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AHIP 2023 MODULE 1, 2, 3, 4 & 5 QUESTIONS WITH CORRECT ANSWERS
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AHIP 2023 MODULE 1, 2, 3, 4 & 5 QUESTIONS WITH CORRECT ANSWERS
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AHIP 2023 MODULE 1, 2, 3, 4 & 5QUESTIONS WITH CORRECT
ANSWERS
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 January 1
next year. He is currently enrolled in Original Medicare. What should you do?
Correct Answer: Tell Mr. Anderson that you cannot accept any enrollment
forms until the annual election period begins.
Willard works as a representative focused on the senior marketplace. What
would be considered prohibited activity by Willard? Correct Answer:
Implying that only seniors can enroll in a Medicare Advantage plan when
meeting with Mr.
Hernandez, who is 58 but qualifies for Medicare because he is disabled.
Which of the following individuals has enrolled in a plan based on a fixed
enrollment period? Correct Answer: Ben, who enrolls in a Medicare
Advantage plan during the Medicare Advantage Open Enrollment Period (MA
OEP).
Mr. Wilcox has been enrolled in Lexington Private Fee-for-Service (PFFS)
Medicare Advantage Health Plan (Lexington) for several years. Recently, Mr.
Wilcox decided to spend time with his children who live in another state that
is not in Lexington's service area. In the future, he may relocate near his
children permanently. How does this move to another service area impact
his PFFS MA coverage? Correct Answer: Lexington can allow for Mr. Wilcox's
continued enrollment for up to 12 months whether or not he is in a
visitor/traveler (V/T) program since it is a PFFS plan.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for
his MA-PD plan. He is worried that he will lose his coverage now when he
needs it the most. He is certain his plan will disenroll him because that is
, AHIP 2023 MODULE 1, 2, 3, 4 & 5
QUESTIONS WITH CORRECT
ANSWERS
what happened to a friend of his in a similar type of plan. What can you tell
Mr. Robinson about his situation? Correct Answer: Plan sponsors have the
option to do nothing when a plan member does not pay their premiums or
disenroll the member after a grace period and notice.
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll into a MA-PD plan. What
enrollment rules would apply in this case? Correct Answer: He can make as
many enrollment changes as he likes during the Annual Election Period and
the last choice made prior to the end of the period will be the effective one
as of January 1.
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
Answer: 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 Answer: She cannot enroll in an MA
Medical Savings Account (MSA) plan.
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 Answer: He may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the doctor the plan's
, AHIP 2023 MODULE 1, 2, 3, 4 & 5
QUESTIONS WITH CORRECT
ANSWERS
identification card and the doctor agrees to accept the PFFS plan's payment
terms and conditions, which could include balance billing.
Ms. Gibson recently lost her employer group health and drug coverage and
now she wants to enroll in a PPO that does not include drug coverage. What
should you tell her about obtaining drug coverage? Correct Answer: She can
enroll in the PPO, but she will not be able to purchase a stand-alone
Medicare Part D prescription drug plan.
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 will be able to enroll in a Medicare
Advantage plan? Correct Answer: To join a Medicare Advantage plan, she
also must enroll in Part B.
Mrs. 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
, AHIP 2023 MODULE 1, 2, 3, 4 & 5
QUESTIONS WITH CORRECT
ANSWERS
additional benefits, but Medicaid will only pay for these services if they are
furnished by Medicaid participating providers.
Mr. 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).
Juan Perez, who is turning age 65 next month, intends to work for several
more years at Smallcap, Incorporated. Smallcap has a workforce of 15
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.
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 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.
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