AHIP 2025 Final Exam /Complete Real Exam With
Correct Answers/updated A+Grade.
Winthrop Brokerage wishes to place an advertisement in the local newspaper that says:
"We offer Medicare Advantage plans offered by AB Health and Top Choice Health.
Contact us if you would like to learn more." Which of the following best describes the
obligation(s) of Winthrop Brokerage regarding the advertisement? - CORRECT
ANSWERS -Winthrop Brokerage does not need to submit the advertisement to CMS for
prior approval because it does not include information about the plans' benefits
structures, cost-sharing, or information about measures or ranking standards.
You are mailing invitations to new Medicare beneficiaries for a marketing event. You
want an idea of how many people to expect, so you would like to request RSVPs. What
should you keep in mind? - CORRECT ANSWERS -You may request RSVPs, but you
are not permitted to require contact information.
Your colleague works at a third-party marketing organization (TMO) and she said she
did not need to take the Medicare training for brokers and agents or pass a test to
market Medicare plans since her contract is with the TMO, not the plans that have the
products she sells. What could you say to her? - CORRECT ANSWERS -You could tell
her she is wrong, and that only agents selling employer/union group plans are permitted
an exemption from testing, but some employer/union group plans may require testing to
promote agent compliance with CMS marketing requirements.
You are meeting with Mrs. Hall in her home. On her scope of appointment form, she
asked to discuss Medicare Advantage plans. During the meeting, she asked to discuss
a stand-alone prescription drug plan. She is leaving the next day to visit her family for a
week in another state, so she needs to decide before she leaves. What must happen
before that additional discussion can take place? - CORRECT ANSWERS -Since Mrs.
Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as
long as she signs a new scope of appointment form first, indicating that she wants to
discuss the Part D plan.
You plan to participate in an educational event sponsored by a large regional health
care system. One of your colleagues suggests that you do a presentation on one of the
Medicare Health plans you market and modify it to include information about preventive
screening tests showcased at the event. How should you respond to your colleague's
suggestion? - CORRECT ANSWERS -You should tell your colleague no, because
marketing representatives are not permitted to participate, in any way, in an educational
event.
Mrs. 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 need 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 ANSWERS -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. 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 ANSWERS -
Medicare does not cover massage therapy, or, in general, glasses or dentures.
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 ANSWERS -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 ANSWERS -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? - CORRECT ANSWERS -Mrs. Gonzalez cannot purchase a Medigap plan that
covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription
drug plan.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him? - CORRECT ANSWERS -He may sign-up for
Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed
her Medicare Summary Notice (MSN) and disagrees with a determination that partially
denied one of her claims for services. What advice would you give her? - CORRECT
ANSWERS -Mrs. Duarte should file an appeal of this initial determination within 120
days of the date she received the MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because the features of Part D might have changed. Mrs.
Geisler can't remember what Part D is so she called you to ask what her neighbor was
talking about. What could you tell her? - CORRECT ANSWERS -Part D covers
prescription drugs and she should look at her premiums, formulary, and cost-sharing
among other factors to see if they have changed.
, 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 ANSWERS
-Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mr. Xi will soon turn 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 ANSWERS -
Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? - CORRECT ANSWERS -Mr. Singh can
enroll in a stand-alone prescription drug plan and continue to be covered for Part A and
Part B services through Original Fee-for-Service Medicare.
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? - CORRECT ANSWERS -Most individuals who are citizens and age 65 or
over 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.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter
informing her that she had been automatically enrolled in Medicare Part B. She wants to
understand what this means. What should you tell Mrs. Quinn? - CORRECT ANSWERS
-Part B primarily covers physician services. She will be paying a monthly premium and,
except for many preventive and screening tests, generally will have 20% co-payments
for these services, in addition to an annual deductible.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
when he turns 66. He wants to understand the health care costs he might be exposed to
under Medicare if he were to require hospitalization because of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare? - CORRECT ANSWERS -Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient hospital stay, after which it
converts into a per-day coinsurance amount through day 90. After day 90, he would pay
a daily amount up to 60 days over his lifetime, after which he would be responsible for
all costs.
What impact, if any, have recent regulatory changes had on Medigap plans? -
CORRECT ANSWERS -The Part B deductible is no longer covered for individuals
newly eligible for Medicare starting January 1, 2020.
