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2024 AHIP EXAM WITH CORRECT ANSWERS
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2024 AHIP EXAM WITH CORRECT ANSWERS
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2024 AHIP EXAM WITH CORRECTANSWERS
What are some of the consequences for non-compliance, fraudulent, or
unethical behavior?
a.Exclusion from participating kin all Federal health care programs
b.Termination of employment
c.Disciplinary action
d.All of the above - CORRECT-ANSWERSAll 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-ANSWERSPlans
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-
ANSWERSMs. 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.
Agent Marvin Millner wants to reach out to his current clients for referrals.
What advice would you give to Marvin? - CORRECT-ANSWERSMarvin should
understand that under CMS guidelines he can no longer provide gifts, even of
minimal value, in exchange for referrals. NOT SURE
Chen has heard about a Medical Savings Account (MSA) but wants to know if
it is just about saving money, or if he will get insurance coverage for his
health care expenditures as well. What should you tell him? - CORRECT-
ANSWERSUnder the Medicare Advantage program, a MSA plan involves the
combination of a high deductible health plan and a savings account for
health expenses. Medicare will make contributions to this savings account to
help him pay his health care expenses while in the deductible. NOT SURE
Lewis understands that Medicare prescription drug plans may use various
methods to control the use of specific drugs. She has heard about a
technique called "step therapy" and is wondering if you can explain what
that is. What should you tell her? - CORRECT-ANSWERSStep therapy involves
,using one or more lower priced drugs before trying a more expensive drug
when all are used to treat the same condition.
Stuart has heard about a special needs plan (SNP) that one of her friends is
enrolled in and is interested in that product. She wants to be sure she also
has coverage for prescription drugs. Would she be able to obtain drug
coverage if she enrolled in the SNP? - CORRECT-ANSWERSYes. All SNPs are
required to provide Part D coverage for prescription drugs.
Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account
(MSA) Medicare health plan. The MSA plan does not offer prescription drug
coverage, so Agent Roderick also enrolls Mrs. Martinez in a standalone
prescription drug plan (PDP). What CMS compensation rules apply to this
situation? - CORRECT-ANSWERSThis situation is considered a "dual
enrollment," and CMS 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-ANSWERSThough 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-ANSWERSMrs. 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-ANSWERSShe 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.
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-
ANSWERSEnrollees 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-ANSWERSPFFS 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-ANSWERSPart 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-ANSWERSMs. Davis who is entitled to Part A and has just enrolled
in Part B.a sales presentation, your client asks you wh
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-ANSWERSPrivate 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-ANSWERSThe 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-
ANSWERSA 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?
I. The enrollee dies.
II. An SNP enrollee loses special 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-ANSWERSI, II, and III only
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