AHIP Final Exam Test Questions and Answers (2022/2023) ., Exams of Nursing

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d. I, II, III, and IV

AHIP Final Exam Test Questions and Answers

Mrs. Paterson is concerned about the deductibles and co-payments associated with Original

MedicareWhat can you tell her about Medigap as an option to address this concern?

a. Medigap plans are not sold by private companies and are a government insurance product. b. All costs not covered by Medicare are covered by some Medigap plans. c. If Mrs. Paterson applies during the Medigap open enrollment period, she will have to undergo a medical review to determine if she has a pre-existing condition that would increase the premium for a Medigap policy. d. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services.

2. Mr Valesquez asked if the Private Fee-for-Service plan you have discussed is like Original Medicare or

a Medigap supplement plan. What should you say about a Private Fee-for-Service (PFFS) plan to

explain it to Mr. Valesquez?

a. It is a type of Medicare Advantage plan that allows you to go to any doctor anywhere. c. It is the same as Original Medicare, but offered by a private company. d. It is not Original Medicare and it works differently than a Medicare supplement plan.

3. Which of the following statements about Medicare Part D are correct?

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.

IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP

or through their plan.

a. I and II only b. I only c. I, II, and III only

4. You are completing a PFFS plan sale to Mr. West who is new to Medicare and prefers to be

AHIP Final Exam Test Questions and Answers

contacted by telephone. As you are finishing up, what should you tell him about next steps in the

enrollment process?

a. You need to ask Mr. West a few final questions to ensure he understands the nature of the plan and really wants to enroll. You also should tell Mr. Schmidt that after you leave, he should not answer any questions about his enrollment in the plan because it could result in a disenrollment. b. You need to get Mr. West’s phone number and include it on the enrollment form because the PFFS plan will contact him once the organization receives the enrollment form and will ask about the quality of your service. You should not discuss the phone call with Mr. West to avoid influencing his answers. c. You need to get Mr. West’s phone number and include it on the enrollment form because the plan must call him after you leave to ensure that he understood the nature of the PFFS plan he selected and to verify his intent to enroll. d. You should not include Mr. West’s phone number on the enrollment form in case he is on the “Do Not Call” registry.

5. What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

have upon Medigap plans?

a. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. b. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. c. The Part A deductible is no longer covered under Medigap plans for all enrollees staring January 1,

d. MACRA provides funding to help individuals age 59 and above enroll in Medigap plans.

6. Able, Baker, and Charles are engaged in the marketing to and enrollment of beneficiaries into Medicare

health plans. Mr. Able is an independent agent paid directly by a health plan. Ms. Baker is an

independent agent paid through a field marketing organization (FMO). Mr. Charles is an independent

agent paid for his work by a third-party marketing organization (TMO). How do the CMS

compensation rules apply to these three agents?

a. All three are treated as independent agents under CMS compensation rules. b. Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not bec he is paid directly by a health plan. c. Able is subject to CMS compensation rules because he is paid directly by a health plan. Agents Baker and Charle not because they are paid by third parties. d. Charles is subject to CMS compliance rules because he works for a TMO and CMS applies an extra layer of scru such organizations. Able and Baker are not.

7. 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?

a. You should sign the form for Mrs. Nunez yourself, since she informed you, as the plan’s

AHIP Final Exam Test Questions and Answers

payment in full.

