 65.Agent Daniel Webber has properly set up a sales appointment to meet with client Edward Young at Agent Webber's office. At the agreed upon appointment time, Mr. Young arrives with his elderly neighbor - Clara Burton, who wants to learn about her Medicare Advantage options. What should Agent Daniel Webber do?: After executing a scope of appointment (SOA) with Clara Burton, meet with Edward Young and Clara Burton to discuss their Medicare Advantage options. 66.Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same marketing requirements as the plans themselves. How should you respond to such a statement?: Your coworker is not correct. Market- ing on behalf of a plan is considered marketing by the plan and requires that all contracted and employed agents comply with all Medicare marketing rules. 67. Linda Sanchez is conducting a previously agreed upon appointment with client, Maria Gomez about a MA-Part D plan she represents. Before an enroll- ment form is completed, Linda needs to provide Maria with information about : whether or not Maria's primary care provider is in the plan's network. whether Maria's current prescriptions are covered by the plan. the monthly premium cost(s). 68.Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you give Miguel?: During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have requested such meet- ings. 69. Evan Marsh is a newly appointed agent. Evan intends to conduct an educational session on Medicare at a senior citizens center near his home. He has advertised the session as an educational event. Evan asks you what is permissible at such an event. What should you say?: Evan may provide a meal as long as its value is $15 or less per attendee and he may make available business reply cards (BRCs). 70.You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with the suggestion. How could you address her concerns?: Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility. 71.Your client, Alexis Jones, calls you on December 4th about changing her Medicare Advantage plan during the annual election period which ends December 7th. What should you do?: Complete a scope of appointment (SOA) during the call and indicate that they will meet to discuss Medicare Advantage plans during an appointment the following day. 72.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?: Marketing in health care facilities is an acceptable practice, as long as it takes place in common areas where patients 77.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?: Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. 78.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?: You may provide her with the required enrollment materials and take her completed enrollment application. 79. 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?: It must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan sponsor may use their information for marketing purposes. 80.You have been providing a pre-Thanksgiving meal during sales presenta- tions in November for many years and your clients look forward to attending this annual event. When marketing Medicare Advantage and Part D plans, what are you permitted to do with respect to meals?: You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. 81.Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the Annual Election Period to help her complete her enrollment in a Part D plan. She asked you when she should have her daughter plan to visit. What could you tell her?: Her daughter should come in November. 82.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?: She can enroll in a Medigap plan to supplement the benefits of the MA plan that she's also enrolling in. 83.You have come to Mrs. Midler's home for a sales presentation. At the beginning of the presentation, Mrs. Midler tells you that she has a copy of her medical records available because she thinks this will help you understand her needs. She suggests that you will know which questions to ask her about her health status in order to best assist her in selecting a plan. What should you do?: You can only ask Mrs. Midler questions about conditions that affect eligibility, specifically, whether she has one of the conditions that would qualify her for a special needs plan. 84. Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell her?: During the MA Open Enrollment Period, from January 1 - March 31, she may disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone prescription drug plan. 85.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)?: Edna would qualify for a SEP because government officials have declared a major disaster for her area and she did not enroll in MA during her ICEP due to the emergency. George would qualify for an SEP because he enrolled in Medicare Advantage (MA) plan for the first time and would now like to return to Original Medicare within the first 12 months of his enrollment. Harriet would also qualify for a SEP to enroll in a C-SNP because she has developed a chronic condition. Felix would not qualify for a SEP since he seeks to enroll in a 4-star not a 5-star MA plan. currently is enrolled in Original Medicare Parts A and B but has heard about a Medicare Advantage plan offered by Senior Health from a neighbor. Mrs. Parker asks you whether she can enroll in Senior Health's MA plan over the telephone. What can you tell her?: Telephone enrollment request calls must be recorded. Telephonic enrollments must include all required elements necessary to complete an enrollment. 94.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.: "If you're not in very good health, you will probably do better with a different product." 95.Mrs. Margolis contacts you in August because she will become eligible for Medicare for the first time in November. She would like to meet and discuss plan choices with you. What advice should you give her?: Tell her to wait until October to discuss plan choices with you so that you can share plan benefits for the current year as well as any changes for the following year that may impact her choice. 96.A client wants to give you an enrollment application on October 1 before the beginning of the Annual Election Period because he is leaving on vacation for two weeks and does not want to forget about turning it in. What should you tell him?: You must tell him you are not permitted to take the form. If he sends the form directly to the plan, the plan will process the enrollment on the day the Annual Election Period begins. 97.Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her about the Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment period that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly after speaking to her neighbor. What should you tell her?: There is a MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but Ms. Gonzales cannot use it because eligibility to use the OEP is available only to MA enrollees. 98.Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren. As a result, Mary has been admitted to a rehabilitation hospital where she is expected to reside for several months. The rehabilitation hospital is located outside the geographic area served by her current Medicare Advan- tage (MA) plan. What options are available to Mary regarding her health plan coverage?: Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. 99.Mr. Ziegler is turning 65 next month and has asked you what he can do, and when he must do it, with respect to enrolling in Part D. What could you tell him?: He is currently in the Part D Initial Enrollment Period (IEP) and, during this time, he may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD plan. 100. 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)?: Mr. Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins in June and ends on September 1- two months after the loss of creditable coverage. 101. This year you decide to focus your efforts on marketing to employer and union groups. Which of the following statements best describes what you can and cannot do in order to stay in compliance?: You are not required to submit communication and marketing materials specific only to those employer plans to CMS at the time of use, but CMS may request and review copies if employee complaints occur. 102. Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in her area. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan's service area. What should you tell her about coverage of emergency care?: Plans are required to cover out-of-network emergency care. 103. Agent Suma has recently had several clients request his assistance in completing their paper enrollment form. What advice would you give him?: In most instances, Agent Suma should be clearly indicating his name on their forms as their marketing representative. 104. Mr. Wong is a single individual. He has had a successful business career and is