AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update, Exams of Nursing

Download AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update and more Exams Nursing in PDF only on Docsity! AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. What could you tell her? - CORRECT ANSWERS She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue, what should you say? - CORRECT ANSWERS Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month in which the individual receives a kidney transplant unless they are eligible for Medicare on another basis such as age or disability. Edward may, however, remain enrolled in Part B but solely for coverage of immunosuppressive drugs if he has no other health care coverage that would cover the drugs. 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? - CORRECT ANSWERS 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. 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 ANSWERS Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. 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 ANSWERS Medicare Supplemental Insurance would help cover his Part A and Part B AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. 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 ANSWERS 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. 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 ANSWERS After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. 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? - CORRECT ANSWERS Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. 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 ANSWERS She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period after the last month on her employer plan that differs from the standard general enrollment period, during which she may enroll in Medicare Part B. 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 ANSWERS He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ 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? - CORRECT ANSWERS 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. Mrs. Lyons is in good health, uses a single prescription, and lives independently 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? - CORRECT ANSWERS 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. 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 ANSWERS 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. Romero is 64, retiring soon, and considering enrollment in his employer- 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? - CORRECT ANSWERS He should compare the benefits in his employer-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. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him? - CORRECT ANSWERS SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ 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? - CORRECT ANSWERS 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. 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 ANSWERS 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. Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and contributed to the Medicare system. Juan suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How would you respond? - CORRECT ANSWERS Juan is eligible to enroll in a Medicare Advantage as long as he is entitled to Part A and enrolled in Part B. Juan should go to the Social Security website to enroll in Medicare Part A and B if he has not done so already. Once he is enrolled, he can choose a Medicare Advantage plan. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? - CORRECT ANSWERS Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. 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 AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ you tell him? - CORRECT ANSWERS You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans? I. MSAs may have either a partial network, full network, or no network of providers. II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits. III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed for inflation. IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full. - CORRECT ANSWERS I, II, and IV only Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost- sharing amounts and Mr. Greco would like to join that plan. What should you tell him? - CORRECT ANSWERS SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him? - CORRECT ANSWERS C- SNP 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 ANSWERS He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ 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 ANSWERS 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. Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? a.Guy, who has illegally crossed the Canadian border. b. Jose, a grandfather who was granted asylum and has worked in the United States for many years. Correct: Jose, having been granted asylum, is legally present in the United States thus meeting one of the criteria for Part D eligibility. c.Betsy, a grandmother from overseas who has overstayed her visa. d.Helena, an overseas college student who has overstayed her visa. - CORRECT ANSWERS Jose, a grandfather who was granted asylum and has worked in the United States for many years. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him? - CORRECT ANSWERS Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to? - CORRECT ANSWERS Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ 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 ANSWERS 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. 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 ANSWERS 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. 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? - CORRECT ANSWERS Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area. 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? I. Her annual PDP deductible II. A drug manufacturer's discount for brand name drugs after her initial coverage period III. The off formulary drug her doctor prescribed but she pays for because the plan denied her exception request IV. Her over-the-counter (OTC) allergy medication. - CORRECT ANSWERS I and II only Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and become Medicare eligible for the first time. What issues might she consider about whether to enroll in a Medicare prescription drug plan? - CORRECT ANSWERS She could compare the coverage to see if the Medicare Part D plan AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ offers better benefits and coverage than the FEHB plan for the specific medications she needs and whether any additional benefits are worth the Part D premium costs on top of her FEHB contribution. 