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2025 AHIP Exam: Comprehensive Practice Questions with Accurate Answers for Effective Preparation and Certification Success in Health Insurance and Policy.$24.99
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2025 AHIP Exam: Comprehensive Practice Questions with Accurate Answers for Effective Preparation and Certification Success in Health Insurance and Policy.
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Course
2025 AHIP
Institution
2025 AHIP
2025 AHIP Exam: Comprehensive Practice Questions with Accurate Answers for Effective Preparation and Certification Success in Health Insurance and Policy.
AHIP 2022 Comprehensive Solutions for
Every Question WITH MULTIPLE Questions
from Premier Scholars Worldwide
QUESTIONS AND THE CORRECT ANSWERS
Guaranteed to Boost Your Grades
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like
to know his options since he has decided to drop his retiree coverage and is eligible for Medicare.
What should you tell him? - -correct ans- -Mr. Chen can disenroll from his employer-sponsored
coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him? - -correct ans- -In most Medicare Advantage HMOs,
Mr. Kumar must generally obtain his services only from providers within the plan's network
(except in an emergency or where care is unavailable within the network).
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to
market non-health related products such as life insurance and annuities. Which statement best
describes ABC's obligation to its enrollees regarding marketing such products? - -correct ans-
XXXIt must obtain a HIPAA complaint authorization from an enrollee that indicates the plan or
plan sponsor may use their information for marketing purposes.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage
that was offered to company retirees. The company told Mr. Yoo that, because he was affected
by this change, he would qualify for a Special election period. Mr. Yoo contacted you to find out
more about what this means. What can you tell him? - -correct ans- -It means that he qualifies
for a one-time opportunity to enroll in an MA-PD or Part D prescription drug plan.
,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.
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 ans- -Medicare will cover a
total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. 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 ans- -A meal
cannot be provided, but light snacks would be permitted.
You have approached a hospital administrator about marketing in her facility. The administrator
is uncomfortable with the suggestion. How could you address her concerns? - -correct ans- -Tell
her that Medicare guidelines allow you to conduct marketing activities in common areas of a
provider's facility.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn
takes a prescription for helping to regrow his hair. They are anxious to have their Medicare
prescription drug plan cover these drug needs. What should you tell them? - -correct ans-
Medicare prescription drug plans are not permitted to cover the prescription medications the
Vaughns are interested in under Part D coverage, however, plans may cover them as
supplemental benefits and the Vaughn's could look into that possibility.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this? - -correct ans- -If the Medicare Advantage plan is a Private
,Feefor-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account plan,
Mrs. Berkowitz can do this.
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
ans- -I, II, and III only
Ms. Brooks has an aggressive cancer and would like to k - -correct ans- -Medicare covers hospice
services and they will be available for her.
You are working several plans and community organizations to sponsor an educational event.
When putting together advertisements for this event, what should you do? - -correct ans- -You
must ensure that the advertisements indicate it is an educational event, otherwise it will be
considered a marketing event.
Which of the following statement is/are correct about a Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay
them as payment in full. - -correct ans- -I and II, only
, 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.
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 ans- -.
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which
include immunizations such as annual flu shots.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type
of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would
be available to her. What should you tell her about PFFS plans? - -correct ans- -A PFFS plan is one
of the various types of Medicare Advantage plans offered by private entities and she may enroll
in one if it is available in her area.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the
presentation, Mrs. Midler tells you that she has a copy of her medical records available because
she thinks this will help you understand her needs. She suggests that you will know which
questions to ask her about her health status in order to best assist her in selecting a plan. What
should you do? - -correct ans- -You can only ask Mrs. Midler questions about conditions that
affect eligibility, specifically, whether she has one of the conditions that would qualify her for a
special needs plan.
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 the prescriptions that she has lost. How would
you advise her? - -correct ans- -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. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income subsidy.
How does that affect his ability to enroll or disenroll in a Part D plan? - -correct ans- -He qualifies
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