Exam (elaborations)
AHIP Questions and Answers (Verified by Expert)2025/2026
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AHIP Questions and Answers (Verified by Expert)2025/2026
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AHIP1. A Medicare beneficiary has walked into your workplace and asked that you sit down with
her and speak her alternatives beneath the Medicare Advantage application. Before
engaging in this kind of dialogue, what should you do? - ANS-You need to have her sign
a scope of appointment shape, indicating which merchandise she desires to discuss.
You may also then proceed with the dialogue
2. Agent Higgins allows Mrs. O'Malley to join AB Medicare Advantage (MA) plan at some
stage in the Annual Open Enrollment Period. Mrs. O'Malley's powerful enrollment date is
January 1st. Subsequently, Mrs. O'Malley disenrolls on February twelfth following a flow
outdoor the plan's provider area. What impact will this have on Agent Higgins
repayment? - ANS-AB MA plan does no longer have to recoup Agent Higgins'
compensation due to the fact she has moved faraway from its provider place.
3. Agent Lopez helps Ralph to join Top Choice Medicare Advantage plan all through the
Annual Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph
disenrolls on February twelfth due to the fact he did not keep in mind that the plan did
now not cover offerings furnished via several of his longtime companies. Which of the
following statements quality describes the impact of Ralph's motion upon Agent Lopez's
reimbursement? - ANS-Agent Lopez's complete reimbursement have to be recouped
because Ralph disenrolled inside three months of enrollment.
4. Agent Martinez desires to solicit Medicare Advantage potentialities thru e mail and asks
you for advice as to whether or not this is feasible. What ought to you inform her? -
ANS-Marketing representatives may additionally provoke digital contact thru email but an
choose-out procedure ought to be provided. Correct
5. All plans ought to cover at the least the usual Part D coverage or its actuarial equivalent.
What prices might a beneficiary incur for pharmaceuticals in 2019 under the standard
coverage? - ANS-Standard Part D coverage would require price of an annual deductible,
25% cost-sharing as much as the coverage gap, a portion of expenses for both generics
and emblem-call capsules in the coverage hole, and co-pays or co-insurance after the
insurance hole.
6. By contacting plans to be had for your area, you have discovered that the plan you
represent has a considerably lower monthly premium than the others. Furthermore, you
see that the plan you constitute has a completely unique benefit bundle. What have to
you do to make sure your customers realize about these pieces of statistics? - ANS-you
can make comparisons between plans if you can guide them through research or
statistical data and such comparisons are factually based totally
7. Daniel is a middle-earnings Medicare beneficiary. He has persistent bronchitis, placing
him at excessive chance for pneumonia. Otherwise, he has no troubles functioning.
Which type of SNP is likely to be most appropriate for him? - ANS-C-SNP
8. Dr. Elizabeth Brennan does not agreement with the PFFS plan however accepts the
plan's phrases and situations for payment. Mary Rodgers sees Dr. Brennan for
treatment. How a lot may also Dr. Brennan price? - ANS-Dr. Brennan can charge Mary
, Rogers no greater than the price sharing unique inside the PFFS plan's phrases and
circumstance of charge which may additionally consist of stability billing up to fifteen
percent of the Medicare price.
9. During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a
5-superstar score in customer support and care coordination, and obtained an common
plan performance score of a four-big name, which of the subsequent could be the correct
announcement to mention to her? - ANS-The Medicare Advantage plan acquired a
5-celebrity score in customer support and care coordination with an average overall
performance rating of 4-stars.
10. During a sales presentation, your patron asks you whether the Medicare enterprise
recommends that she join up for your plan or live in Original Medicare. What need to you
tell her? - ANS-Tell her that the Medicare corporation does not suggest or suggest any
plan.
11. For which of the following people might a Cost Plan be most appropriate? - ANS-Ms.
Baker who is enrolled in Medicare Part B and is inclined to continue paying Part B
charges plus any plan premiums.
12. If Mr. Johannsen profits the Part D low-income subsidy, how does that have an effect on
his capability to enroll or disenroll in a Part D plan? - ANS-He qualifies for a special
enrollment length and can join in or disenroll from a Part D plan and the subsidy will
practice to the plan he chooses.
13. Mr. Garcia changed into informed he qualifies for a Special Enrollment Period (SEP), but
he misplaced the paper that explains what he should do all through the SEP. What can
you tell him? - ANS-If the SEP is for MA coverage, he will commonly have one possibility
to alternate his MA insurance.
14. Mr. Rice has coverage for scientific offerings and medications through his agency's
retiree plan. He is considering switching to a Medicare prescription drug plan because
his retiree plan does not cowl two critical medications. What ought to he don't forget
before creating a change? - ANS-If Mr. Rice drops his drug coverage thru the retiree
plan, he might not be able to get it lower back and he additionally may also lose his
medical fitness coverage.
15. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus protected with
the aid of both Medicare and Medicaid. He makes a decision to join a Medicare
Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a
Medicare included service. How lots may additionally the doctor gather from Mr. Rivera?
- ANS-The medical doctor may most effective collect from Mr. Rivera the value sharing
allowable underneath the kingdom's Medicaid software.
16. Mr. Wendt suffers from diabetes which has gotten step by step worse over the last yr. He
is currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug
plan and did now not join in a Medicare Advantage (MA) plan over the past annual open
enrollment length (AEP) which has simply closed. Mr. Wendt has heard that there are
certain MA plans that might offer him with extra specialized insurance for his diabetes
and wants to recognize if he have to wait till the next annual open enrollment length
(AEP) before enrolling in this sort of plan. What should you tell him? - ANS-f there's a
unique wishes plan (SNP) in Mr. Wendt's vicinity that focuses on worrying for people with
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