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? - CORRECT ANSWERS If the Medicare Advantage 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. 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 ANSWERS In general, he must select a single Part D premium payment mechanism that will be used throughout the year. 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 ANSWERS 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. 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 ANSWERS 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. 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. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ I. whether or not Maria's primary care provider is in the plan's network.II. whether Maria's current prescriptions are covered by the plan.III. the monthly premium cost(s).IV. the life insurance products that Linda also sells - CORRECT ANSWERS I, II, and III only 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 ANSWERS 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. Another agent you know has engaged in misconduct that has been verified by the plan she represented. What sort of penalty might the plan impose on this individual? - CORRECT ANSWERS The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract. 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 ANSWERS It must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan sponsor may use their information for marketing purposes. You have been providing a pre-Thanksgiving meal during sales presentations 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? - CORRECT ANSWERS You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. 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 ANSWERS Marketing in health care facilities is an acceptable AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ practice, as long as it takes place in common areas where patients are not receiving health care services. 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? - CORRECT ANSWERS Your coworker is not correct. Marketing 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. 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? - CORRECT ANSWERS 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). 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 ANSWERS 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." 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 ANSWERS Marketing representatives may initiate electronic contact through e-mail but an opt-out process must be provided. Sal D'Angelo is new to the Medicare marketplace having previously been focused on life insurance and disability income protection products. He intends to conduct an educational seminar during the AEP at a local hotel and then invite those who attend to a subsequent marketing meeting to discuss the benefits of next year's plans. How would you advise Sal? - CORRECT ANSWERS Sal should conduct AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ the education seminar as an early morning meeting and the marketing meeting on the following day in the late afternoon so that there are at least 12 hours between the two meetings. 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 ANSWERS She can enroll in a Medigap plan to supplement the benefits of the MA plan that she's also enrolling in. You are visiting with Mr. Tully and his daughter at her request. He has advanced Alzheimer's and is incapable of understanding the implications of choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the enrollment form and sign it for him? - CORRECT ANSWERS Mr. Tully's daughter can do so only, if she is authorized under state law as a court-appointed legal guardian, has a durable power of attorney for health care decisions, or is authorized under state surrogate consent laws to make health decisions. 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? - CORRECT ANSWERS Her daughter should come in November. Mr. White has Medicare Parts A and B with a Part D plan. Last year, he received a notice that his plan sponsor identified him as a "potential at-risk" beneficiary. This month, he started receiving assistance from Medicaid. He wants to find a different Part D plan that's more suitable to his current prescription drug needs. He believes he's entitled to a SEP since he is now a dual eligible. Is he able to change to a different Part D plan during a SEP for dual eligible individuals? - CORRECT ANSWERS No. Once he is identified by the plan sponsor as a "potential at- risk" beneficiary, he cannot use the dual eligible SEP to change plans while this designation is in place. No. Once he is identified by the plan sponsor as a "potential at-risk" beneficiary, he cannot use the dual eligible SEP to change plans while this designation is in place. - CORRECT ANSWERS Mary may make an unlimited number of MA enrollment requests and may disenroll from her current MA plan. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ 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? - CORRECT ANSWERS 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. 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 (MA) plan and approaches you about her options. What advice would you give her? - CORRECT ANSWERS 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. 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? - CORRECT ANSWERS 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. 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 ANSWERS 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. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ 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 ANSWERS "If you're not in very good health, you will probably do better with a different product." 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? - CORRECT ANSWERS 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. 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? - CORRECT ANSWERS 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. Mr. Polanski likes the cost of an HMO plan available in his area but would like to be able to visit one or two doctors who aren't participating providers. He wants to know if the Point of Service (POS) option available with some HMOs will be of any help in this situation. What should you tell him? - CORRECT ANSWERS The POS option might be a good solution for him as it will allow him to visit out-of-network providers, generally without prior approval. However, he should be aware that it is likely he will have to pay higher cost-sharing for services from out-of-network providers. 