a. II and III only b. I, II, and III only c. I, II, and IV only d. I and II only

11. Mr. James has end stage renal disease (ESRD). He has been covered under Original Medicare but would like to know if he can enroll in a Medicare Advantage plan. What should you tell him? a. Individuals with end stage renal disease may enroll in a Medicare Advantage plan, but only if they are willing to pa extra premium to do so. b. Individuals with end stage renal disease can only enroll in a Medicare Advantage plan after they have been on dia for 12 months. c. Individuals with end stage renal disease can enroll in any Medicare Advantage plan that they choose without payin extra premium. d. He will not be able to enroll in a Medicare Advantage plan because he has end stage renal disease, unless a spec needs plan for beneficiaries with ESRD is available in his service area.
12. Ms. Jensen has heard about “Original Fee-for-Service Medicare” and “Private Fee-for-Service” plans. She wants to know what the difference is, if any. What should you tell her? a. Original Medicare and PFFS plans are essentially the same thing. b. PFFS plans are a type of Medicare Advantage plan offered by private companies. c. PFFS plans primarily cover drugs that Original FFS Medicare does not cover. d. PFFS is a form of supplemental coverage that fills in the gaps where Original Medicare leaves

AHIP Final Exam Test Questions and Answers

off.

13. Agent Herman works in the senior marketplace and depends on referrals and leads to grow and maintain his business. Which of the following situations may Agent Herman contact and speak with the Medicare Advantage prospect?
14. a. Agent Herman recognizes some elderly neighbors in the lobby of his condominium complex and would like to appr them about how Medicare Advantage compares to Original Medicare. b. Agent Herman’s wife called a former neighbor and told her about Herman’s extensive knowledge of Medicare and rules. The neighbor agreed to meet with Herman about the Medicare Advantage products he represents. c. Agent Herman has left business cards with Edgar, one of his clients. Edgar passes one of the cards to Sam who expresses an interest in meeting with Herman about Medicare Advantage. Sam subsequently calls Herman’s office. d. Agent Herman learns during a meeting of his book club that fellow member Eleanor is voluntarily disenrolling from her current Medicare Advance plan.

14. Mrs. Kendrick is six months away from turning 65. She wants to know what she will have to do to

enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her?

a. She must first enroll in a Medicare Part D plan, before enrolling in a Medicare Advantage plan. b. She must have previously been enrolled in Original Fee-for-Service Medicare for at least one year before she m enroll in an MA plan. c. She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare and Part B. d. MA plans are only available to those who have been enrolled in a Medigap plan for at least six months. Therefor before enrolling in an MA plan, she must first use a Medigap plan to supplement her Original Medicare coverage .

15. 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?

a. You can make unsolicited contacts but you cannot cross-sell other products. b. You do not need to take an annual test, but you must not provide potential enrollees with more than light snacks at presentations. c. You are not required to submit copies of disseminated materials to CMS at the time of use, but CMS may reques and review copies if employee complaints occur. d. You do not need to complete a scope of appointment, but CMS can ask you to reconstruct one if there is a subsequent employee complaint.

16. Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare

enrollment period because 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?

a. Part D covers prescription drugs and she should look at her premiums, formulary, and cost sharing among other to see if they have changed.

AHIP Final Exam Test Questions and Answers

a. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval

because it does not include information about the plans’ benefit structures, cost sharing, or information about measures or ranking standards.

17. Mr. Rice has coverage for medical services and medications through his employer’s retiree plan. He is considering switching to a Medicare prescription drug plan because his retiree plan does not cover two important medications. What should he consider before making a change? a. Mr. Rice’s retiree plan is required to take him back if, within 63 days of having voluntarily quit the employer’s pla he decides that he prefers it to his Medicare Part D plan. b. Mr. Rice can only receive his prescription drug coverage through a Medicare Advantage prescription drug plan so he should drop his employer coverage. c. If his drug coverage through the retiree plan is “creditable” he should not switch, even though it is possible to do d. If Mr. Rice drops his drug coverage through the retiree plan, he may not be able to get it back and he also may l his medical health coverage.

18. 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?

b. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it is considered gene audience marketing. c. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval and may also inclu the advertisement information about the plans’ benefit structures and star rankings. d. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it meets the definition of marketing material.

19. Ms. Bushman has two homes in different states and is concerned about restrictions on where she

can get her medications. What should you tell her?

a. Part D prescription drug plans focus almost entirely on mail order with fairly limited access to retail pharmacies, as long as she orders all of her medications through the mail, she will be fine. b. Part D prescription drug plans generally contract with every pharmacy in the country, so she should be able to o her drugs in both states with no problem. c. Part D prescription drug plans use networks of pharmacies within their service areas. She could look for a plan that maintains a network in both states. d. Part D prescription drug plans are restricted to local service areas. She will have to use mail order to fill all of her prescriptions.

