AHIP 2022 Final Exam with Correct Answers Dr. Elizabeth Brennan does not cont ract 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 ANSWER 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. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cover? CORRECT ANSWER Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime. Mr. Moreno invited his neighbo r, 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. You have approached a hospital administrator about marketing in her facility. The administrator is uncomfortable with t he suggestion. How could you address her concerns? CORRECT ANSWER Tell her that Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility. Mr. and Mrs. 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 t o 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. 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 ANSWER If the Medicare Advantage plan is a Private Fee -for-Service (PFFS) plan that does not offer dru g coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this. Which of the following is/are most likely to be characterized as an involuntary disenrollment from a Medicare Advantage (MA) plan? I. The enrollee dies. II. An SNP enrollee loses sp ecial needs status due to substantially improved health. III. It is determined that the member is not lawfully present in the United States. IV. The member enrolls in another plan during the Annual Open Enrollment period. CORRECT ANSWER I, II, and III onl y Ms. Brooks has an aggressive cancer and would like to k CORRECT ANSWER Medicare covers hospice services and they will be available for her. 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. 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 Par t 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 ANSWER I and II, only 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 Advantag e Special Needs Plans (SNPs). What could you tell him? CORRECT ANSWER 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. Mr. Xi will soon tu rn 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 ANSWER . Beneficiaries under Original Medica re have no cost -sharing for most preventive services which include immunizations such as annual flu shots. 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 ANSWER 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 i s available in her area. 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 ne eds. 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, sp ecifically, whether she has one of the conditions that would qualify her for a special needs plan. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She is traveling and wishes to fill two of the pre scriptions that she has lost. How would you advise her? CORRECT ANSWER She may fill prescriptions for covered drugs at non -network pharmacies, but likely at a higher cost than paid at an in-network pharmacy. Mr. Johannsen is entitled to Medicare Part A a nd Part B. He gains the Part D low -income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? CORRECT ANSWER He qualifies for a special election period and can enroll in or disenroll from a Part D plan once during that perio d. 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 ANSWER 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 eligibilit y period to avoid the late enrollment penalty. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr. Moy? CORRECT ANSWER Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee -for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. 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? C ORRECT 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. You have decided to focus on doing in -home presen tations to market the Medicare Advantage (MA) plans you represent. Before you conduct such sales presentations, what must you do? CORRECT ANSWER You must receive an invitation from the beneficiary and document the specific types of products the beneficiar y wants to discuss prior to making an in -home presentation. Mr. 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 a ll the Original Medicare benefits through private health insurance companies. 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 aske d you when she should have her daughter plan to visit. What could you tell her? CORRECT ANSWER Her daughter should come in November. Plan sponsors may undertake the following marketing activities with current Medicare Advantage plan members? CORRECT ANSW ER Market non -health related items or services such as life insurance or annuities policies to current members as permitted following HIPAA Privacy Rules. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investm ents. 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 en rollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare prescription d rug 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 dru g 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. 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 co uld be considered discriminatory activity and a prohibited practice. 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 ANSWER She could file a grievance wi th her plan to complain about the lack of timeliness in getting an appointment. 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 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. What types of tools can Medicare Part D prescription drug plan s use that affect the way their enrollees can access medications? CORRECT ANSWER 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 cont ainment techniques such as tiered co -payments and prior authorization.