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? - CORRECT ANSWERS Baker and Charles are subject to CMS compensation rules because they are paid by third parties. Able is not because he is paid directly by a health plan. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but he did not enroll in Part B because he has employer-sponsored coverage and intends to keep working for several more years. But he is considering enrolling in Part D prescription drug coverage because he believes it is superior to his employer plan. How would you advise him? - CORRECT ANSWERS Mr. Landry is eligible for Part D since he has Part A, and his initial enrollment period (IEP) for Part D will continue for three months after his 65th birthday. Who is most likely to be eligible to enroll in a Part D prescription drug plan? - CORRECT ANSWERS Ms. Davis who is entitled to Part A and has just enrolled in Part B. 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? - CORRECT ANSWERS 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. Which of the following statements best describes Section 1557 of the Affordable Care Act (ACA)? - CORRECT ANSWERS Section 1557 incorporates earlier civil rights protections in regard to race, color, national origin, disability, age and sex. Under ACA Section 1557, a health plan premium sold through a state exchange may, based on an individual's age and - CORRECT ANSWERS charge higher premiums As a result of violations of ACA Section 1557 nondiscrimination rules, - CORRECT ANSWERS a health plan may revoke an agent or broker's appointment with the health plan. Which Medicare programs are covered by ACA Section 1557 under the Biden Administration's Final Rule (2024)? - CORRECT ANSWERS Parts A, C, and D, and Part B. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ You are performing a regular inventory of the controlled substances in the pharmacy. You discover a minor inventory discrepancy. What should you do? - CORRECT ANSWERS Follow your pharmacy's procedures. You are in charge of paying claims submitted by providers. You notice a certain diagnostic provider ("Doe Diagnostics") requested a substantial payment for a large patient group. Many of these claims are for a certain procedure. You review the same type of procedure for other diagnostic providers and realize Doe Diagnostics' claims far exceed any other provider you reviewed. What should you do? - CORRECT ANSWERS Consult with your immediate supervisor for next steps or contact the compliance department (via compliance hotline, Special Investigations Unit [SIU], or other mechanism) Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly or intentionally misrepresented facts to obtain payment. - CORRECT ANSWERS True Bribes or kickbacks of any kind for services that are paid under a Federal health care program (which includes Medicare) constitute fraud by the person making as well as the person receiving them. - CORRECT ANSWERS True Ways to report potential fraud, waste, and abuse (FWA) include: a.Telephone hotlines b.Mail drops c.In-person reporting to the compliance department/supervisor d.Reporting to a Special Investigative Units (SIUs) e.All of the above - CORRECT ANSWERS All of the above You can help prevent fraud, waste, and abuse (FWA) by doing all the following: Look for suspicious activity Conduct yourself in an ethical manner AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ Ensure accurate and timely data and billing Ensure you coordinate with other payers Keep up to date with FWA policies and procedures, standards of conduct, laws, regulations, and the Centers for Medicare & Medicaid Services (CMS) guidance Verify all information provided to you - CORRECT ANSWERS True These are examples of issues that should be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA); potential health privacy violation, unethical behavior, and employee misconduct. - CORRECT ANSWERS True Once a corrective action plan is started, the corrective action plan must be monitored annually to ensure they are effective. - CORRECT ANSWERS False Waste includes any misuse of resources, such as the overuse of services or other practices that directly or indirectly result in unnecessary costs to the Medicare Program. - CORRECT ANSWERS True What are some of the penalties for violating fraud, waste, and abuse (FWA) laws? a.Civil Monetary Penalties b.Imprisonment c.Exclusion from participation in all Federal health care programs d.All of the above - CORRECT ANSWERS All of the above Some of the laws governing Medicare Part C and D fraud, waste, and abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA), the Civil False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud Statute. - CORRECT ANSWERS True You work for a Sponsor. Last month, while reviewing a Centers for Medicare & Medicaid Services (CMS) monthly report, you identified multiple individuals not enrolled in the plan but for whom the Sponsor is paid. You spoke to your supervisor who said don't worry about it. This month, you identify the same enrollees on the AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ report again. What should you do? - CORRECT ANSWERS Although you know about the Sponsor's non-retaliation policy, you are still nervous about reporting—to be safe, you submit a report through your compliance department's anonymous tip line to avoid identification A sales agent, employed by the Sponsor's first-tier, downstream, or related entity (FDR), submitted an application for processing and requested two things: 1) to back- date the enrollment date by one month, and 2) to waive all monthly premiums for the beneficiary. What should you do? - CORRECT ANSWERS Process the application properly (without the requested revisions)—inform your supervisor and the compliance officer about the sales agent's request You discover an unattended email address or fax machine in your office receiving beneficiary appeals requests. You suspect no one is processing the appeals. What should you do? - CORRECT ANSWERS Contact your compliance department (via compliance hotline or other mechanism) Correcting non-compliance________ - CORRECT ANSWERS Protects enrollees, avoids recurrence of same non-compliance, and promotes efficiency What is the policy of non-retaliation? - CORRECT ANSWERS Protects employees, who in good faith report suspected non-compliance Standards of Conduct are the same for every Medicare Parts C and D sponsor. - CORRECT ANSWERS False At a minimum, an effective compliance program includes four core requirements. - CORRECT ANSWERS False Compliance is the responsibility of the Compliance Officer, Compliance Committee, and Upper Management only. - CORRECT ANSWERS False AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ Which of the following would be considered permissible under Section 1557? - CORRECT ANSWERS Broker Mary Jones has recruited a diverse workforce. She encourages her agents to prospect through community-based marketing and within their community of influence. Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty. - CORRECT ANSWERS False You are working with several plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do? - CORRECT ANSWERS You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. Agent Willis had several clients who disenrolled from the plans he represents during the AEP to enroll in Medicare Advantage plans that are competitors of his. Agent Willis believes that the choices they made are not ideal for them and would like to get their business back during the Medicare Advantage Open Enrollment Period (MA-OEP). What can agent Willis do? - CORRECT ANSWERS He can call them to let them know that if they do not like their new plans, they can change back during the MA-OEP. During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be available to her. What should you tell her about PFFS plans? - CORRECT ANSWERS A PFFS plan is one of the various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her area. Ms. Morris will turn 65 on June 10th. She has never previously qualified for Medicare. She is entitled to Medicare Part A and intends to enroll in Part B. She wants to know if she is eligible to enroll in a Medicare Advantage plan that includes prescription drug coverage. What do you tell her? - CORRECT ANSWERS Ms. Morris can enroll in an MA-PD plan now since her initial election period (IEP) for Part D AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ prescription drug coverage and initial coverage period are occurring together beginning March 1st and ending September 30th. You have decided to focus on doing in-home presentations to market the Medicare Advantage (MA) plans you represent. Before you conduct such sales presentations, what must you do? - CORRECT ANSWERS You must receive an invitation from the beneficiary and document the specific types of products the beneficiary wants to discuss prior to making an in-home presentation. Ms. Hernandez has marketed several different types of insurance products in her home state and has typically sought approval of her materials from her State Department of Insurance. What would you advise her regarding seeking such approval for materials she uses to market Medicare Advantage plans? - CORRECT ANSWERS Materials need only be reviewed and approved by the company(s) she represents. Ms. Gates has recently become dually eligible for Medicare and Medicaid. She is very concerned about how this will affect her prescription drug coverage. What should you tell her? - CORRECT ANSWERS As a dual eligible beneficiary, her Part D drugs will be covered by Medicare once she is enrolled in a Part D plan. If she doesn't select a plan, Medicare will select a plan for her. Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has recently received a letter from her Medigap carrier informing her that her drug coverage is not "creditable." She wants to know what this means. What should you tell her? - CORRECT ANSWERS 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. During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor told him about. What should his agent do? - CORRECT ANSWERS Since Mr. Peters requested a description of the Part D plan, his agent must have Mr. Peters sign a new scope of appointment form that AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ includes Part D, and then the agent may discuss the Part D plan so Mr. Peters can compare plans and make an informed enrollment choice during the appointment. You would like to offer gifts of nominal value to potential enrollees who call for more information about a plan you represent. You would then like to offer additional gifts if they come to a marketing event. Each of the gifts meets the CMS definition of nominal value, but together, the gifts are more than the nominal value. Is this permissible? - CORRECT ANSWERS No, the total value of the gifts given to an enrollee in a year cannot exceed the CMS definition of nominal value. Agent Suma has recently had several clients request his assistance in completing their paper enrollment form. What advice would you give him? - CORRECT ANSWERS Agent Suma is only permitted to fill out the applicant's name and contact information. The applicant must fill in the remaining information in order to protect his or her privacy. Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently told her that there is an excellent Medicare Advantage (MA) plan with a five-star rating serving her area. On January 15 she comes to you for advice as to what options, if any, she has. What should you say regarding special enrollment periods (SEPs)? - CORRECT ANSWERS Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan. Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her? - CORRECT ANSWERS You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? - CORRECT ANSWERS Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. What should you tell him? - CORRECT ANSWERS He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing. Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Carolina. She is worried that without additional support, her mother will need to go into a nursing home. Mrs. Velasquez asks you if there is any Medicare plan that might allow her mother to remain in the community rather than going into a nursing home. How should you advise Mrs. Velasquez? - CORRECT ANSWERS There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly beneficiaries certified as needing a nursing home level of care but are able to live safely in the community at the time of enrolment. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do? - CORRECT ANSWERS He will have to enroll in Part B. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? - CORRECT ANSWERS She cannot enroll in an MA Medical Savings Account (MSA) plan. 