20. Mr. Barker had surgery recently 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

AHIP Final Exam Test Questions and Answers

fully covered. He called you to ask what he could do? What could you tell him?

a. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. b. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state. c. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision.

AHIP Final Exam Test Questions and Answers

also cover Part D prescription drugs. b. Medicare health plans offer a menu of benefits, from which he may choose, so if he ever wants to increase his coverag need only contact the plan and select other options. c. Medicare health plans have the option of deciding, each year, what services they will cover. He is correct that the healt plan could eliminate some benefits covered by Medicare and he should think carefully before enrolling in a Medicare heal plan. d. He should not be concerned because Medicare health plans must cover all IRS-approved health care expenses, which means

AHIP Final Exam Test Questions and Answers

that all of them provide substantially greater benefits than are available under Medicare Part A and Part B.

25. Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving Social Security

benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled

in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn?

a. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many prevent and screening tests, generally will have 20% co-payments for these services, in addition to an annual deductible. b. She will need to pay no premiums for Part B as she qualifies for premium free coverage due to the number of quarters sh has worked. c. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage to doing so. d. Part B will cover her dental and vision needs.

26. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for tha

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?

a. Medicare will cover Mrs. Shields' skilled nursing services provided during the first 20 days of her stay, after which she would have a coinsurance until she has been in the facility for 100 days. b. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields' long-term care costs. c. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. d. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed.

27. Which of the following individuals are likely to qualify for a special enrollment period (SEP) for both MA and

Part D due to a change of residence?

I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his existing

plan's service area.

II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service area.

III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a service area where

no Part D plan was available.

IV. Henry makes a permanent move providing him with new MA and Part D options.

a. II and III only b. I, II, III and IV c. I and II only d. II, III, and IV only

AHIP Final Exam Test Questions and Answers

institutionalized individuals. d. Mary’s only option in this situation is to return to Original Medicare.

29. Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive

premium. He wants to Mr know what makes them different from an HMO or a PPO. What should you tell

him?

a. PFFS plans are the same as Medicare supplement plans and he may obtain care from any provider in the U.S. b. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan’s terms and conditions and agrees to accept them. c. If a PFFS enrollee shows his/her card when obtaining services from a provider who participates in Original Medicare, t that provider is required to accept the plan’s terms and conditions. d. If offered, beneficiaries can select a stand-alone Part D prescription drug plan (PDP) with an HMO or a PPO, but not w PFFS plan.

30. 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?

a. You may request RSVPs, but you are not permitted to require contact information. b. You are not permitted to request RSVPs, so you will need to find a different way to estimate how many people are com c. You may require RSVPs and an e-mail address so you can follow up in the event of a cancellation. d. You may not require RSVPs, but when people arrive, you may require completion of contact information on a sign-up s

31. 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?

a. FeelBetter will pay Agent Chan initial year compensation for the period July 1 through October 15th - (the date open enrollment begins). If Ms. Park remains enrolled in the plan, renewal amounts will be paid. b. FeelBetter will pay Agent Chan initial year compensation for the 12 months of July through July. Renewal amount will b paid thereafter if Ms. Park remains enrolled. c. FeelBetter will pay Agent Chan a bonus equal to three months initial year compensation since he has successfully enro Ms. Park in a MA plan when she is both first eligible and a younger, and likely healthier, enrollee. d. FeelBetter will pay Agent Chan initial year compensation for the months July through December. Renewal amounts wil be paid starting in January if Ms. Park remains enrolled the following year.

32. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare

and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network

doctor to receive a Medicare covered service. How much may the doctor collect from Mr. Rivera?

