AHIP Final Exam Attempt 1 with Accurate Answers.
AHIP Final Exam - Attempt 1
Question1
Marks: 1
Mrs. Roberts has Original Medicare and would like
... [Show More] to enroll in a Private Fee-for-Service (PFFS)
plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts
consider before selecting a PFFS plan?
Choose one answer.
Question2
Marks: 1
Mr. Wong is a single individual. He has had a successful business career and is now able to
retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong
b. A stand-alone prescription drug plan in combination with a PFFS plan or a
c. A PFFS plan offering only medical benefits or a PFFS Medigap Suppleme
d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combin
benefits and Part D prescription drug coverage, a PFFS plan offering only m
benefits, or PFFS Medigap Supplemental Insurance plan.
Insurance plan.
Medigap Supplemental Insurance plan.
a. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combin
benefits and Part D prescription drug coverage, a PFFS plan offering only m
benefits, or a PFFS plan in combination with a stand-alone prescription drughas health coverage through his employer but will sign-up Medicare Part A, Part B and Part D
when he leaves the workforce. How would you advise him as he budgets for Medicare
premiums?
Choose one answer.
Question3
Marks: 1
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe
risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to
be most appropriate for him?
Choose one answer.
Question4
Marks: 1
You are doing a sales presentation for Ms. Duarte and her son. Ms. Duarte has some cognitive
impairment and her son informs you that he has power of attorney to make financial decisions
for her. Can he execute the enrollment for her?
Choose one answer.
b. Due to his participation in the workforce he will not have to pay premiu
c. Due to the provisions of MACRA, his Part B and D coverage will be co
d. Due to his participation in the workforce he will not have to pay premiu
A but he will pay higher premiums for Part B and Part D due to the amou
income.
covered through a low-cost Medigap policy to supplement his Part A cove
A and will pay reduced premiums for Part B and Part D.
a. Due to his participation in the workforce he will not have to pay premiu
A and he will pay the lowest monthly premium rates for Part B and Part D
c. FIDE-SNP
d. I-SNP
b. C-SNP
a. D-SNP
b. Yes, he can execute the enrollment for her. He can do so because he is a
c. Yes, he can execute the enrollment for her. A financial power of attorney i
immediate family member. No power of attorney is necessary.
a. No, he cannot execute the enrollment for her. Only Ms. Duarte can sign t
regardless of her mental capacities.Question5
Marks: 1
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in
what they charge for deductibles, premiums, and cost sharing. How can you explain this to
him?
Choose one answer.
Question6
Marks: 1
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
Medicare enrollment period because 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?
Choose one answer.
Question7
Marks: 1
d. No, he cannot execute the enrollment for her. He must have a legal autho
under state law that explicitly allows him to make health care decisions for h
b. The government allows Part D plans to adopt any benefit structure as lon
c. The government bases its payments to Part D plans on the standard ben
d. Medicare Part D drug plans may have different benefit structures, but on
they must all be at least as good as the standard model established by the
For Part D plans to receive the full government payment, they must offer th
model, however, they can take a risk and revise their benefit structure to att
beneficiaries.
of covered drugs meets their approval.
a. The Part D standard model’s importance is that it is the only type of plan
low-income beneficiaries can enroll and still receive any extra help for whic
qualify.
b. Part D covers long-term care services and she shouldn’t worry becau
c. Part D covers hospital and home health services and the cost sharing
d. Part D covers physician and non-physician practitioner services and t
deductible has not changed this year, but the physician charges may go
changed this year.
been no change in coverage.
a. Part D covers prescription drugs and she should look at her premium
and cost-sharing among other factors to see if they have changed.Mr. Jackson just turned 65. He has been seeing the same general practitioner for annual
check-ups for the past 15 years, likes these yearly visits, and would like to continue obtaining
these services as a Medicare beneficiary. What should you tell him about annual check-ups?
Choose one answer.
Question8
Marks: 1
Mrs. Allen has a rare condition for which two different brand name drugs are the only available
treatment. She is concerned that since no generic prescription drug is available and these
drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan
that covers either one of them. What should you tell her?
Choose one answer.
Question9
Marks: 1
Ms. Hernandez has marketed several different types of insurance products in her home state
and has typically sought approval of her materials from her State Department of Insurance.
What would you advise her regarding seeking such approval for materials she uses to market
Medicare Advantage plans?
Choose one answer.
b. He can have as many preventive physical exams as he feels that he needs.
c. Physical exams, in the absence of readily observable illness or injury, are n
d. Medicare will cover an annual wellness visit, even if he has no illnesses or i
under any circumstances.
be covered by Medicare.
a. Medicare will cover only a one-time “Welcome to Medicare” wellness visit.
b. Medicare prescription drug plans are required to cover drugs in each th
c. Medicare prescription drug plans are allowed to restrict their coverage
d. Medicare prescription drug plans are required to include only a certain
of brand name drugs among those they cover. It may be possible that pla
in her area have opted not to include in their formularies the brand name
needs. She may need to pay for this particular medication out of pocket.
drugs. She will need to pay for her brand name medications out of pocke
category. She should be able to enroll in a Medicare prescription drug pla
covers the medications she needs.
a. When medication costs exceed a certain threshold amount, which rise
a Medicare prescription drug plan is permitted to exclude coverage for all
least expensive of the medications in a given category. Mrs. Allen will nee
encourage her physician to prescribe the least expensive of the two alterQuestion10
Marks: 1
Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. In mid-January of
the following year, she wants to switch back to Original Medicare and enroll in a stand-alone
prescription drug plan. What should you tell her?