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 ANSWERS He could enroll either in one of the MA plans that include prescription drug coverage or Original Medicare with a Medigap plan and standalone Part D prescription drug coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ 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? - CORRECT ANSWERS There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the store owner, has provided excellent health benefits to the store's workforce. William, one of the store's long-time employees, will soon be reaching age 65 and eligible for Medicare. William is in good health. He intends to remain an active full-time employee, working several years after becoming eligible for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer William? - CORRECT ANSWERS Hank's can continue to offer William the same employee health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is offered to the public. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she can enroll in a Medicare Advantage plan? - CORRECT ANSWERS To join a Medicare Advantage plan, she also must enroll in Part B. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a stand- alone prescription drug plan. What should you tell her? - CORRECT ANSWERS She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors called TrOOP. She asks you to explain it. What do you say? - CORRECT ANSWERS TrOOP stands for true out-of-pocket costs that count toward the Medicare Part D catastrophic limit and include not only expenses paid by a beneficiary but also in some instances amounts paid by or through qualified State Pharmaceutical Assistance Programs.ards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) c Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is interested in selecting a Medicare Part D prescription drug plan. She takes several medications and is concerned that she has not been able to identify a plan that AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ covers all of her medications. She does not want to make an abrupt change to new drugs that would be covered and asks what she should do. What should you tell her? - CORRECT ANSWERS Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime during a 90-day transition period. Mr. Hildalgo complains to you that because he takes multiple expensive drugs, he has trouble paying his cost sharing for his prescription drugs, particularly at the beginning of the year during the deductible phase. He is happy with his plan and does not want to change. However, he said he had heard about a new program called the Medicare Prescription Payment Plan and asked whether it might help. What do you tell him? - CORRECT ANSWERS The Medicare Prescription Payment Plan helps spread out beneficiary cost-sharing payments but does not decrease the total amount owed. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription to help to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them? - CORRECT ANSWERS Medicare prescription drug plans are not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental benefits and the Vaughns could look into that possibility. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications? - CORRECT ANSWERS Part D plans do not have to cover all medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-payments and step therapy. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition to drugs on his plan's formulary, he takes several other medications. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you say. - CORRECT ANSWERS None of the costs of Mr. Wingate's other medications would currently count toward TrOOP but he may wish to ask his plan for an exception to cover the prescription, not on its formulary. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do? - CORRECT ANSWERS Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th. You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion? - CORRECT ANSWERS You should tell your colleague no because participation in an educational event may not include a sales presentation. When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? - CORRECT ANSWERS You may provide gifts or prizes to all potential enrollees during an event that does not exceed $15 in retail value. 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? - CORRECT ANSWERS Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval because it does not include information about the plans' benefits structures, cost-sharing, or information about measures or ranking standards. Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational. 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 ANSWERS Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services (CMS) Communication and Marketing Guidelines to ensure he is compliant with which type of products. - CORRECT ANSWERS Medicare Advantage (MA) and Prescription Drug (PDP) plans. 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? - CORRECT ANSWERS You may request RSVPs, but you are not permitted to require contact information. You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To comply with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plansl? - CORRECT ANSWERS You will have to avoid calling any potential client unless he or she initiates contact with you and specifically asks that you give him or her a call. During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in customer service and care coordination, and received an overall plan performance rating of a 4-star, which of the following would be the best statement to say to her? - CORRECT ANSWERS The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4 stars. If you are to comply with Medicare's guidance regarding educational events, which of the following would be acceptable activities? - CORRECT ANSWERS You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent. Your colleague works at a third-party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells. What could you say to her? - CORRECT ANSWERS You could tell her she is wrong, and that only agents selling employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do? - CORRECT ANSWERS Before conducting the presentation, obtain and document having obtained her permission to visit, along with her interest in the specific products you will present.gues argues that it is better to focus your tim By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefits package. What should you do to make sure your clients know about these pieces of information? - CORRECT ANSWERS You may make comparisons between plans if you can support them with studies or statistical data and such comparisons are factually based and referenced. 