AHIP 2024 final exam | ACCURATE
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UPDATE 2024-2025 WITH 150+ QUESTIONS
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 ANS-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.
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 ANS-Her daughter should come in November.
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 ANS-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. Garrett has just entered his MA Initial Coverage Election Period (ICEP). What action could
you help him take during this time?
- CORRECT ANS-He will have one opportunity to enroll in a Medicare Advantage plan
Mr. 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 ANS-His open enrollment period as an institutionalized individual will continue for
two months after the month he moves out of the facility.
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 ANS-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.
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 ANS-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.
Mr. Albert has heard about something called the Star Rating system for Medicare Advantage
plans. He asks you to explain it to him since he is interested in enrolling in a plan that is newly
available in his area. After you explain that it is the way for consumers to judge plan
performance, what else would you say?
- CORRECT ANS-New plans and Part D sponsors that do not have any Star Rating are not
required to provide Star Rating information until the next contract year.
Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her?
- CORRECT ANS-Medicare covers hospice services and they will be available for her.
Mr. Lee was intending to enroll in MaxCare's Medicare Advantage plan this year. However, due
to his current medical condition, his daughter Debbie has been appointed as his legal
representative over both health and financial matters. Debbie would like to ensure that her
, father is still able to enroll in MaxCare's plan, but she is unsure what her role is to help with his
enrollment request. What advice can you give her?
- CORRECT ANS-Debbie can submit an telephonic enrollment request on Mr. Lee's behalf as
long as she attests that she has the legal authority to do so
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through massage therapy. She is concerned about whether or not Medicare will cover these
items and services. What should you tell her?
- CORRECT ANS-Medicare does not cover massage therapy, or, in general, glasses or dentures.
. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
treated for that condition. However, she and her physicians feel that after her lengthy hospital
stay, she will neMrsed a month or two of nursing and rehabilitative care. What should you tell
them about Original Medicare's coverage of care in a skilled nursing facility?
- CORRECT ANS-Medicare will cover Mrs. Shield's skilled nursing services provided during the
first 20 days of her stay, after which she would have a copay until she has been in the facility for
100 days.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance?
- CORRECT ANS-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.
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 ANS-He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
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?
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