AHIP Final Exam Test Questions and Answers

a. The doctor may only collect the amount allowable under Medicare Advantage (MA) PPO plan cost sharing for non-QMB enrollees. b. The doctor may only collect the amount allowable under Medicare plus 25 percent balance billing. c. The doctor may only collect the amount allowable under Medicare plus 15 percent balance billing. d. The doctor may only collect from Mr. Rivera the cost sharing allowable under the state’s Medicaid program.

33. 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?

AHIP Final Exam Test Questions and Answers

d. She should remain in Original Medicare until the annual election period running from October 15 to December 7, durin which she January 1 and M 31. b. She could enroll in an MA plan during the period including the three months before, the month of, and up to three mont after turning 68. c. She could immediately enroll in MA plan based on the one-time special enrollment period available to those 70 and you

38. Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and

requested a meeting so that she can learn about Medicare and the products you represent. How should you

respond?

AHIP Final Exam Test Questions and Answers

a. Tell Julia that you will meet with her to explain Medicare and should she be interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying her for a special enrollment period. b. Tell Julia that she must first complete a questionnaire providing her health history so that you can recommend an appropriate product before submitting an enrollment application, since she qualifies for a special enrollment period. c. Tell Julia that you will meet with her at a time of her convenience within the next week, when you can accept a completed enrollment application to be submitted after October 15th. d. Tell Julia that you are happy to meet with her once this year’s open enrollment begins on October 15th.

39. BestCare Health Plan has received a request from a state insurance department in connection with the

investigation of several marketing representatives licensed by the state who sell Medicare Advantage

plans. What action(s) should BestCare take in response?

a. Immediately meet with the marketing representatives and suggest they obtain licensing in another jurisdiction. b. Immediately terminate all the agents involved as a precaution against potential legal liability. c. Under Federal privacy statutes, BestCare is not obligated to provide information about marketing representatives to the and should refuse to do so. d. Cooperate with the state and supply requested information.

40. 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?

a. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. b. She can enroll in the PPO and purchase drug coverage through a Medigap plan. c. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any tim favor of a Medicare Advantage plan that includes such drug coverage. d. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan.

41. 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?

a. When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. Mrs. Allen will need to encoura her physician to prescribe the least expensive of the two alternatives. b. Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. She will need to pay for her br name medications out of pocket. c. Medicare prescription drug plans are required to include only a certain percentage of brand name drugs

AHIP Final Exam Test Questions and Answers

a. Medicare Health Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services. b. All Medicare Health Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare. c. Medicare Health 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. d. Medicare Health Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare.

43. Mr. Denton 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?

a. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments b. He may sign-up for Medicare at any time and coverage usually begins immediately. c. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatment start. d. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits

44. You are scheduled to give a sales presentation at a local senior center. At the beginning of the

presentation, which of the following must you do?

a. Clearly state that no obligation exists to enroll if a gift or prize is being provided. b. Determine whether the beneficiaries present are healthy enough for the plan. c. Explain, in your own words, how the plan you represent compares to other companies’ plans. d. Make sure that those present provide leads.

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?

a. He should contact his neighbors and family members and let them know that any contributions they make toward his drug expenses will be tax deductible. b. 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 pharma assistance program to help him with his expenses. c. He should look into the possibility of purchasing his medications through the internet from off-shore pharmacies. d. The only option available is to reduce his income so that he can qualify for the Part D extra help or wait until next year to see if the annual limits change.

46. You have had a good meeting with Mr. Claggett and he has selected a Medicare Advantage plan. He

would like you to help him complete the enrollment application because he wants to make sure he gets into the

AHIP Final Exam Test Questions and Answers

right plan. You offer to help, but you tell him that you cannot do which of the following?

a. Help him place a phone call to the plan sponsor’s enrollment center. b. Help him correct any information on the enrollment form if he makes a mistake. c. Help him fill out any portion of the enrollment form. d. Help him find the plan’s enrollment website on your laptop computer.

AHIP Final Exam Test Questions and Answers