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 ANSWERS Gift cards or gift certificates of $15 or less that can be readily converted to cash. While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointments? - CORRECT ANSWERS You can present only health care related lines of business but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission. You would like to market a MA plan at a neighborhood pharmacy. What should you keep in mind to comply with the marketing requirements for MA plans? - CORRECT ANSWERS You must set up your table, make marketing presentations, and accept enrollment applications only in common areas outside of where the patient waits for services from the pharmacist. A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ IV. Henry makes a permanent move to a new state providing him with new MA and Part D options. - CORRECT ANSWERS II, III, and IV only. Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription drug coverage. She comes to you for advice about when she can enroll in a plan you have previously discussed. What should you tell her? - CORRECT ANSWERS Enrollment in Cost plans offering Part D coverage is available only during enrollment periods under the Part D program, and Cost plans must accept enrollments during these periods. Ms. Claggett is sixty-six (66) years old. She has been covered under Original Medicare for the last six years due to her disability and has never been enrolled in a Medicare Advantage or a Part D plan before. She wants to enroll in a Part D plan. She knows that there is such a thing as the "Part D Initial Enrollment Period" (IEP) and has concluded that, since she has never enrolled in such a plan before, she should be eligible to enroll under this period. What should you tell her about how the Part D Initial Enrollment Period applies to her situation? - CORRECT ANSWERS Ms. Claggett has had two IEPs and missed them both. The first occurred three months before and three months after the month when she was first entitled to Part A OR enrolled in Part B. Because she was eligible for Medicare before age 65, Ms. Claggett had a second IEP based on turning age 65, which has also expired. Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirement several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs. Ridgeway has found that many of her providers are not in the MA plan's network. She has come to you for advice. What should you tell her? - CORRECT ANSWERS She qualifies for a special election period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan. Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's service area next month. She is worried that she will not be able to enroll in another plan available in her new residence until the Annual Election Period. What should you tell her? - CORRECT ANSWERS She is eligible for a special election period (SEP) that begins either the month before her permanent move, if the plan is notified in advance, or the month she provides notice of the move, and this period typically lasts an additional two months. AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ Mrs. Kendrick is in good health, has worked for many years, and 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? - CORRECT ANSWERS She may enroll in an MA plan beginning three months immediately before her first entitlement to both Medicare Part A and Part B. Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug coverage. He found a stand-alone Medicare prescription drug plan in his area that offers better coverage than that available through his MA-PD plan and in addition, has a low premium. It won't cost him much more and, because he has the means to do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan. What should you tell him? - CORRECT ANSWERS If Mr. Block enrolls in the stand-alone Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage plan. Which of the following individuals has enrolled in a plan based on a fixed enrollment period? - CORRECT ANSWERS Ben enrolls in a Medicare Advantage plan during the Medicare Advantage Open Enrollment Period (MA OEP). Mr. Anderson is a very organized individual and has filled out and brought to you an enrollment form on October 10 for a new plan available on January 1 next year. He is currently enrolled in Original Medicare. What should you do? - CORRECT ANSWERS Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election period begins. 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 ANSWERS It is a 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. 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 AHIP Test Exam with 255questions and answers 100%Correctly verified answers latest update 2024/2025 RATED A+ considering suggesting that he and Mrs. Young complete the application together before she leaves. He will then submit the paper application before the start of the annual enrollment period (AEP). What would you say If you were advising Agent Adams? - CORRECT ANSWERS This is a bad idea. Agents are generally prohibited from soliciting or accepting an enrollment form before the start of the AEP. Mr. Wendt suffers from diabetes which has gotten progressively worse during the last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP) which has just closed. Mr. Wendt has heard certain MA plans might provide him with more specialized coverage for his diabetes and wants to know if he must wait until the next annual open enrollment period (AEP) before enrolling in such a plan. What should you tell him? - CORRECT ANSWERS If there is a special needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals with diabetes, he may enroll in the SNP at any time under a special election period (SEP). 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 ANSWERS 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. Agent Rory Clark's client, Henrik Schultz, signs a scope of appointment (SOA) at the beginning of the annual open enrollment period on October 15th. This SOA is valid ________ - CORRECT ANSWERS for 12 months from the date of signature. Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Medicare Part A, Part B when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? - CORRECT ANSWERS Due to his participation in the workforce, he will not have to pay premiums for Part A but he will pay higher premiums for Part B due to the amount of his income.