AHIP Module 5 2023 Exam/ Questions & Answers Updated 2025
Mrs. Kendrick is in good health, has worked for many years and is six months away from turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA) plan as soon as possible. What could you tell her? - CORR...
AHIP Final Exam Test Questions &
Answers Latest Update
Which of the following individuals is most likely to be eligible to enroll in a part d plan? -
CORRECT ANSWERS-Jose, a grandfather who was granted asylum and has worked in
the United States for many years.
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 ANSWERS-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. Chen has heard about 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 ANSWERS-Under the
Medicare Advantage program. an MSA plan involves the combination of high deductible
health plan and 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.
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 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.
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug
plan (PDP) coverage. She is traveling and wishes to fill two of her prescriptions that she
has lost. How would you advise her? - CORRECT ANSWERS-She may fill prescriptions
for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an
in-network pharmacy.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work
and is covered by an employer health plan, he has not enrolled in Part B or Part D. He
receives a notice on June 1 that his employer is cutting back on prescription drug
benefits and that as of July 1 his coverage will no longer be creditable. He has come to
you for advice. What advice would you give Mr. Rockwell about special enrollment
periods (SEPs)? - CORRECT ANSWERS-Mr. Rockwell is eligible for a SEP due to his
involuntary loss of creditable drug coverage; the SEP begins in June and ends
September 1 - two months after the loss of creditable coverage.
, 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. 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. and Mrs. Nunez attended one of your sales presentations. They've asked you to
come to their home to clear up a few questions. During the presentation, Mrs. Nunez
feels tired and tells you that her husband can finish things up. She goes to bed. At the
end of your discussion, Mr. Nunez says that he wants to enroll both himself and his
wife. What should you do? - CORRECT ANSWERS-As long as she is able to do so,
only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign
her form or do so at another time.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for
Medicare as well. He is concerned about changes in his cost-sharing. What should you
tell him? - CORRECT ANSWERS-He should know that Medicaid will pay cost sharing
only for services provided by Medicaid participating providers.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included a number of services and items he
thought would be fully covered. He called you to ask what he could do? What could you
tell him? - CORRECT ANSWERS-You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
Mr. Zachow has a condition for which three drugs are available. He has tried two, but
had an allergic reaction to them. Only the third drug works for him and it is not on his
Part D plan's formulary. What could you tell him to do? - CORRECT ANSWERS-Mr.
Zachow has a right to request a formulary exception to obtain coverage for his Part D
drug. He or his physician could obtain the standardized request form on the plan's
website, fill it out, and submit it to his plan.
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 as a result of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
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