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. Wh...
mr carlini has heard that medicare prescription drug plans are only offered through private companies under a program known as medicare advantage ma
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AHIP Practice Exam
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? - ANSWERMr. 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.
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 of a 4-star, which of
the following would be the correct statement to say to her? - ANSWERThe Medicare Advantage plan
received a 5-star rating in customer service and care coordination with an overall performance rating of
4-stars
Mrs. Pena 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? -
ANSWERShe may enroll at any time while she is covered under her employer plan, but she will have a
special eight-month enrollment period that differs from the standard general enrollment period, during
which she may enroll in Medicare Part B
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? - ANSWERHe could check with the
manufacturers of his medications to see if they offer an assistance program to help people with limited
means obtain the medications they need. Alternatively, he could check to see whether his state has a
pharmacy assistance program to help him with his expenses.
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan
who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one
plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an
independent agent who markets only to employer and union groups. CMS marketing representative
compensation rules generally apply to: - ANSWERBetty and Denise, but not Alice (the employee) or Carl
or Edward (to whom exceptions apply).
, Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no longer meeting her needs,
but it is now mid-year and past the annual election period (AEP). What would you say to Mrs. Valentino
regarding her options? - ANSWERMrs. Valentino can submit a written request to Medicare to be
disenrolled from the Cost plan and enroll in Original Medicare.
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? - ANSWERShe 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.
Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point of service options. This allows
Mrs. Tanner to do which of the following? - ANSWERMrs. Tanner can go to non-plan doctors for certain
services without receiving prior approval
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? - ANSWERInquire 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.
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? - ANSWERMost individuals
who are citizens and over age 65 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. Katz reached the Part D coverage gap in August last year. His prescriptions have not been changed,
he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the
same as last year. He asked what to expect for this year about his out-of-pocket costs. What could you
tell him? - ANSWERBecause he reached the coverage gap last year, he will probably reah it again this
year close to the same time.
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