Medicare Exam Questions and Answers: AHIP Exam Preparation, Exams of Nursing

Download Medicare Exam Questions and Answers: AHIP Exam Preparation and more Exams Nursing in PDF only on Docsity! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? - correct answer ✅He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer- sponsored healthcare coverage. How would you respond? - correct answer ✅Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr. Moy? - correct answer ✅Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ 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 answer ✅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. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? - correct answer ✅Most individuals who are citizens and 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. 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 answer ✅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. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ answer ✅Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for services. What advice would you give her? - correct answer ✅Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received the MSN in the mail. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him? - correct answer ✅It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance? - correct answer ✅She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help with Medicare costs for which she is responsible. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? - correct answer ✅Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? What could you tell him? - correct answer ✅Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? - correct answer ✅Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. 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 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ wondering whether he can obtain coverage under Medicare. What should you tell him? - correct answer ✅After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him? - correct answer ✅Medicare covers the periodic performance of a range of screening tests that are meant to provide early detection of disease. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. Which of the following statement 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. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description? - correct answer ✅Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? - correct answer ✅Mrs. Chi may enroll in a MS MSA plan and remain in her current standalone Part D prescription drug plan. 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 answer ✅. C-SNP 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 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ 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 answer ✅She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. 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 answer ✅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. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? - correct answer ✅Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State. What should you tell her? - correct answer ✅Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with Medicaid participating providers. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? - correct answer ✅He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? - correct answer ✅She may remain in her ABC MA plan, enroll in another MA plan in her service area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? - correct answer ✅In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers within the plan's network (except in an emergency or where care is unavailable within the network). 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them? - correct answer ✅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 Vaughn's could look into that possibility. 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 answer ✅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. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you advise her? - correct answer 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ ✅She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable coverage previously available through her husband's employer. She is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What should you tell her? - correct answer ✅If a Part D benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP. 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? - correct answer ✅Medicare prescription drug plans are required to cover drugs in each therapeutic category. She should be able to enroll in a Medicare prescription drug plan that covers the medications she needs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. She currently does not have creditable coverage. What could you tell her about the implications of such 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ a decision? - correct answer ✅If she does not sign up for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, her premium will be permanently increased by 1% of the national average premium for every month that she was not covered. Shultz was still working when he first qualified for Medicare. At that time, he had employer group coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied with his drug coverage. It is now a year later and Mr. Shultz has lost his employer group coverage within the last two weeks. How would you advise him? - correct answer ✅Mr. Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a premium penalty. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her? - correct answer ✅An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ 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 answer ✅Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area. 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 answer ✅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. 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. - correct answer ✅I, II, and III only 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Torres has a small savings account. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. What should you tell him? - correct answer ✅In general, he must select a single Part D premium payment mechanism that will be used throughout the year. You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation? - correct answer ✅Gift cards or gift certificates of $15 or less that can be readily converted to cash. 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 answer ✅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. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ meet with you on October 15. During the appointment, what are you permitted to do? - correct answer ✅You may provide her with the required enrollment materials and take her completed enrollment application. One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond? - correct answer ✅This could be considered discriminatory activity and a prohibited practice. 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 engaging in such a discussion, what should you do? - correct answer ✅You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion. Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him? - correct answer ✅You appreciate the opportunity and would be happy to schedule an appointment with anyone at their request. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a website marketing the MA plans with which it has contracts. Agent Armstrong follows up with individuals who request more information about ABC MA plans via the website and tries to persuade them to enroll in ABC plans. What statement best describes the marketing and compliance rules that apply to Agent Armstrong? - correct answer ✅Agent Armstrong needs to be licensed and appointed in every state in which beneficiaries to whom he markets ABC MA plans are located. You 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 answer ✅You may provide light snacks, but a Thanksgiving style meal would be prohibited, regardless of who provides or pays for the meal. Next week you will be participating in your first "educational event" for prospective enrollees. To be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? - correct answer ✅You should plan to ensure that the educational event is an informative event and 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ must not conduct a sales presentation or distribute or accept enrollment forms at the event. You are working several plans and community organizations to sponsor an educational event. When putting together advertisements for this event, what should you do? - correct answer ✅You must ensure that the advertisements indicate it is an educational event, otherwise it will be considered a marketing event. 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 answer ✅The plan may withhold commission, require retraining, report the misconduct to a state department of insurance or terminate the contract. You are seeking to represent an individual Medicare Advantage plan and an individual Part D plan in your state. You have completed the required training for each plan, but you did not achieve a passing score on the tests that came after the training. What can you do in this situation? - correct answer ✅You will not be able to represent any Medicare Advantage or Part D plan until you complete the training and achieve an adequate score. However, you will not 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ have to take a test if you exclusively market employer/union group plans and the companies do not require testing. Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members? - correct answer ✅Market non-health related items or services such as life insurance or annuities policies to current members as permitted following HIPAA Privacy Rules. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his coverage will no longer be creditable. He has come to you for advice. What advice would you give Mr. Rockwell about special election periods (SEPs)? - correct answer ✅Mr. Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP begins in June and ends on September 1- two months after the loss of creditable coverage. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting that he and Mrs. Young complete the 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ compensation rules are applied to the two plans at once and independently of each other. Olsen is concerned that a Medicare Advantage plan will not cover the same range of services that would be covered under Original fee-for-service Medicare. What should you tell him? - correct answer ✅Though their cost-sharing may differ from Original Medicare's, Medicare Advantage plans are required to cover all services covered by original Medicare. 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 answer ✅Mrs. Wellington is eligible for a SEP that may be used once until November 30 to enroll in the five-star plan. Gardner is currently enrolled in an MA-PD plan. However, she wants to disenroll from the MA-PD plan and instead enroll in a Part D only plan and go back to Original Medicare. According to Medicare's enrollment guidelines, when could she do this? - correct answer ✅She may make such a change during the Annual Election Period that runs from Oct. 15 to December 7, or during the MA Open Enrollment Period which takes place from January 1- March 31 of each year. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug plan you represent and simply give you a check to cover his premiums for the entire year. What should you tell him? - correct answer ✅Enrollees should pay using automatic withdrawal from a bank account or credit or debit card, direct monthly billing from the plan, or deductions from their Social Security check. 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? - correct answer ✅PFFS plans are a type of Medicare Advantage plan offered by private companies. 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 answer ✅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. NOT SURE Who is most likely to be eligible to enroll in a Part D prescription drug plan? - correct answer ✅Ms. Davis who is entitled to Part A and has just enrolled in Part B.a sales presentation, your client asks you wh 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Lopez takes several high-cost prescription drugs. He would like to enroll in a standalone Part D prescription drug plan that is available in his area. In what type of Medicare Health Plan can he enroll? - correct answer ✅Private Fee-for- Service (PFFS) plan that does not include drug coverage. If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that plan, what type of Medicare health plan could the individual also enroll in, without being automatically disenrolled from the stand-alone prescription drug plan? - correct answer ✅The beneficiary could enroll in a private fee-for-service (PFFS) plan that does not include prescription drug coverage; a cost plan; or a Medicare Medical Savings Account (MSA) plan. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the sales presentation? - correct answer ✅A meal cannot be provided, but light snacks would be permitted Which of the following is/are most likely to be characterized as an involuntary disenrollment from a Medicare Advantage (MA) plan? 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Chen can disenroll from his employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment. 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 answer ✅Her daughter should come in November. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What advice would you give him regarding his health coverage options? - correct answer ✅His open enrollment period as an institutionalized individual will continue for two months after the month he moves out of the facility. 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 answer ✅No. Once he is identified by the plan sponsor as a "potential at- 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ risk" beneficiary, he cannot use the dual eligible SEP to change plans while this designation is in place. 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 answer ✅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. 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 answer ✅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. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could you help him take during this time? - correct answer ✅He will have one opportunity to enroll in a Medicare Advantage plan. You are meeting with Ms. Berlin and she has completed an enrollment form for a MA-PD plan you represent. You notice that her handwriting is illegible and as a 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ result, the spelling of her street looks incorrect. She asks you to fill in the corrected street name. What should you do? - correct answer ✅You may correct this information as long as you add your initials and date next to the correction. You have come to Mrs. Midler's home for a sales presentation. At the beginning of the presentation, Mrs. Midler tells you that she has a copy of her medical records available because she thinks this will help you understand her needs. She suggests that you will know which questions to ask her about her health status in order to best assist her in selecting a plan. What should you do? - correct answer ✅You can only ask Mrs. Midler questions about conditions that affect eligibility, specifically, whether she has one of the conditions that would qualify her for a special needs plan. Nunez attended one of your sales presentations. They've asked you to come to their home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both himself and his wife. What should you do? - correct answer ✅As long as she can do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at another time. