AHIP 2022-2023 Test/ AHIP Module 2
2022/AHIP 2021 Expert-Reviewed
Questions and AnswersHigh-Quality
Questions with Expert Answers Tailored for
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Mrs. Willard wants to know generally how the benefits under Original Medicare might compare
to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? - -correct ans- -Medicare Advantage Plans may offer extra benefits that
Original Medicare does not offer such as vision, hearing, and dental services and must include a
maximum out-of-pocket limit on Part A and Part B services.
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 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.
Mr. Robinson was quite ill recently and forgot to pay his monthly premium for his MA-PD plan.
He is worried that he will lose his coverage now when he needs it the most. He is certain his plan
will disenroll him because that is what happened to a friend of his in a similar type of plan. What
can you tell Mr. Robinson about his situation? - -correct ans- -Plan sponsors have the option to
do nothing when a plan member does not pay their premiums or disenroll the member after a
grace period and notice.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has
received under Original Medicare, but he would like to know more about Medicare Advantage
Special Needs Plans (SNPs). What could you tell him? - -correct ans- -SNPs have special programs
,for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug
coverage that could be very helpful as well.
Willard works as a representative focused on the senior marketplace. What would be considered
prohibited activity by Willard? - -correct ans- -Implying that only seniors can enroll in a Medicare
Advantage plan when meeting with Mr. Hernandez, who is 58 but qualifies for Medicare because
he is disabled.
Agent Harriet Walker has recently begun marketing Medicare Advantage and related products
aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a
Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's
position, what would you do? - -correct ans- -Inquire whether the client qualifies for a special
enrollment period, and if not, solicit an enrollment application once the annual open enrollment
election period begins on October 15th.
Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but he did not
enroll in Part B because he has employer-sponsored coverage and intends to keep working for
several more years. But he is considering enrolling in Part D prescription drug coverage because
he believes it is superior to his employer plan. How would you advise him? - -correct ans- -Mr.
Landry is eligible for Part D since he has Part A, and his initial enrollment period (IEP) for Part D
will continue for three months after his 65th birthday.
Agent Marvin Millner wants to reach out to his current clients for referrals. What advice would
you give to Marvin? - -correct ans- -Marvin should consult with the health plans he represents to
determine whether those plans impose requirements around beneficiary referrals.
Mr. Buck has several family members who died from different cancers. He wants to know if
Medicare covers cancer screening. What should you tell him? - -correct ans- -Medicare covers
the periodic performance of a range of screening tests that are meant to provide early detection
of disease. Mr. Buck will need to check specific tests before obtaining them to see if they will be
covered.
,If you are to comply with Medicare's guidance regarding educational events, which of the
following would be acceptable activities? - -correct ans- -You may distribute business cards to
individuals who request information on how to contact you for further details on the plan(s) you
represent.
You market many different types of insurance and ordinarily you spend time each evening calling
potential clients. To comply with requirements for marketing Medicare Advantage and Part D
plans, what must you do about contacting potential clients to market those plans? - -correct ans-
You will have to avoid calling any potential client unless he or she initiates contact with you and
specifically asks that you give him or her a call.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree
group health plan that includes drug coverage with nominal copays. He heard about a neighbor's
MA-PD plan that you represent and because he takes numerous prescription drugs, he is
considering signing up for it. What should you tell him? - -correct ans- -He should compare the
benefits in his employer-sponsored retiree group health plan with the benefits in his neighbor's
MA-PD plan to determine which one will provide sufficient coverage for his prescription needs.
Ms. 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 ans- -Yes. All
SNPs are required to provide Part D coverage for prescription drugs.
Which of the following individuals has enrolled in a plan based on a fixed enrollment period? -
correct ans- -Ben, who enrolls in a Medicare Advantage plan during the Medicare Advantage
Open Enrollment Period (MA OEP).
Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his first Medicare
eligibility date will be by June 1. Mr. Liu's ICEP and Part D IEP begin March 1 and end on
September 30. He wants prescription drug coverage with his Part A and Part B benefits. What
advice can you provide him? - -correct ans- -He can enroll in a MA-PD as long as he enrolls in
Part B and is entitled to Part A.
, Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network as his current HMO plan
requires him to do. What should you tell him? - -correct ans- -He may receive health care
services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's
identification card and the doctor agrees to accept the PFFS plan's payment terms and
conditions, which could include balance billing.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and
conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr.
Brennan charge? - -correct ans- -Dr. Brennan can charge Mary Rogers no more than the cost
sharing specified in the PFFS plan's terms and condition of payment which may include balance
billing up to 15%of the Medicare rate.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to
enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed several expensive medications.
Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi? - -correct ans- -Mrs. Chi may enroll in a MA MSA plan but if she wishes
prescription drug coverage it must be a MSA-PD plan that includes drug coverage.
You work for Caring Health, a Medicare Advantage (MA) plan sponsor. Recently, Mrs. Garcia has
completed an enrollment application for a plan offered by Caring Health, which is waiting for a
reply from CMS indicating whether or not Mrs. Garcia's enrollment has been accepted. Once
CMS replies, how long does Caring Health have to notify Mrs. Garcia that her enrollment has
been accepted and in what format? - -correct ans- -The plan has 10 calendar days to notify Mrs.
Garcia in writing.
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 ans- -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.
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