Choose one answer.
Question11
Marks: 1
Agent Willis had several clients who disenrolled from the plans he represents during the AEP to
try new Medicare Advantage plans. Agent Willis believes that the choices they made are not
ideal for them and would like to get their business back during the Medicare Advantage Open
Enrollment Period (MA-OEP). What can agent Willis do?
Choose one answer.
b. States often volunteer to review marketing materials on behalf of the Med
c. Obtaining approval of her materials from the State Department of Insuran
d. Materials for marketing Medicare health plans to individuals are subject to
uniform national requirements. They do not need to be reviewed by the state
company she represents must obtain approval from the Medicare agency (C
materials she uses.
practice and she should continue it with materials for the Medicare health pl
represents.
agency. She should check with her Department of Insurance to see if such a
available and would satisfy CMS requirements.
a. Materials need only be reviewed and approved by the company(s) she re
b. During the MA Open Enrollment Period, from January 1 – March 31, s
c. During the MA Open Enrollment Period, from January 1 – March 31, s
d. During the MA Open Enrollment Period, from January 1 – March 31, s
drop a MA or MA-PD plan and go back to Original Medicare, but she ma
in a stand-alone prescription drug plan if she also purchases a Medigap
only add or drop Part D coverage, so she cannot switch back to Original
only disenroll from a MA or MA-PD plan, but cannot enroll in a stand-alo
plan.
a. During the MA Open Enrollment Period, from January 1 – March 31, s
disenroll from the MA-PD plan into Original Medicare and also may add
alone prescription drug plan.
a. He can send them information about the MA-OEP along with a flyer o
he represents.Question12
Marks: 1
This year you decide to focus your efforts on marketing to employer and union groups. Which of
the following statements best describes what you can and cannot do in order to stay in
compliance?
Choose one answer.
Question13
Marks: 1
Ms. Lewis understands that Medicare prescription drug plans may use various methods to
control the use of specific drugs. She has heard about a technique called “step therapy” and is
wondering if you can explain what that is. What should you tell her?
Choose one answer.
Question14
Marks: 1
c. He can wait until October and send them information about the plans
d. He can call them to let them know that if they do not like their new pl
can change back during the MA-OEP.
represents.
b. He can e-mail them in January and ask them to let him know if they a
happy with their new plans.
b. You do not need to complete a scope of appointment, but CMS can ask you
c. You are not required to submit communication and marketing materials spe
d. You do not need to take an annual test, but you must not provide potential e
more than light snacks at presentations.
those employer plans to CMS at the time of use, but CMS may request and re
if employee complaints occur.
reconstruct one if there is a subsequent employee complaint.
a. You can make unsolicited contacts but you cannot cross-sell other products
b. Step therapy involves slow changes in the dosages of a given drug in or
c. Step therapy involves using one or more lower priced drugs before tryin
d. Step therapy involves taking somewhat larger doses but skipping every
resulting in lower overall consumption of the drug.
expensive drug when all are used to treat the same condition.
discover the correct amount.
a. Step therapy refers to incentives plans can provide to enrollees to enga
walking in order to reduce their need for medications treating heart and ch
problems.Mr. Chen has heard about a 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?
Choose one answer.
Question15
Marks: 1
Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the
Annual Enrollment Period (AEP). At the beginning of January, her neighbor told her about the
Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment
period that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for
advice shortly after speaking to her neighbor. What should you tell her?
Choose one answer.
Question16
Marks: 1
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
b. Under the Medicare Advantage program, the MSA plan is a form of pres
c. Under the Medicare Advantage program, a MSA plan involves the comb
d. Under the Medicare Advantage program, the MSA is funded by money h
each year. If he does not use it all on IRS allowable health care expenditur
will lose the money the following year.
high deductible health plan and a savings account for health expenses. Me
make contributions to this savings account to help him pay his health care
while in the deductible.
coverage.
a. Under the Medicare Advantage program, the MSA is only an account to
pay for IRS-allowed health expenditures he may have. It does not involve
insurance of any kind.
b. There is a MA Open Enrollment Period (OEP) that takes place between J
c. There is a MA Open Enrollment Period (OEP) that takes place between J
d. There is a MA Disenrollment Period that takes place between January 1 a
14 but since Ms. Gonzales enrolled in Original Medicare and Part D during t
would not apply to her.
and March 31 and Ms. Gonzales can use it to change from Original Medicar
to a MA or MA-PD plan.
and March 31, but Ms. Gonzales cannot use it because eligibility to use the
available only to MA enrollees.
a. There is a MA Open Enrollment Period (OEP) that takes place between J
and March 31 and Ms. Gonzales can use it to change from Original Medicar
only to a MA plan that includes prescription drug coverage.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)?
Choose one answer.
Question17
Marks: 1
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage?
Choose one answer.
Question18
Marks: 1
You market many different types of insurance and ordinarily you spend time each evening
calling potential clients. To be in compliance with requirements for marketing Medicare
Advantage and Part D plans, what must you do about contacting potential clients to market [Show Less]