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion. Perry is entitled to Medicare Part A but has not yet enrolled in Part B, even though he is 69 years old. He would like to enroll in a Medicare Part D prescription drug plan but is concerned that he will have to sign up for Part B as well in order to qualify for enrollment in a Part D plan. What should you tell him? - correct answer ✅He does not have to enroll in Part B but, must pay a penalty for his failure to do so when he first turned 65. After that, he can enroll in a Part D prescription drug plan. Nguyen understands that Medicare prescription drug plans can use a formulary or list of covered drugs. He is suspicious about how plans establish these formularies. What should you tell him? - correct answer ✅Formularies must be developed with input from pharmacists, doctors, and other experts. ACA Section 1557 rules for disability concern - correct answer ✅Policies and procedures, physical access, and communication. Under ACA Section 1557, a health plan premium sold through a state exchange may, based on an individual's age, - correct answer ✅charge higher premiums. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Which of the following statements best describes Section 1557 of the Affordable Care Act (ACA)? - correct answer ✅Section 1557 incorporates earlier civil rights protections in regard to race, color, national origin, disability, age and sex. Which Medicare programs are covered by ACA Section 1557? - correct answer ✅Parts A, C, and D, but not B. As a result of violations of ACA Section 1557 nondiscrimination rules, - correct answer ✅a health plan may revoke an agent or broker's appointment with the health plan. Which of the following statements best describes the scope of operations subject to Section 1557 under the 2020 Final Rule? - correct answer ✅Health insurers under the 2020 Final Rule are not considered to be principally engaged in delivering health care, and thus lines of business that do not receive federal funding or administered under Title I of the ACA, such as life insurance, do not fall under the scope of 1557. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ Section 1557 of the Affordable Care Act applies to - correct answer ✅all health programs and activities administered by or receiving federal financial assistance from HHS Under Section 1557, 2020 Final Rule issued during the Trump Administration sex was initially defined____________ - correct answer ✅as biologic sex only, meaning whether a person was determined to be male or female at birth. Which of the following would be considered permissible under Section 1557 and the 2020 Final Rule? - correct answer ✅Broker Mary Jones has recruited a diverse workforce. She encourages her agents to prospect through community- based marketing and within their community of influence. Auxiliary aids and services must be provided to individuals with disabilities, such as those suffering from vision or hearing impairments, free of charge, and in a timely manner. Auxiliary aids and services include which of the following: I. large print materials II. qualified sign language interpreters III. braille materials and displays IV. screen reader software - correct answer ✅I, II, III, and IV 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ A person drops off a prescription for a beneficiary who is a "regular" customer. The prescription is for a controlled substance with a quantity of 160. This beneficiary normally receives a quantity of 60, not 160. You review the prescription and have concerns about possible forgery. What is your next step? - correct answer ✅Call the prescriber to verify the quantity 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 answer ✅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 answer ✅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 answer ✅True 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ 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 answer ✅True Ways to report potential fraud, waste, and abuse (FWA) include: a. Mail drops b. Special Investigative Units (SIUs) c. Tekephone hotlines d. All of the above e. In-person reporting to the compliance department/supervisor - correct answer ✅All of the above Once a corrective action plan is started, the corrective action plan must be monitored annually to ensure they are effective. - correct answer ✅False What are some of the penalties for violating fraud, waste, and abuse (FWA) laws? a.Civil Monetary Penalties b.Imprisonment c.All of the above 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ d.Exclusion from participation in all Federal health care programs - correct answer ✅All of the above 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 answer ✅False 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 False Claims Act the Anti-Kickback Statute, and the Health Care Fraud Statute. - correct answer ✅False You can help prevent fraud, waste, and abuse (FWA) by doing all the following: Look for suspicious activity Conduct yourself in an ethical manner 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 answer ✅True 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ At a minimum, an effective compliance program includes four core requirements. - correct answer ✅False Correcting non-compliance________ - correct answer ✅Protects enrollees, avoids recurrence of same non-compliance, and promotes efficiency These are examples of issues that can be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA), potential health privacy violation, and unethical behavior/employee misconduct. - correct answer ✅True Once a corrective action plan begins addressing non-compliance for fraud, waste, and abuse (FWA) committed by a Sponsor's employee or first-tier, downstream, or related entity's (FDR's) employee, ongoing monitoring of the corrective actions is not necessary. - correct answer ✅False Standards of Conduct are the same for every Medicare Parts C and D sponsor. - correct answer ✅False What are some of the consequences for non-compliance, fraudulent, or unethical behavior? a.Exclusion from participating kin all Federal health care programs 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!! AHIP Exam Questions and Answers Correct & Verified Latest Update 2024/2025!!!GRADED A+ b.Termination of employment c.Disciplinary action d.All of the above - correct answer ✅All of the above Levi is considering enrollment in a Medicare Advantage HMO plan offered in her area. Ms. Levi often travels to visit relatives and is concerned that she may need emergency care outside of her plan's service area. What should you tell her about coverage of emergency care? - correct answer ✅Plans are required to cover out-of-network emergency care. 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 answer ✅Ms. Morris can enroll in an MA-PD plan now since her initial election period (IEP) for Part D prescription drug coverage and initial coverage period are occurring together beginning March 1st and ending September 30th. 2023 AHIP Exam Questions and Answers Correct & Verified Latest!!!