1|Pag e
AHIP FINAL EXAM/ AHIP MODULE 1, 2, 3, 4, 5
PRACTICE EXAM/ AHIP STUDY GUIDE OVER
1100+ QUESTIONS AND 100% CORRECT
ANSWERS/ MOST RECENT AND VERIFIED
EDITION GRADED A+| BRAND NEW!!!!
Alice is enrolled in a MA-PD plan. She makes a permanent move across the
country and wonders what her options are for continuing MA-PD coverage. What
would you say to her in regard to a special enrollment period (SEP)? - ANSWER:
She is likely to qualify for a SEP. She can choose an effective date of up to three
months after the month in which the enrollment form is received by the new plan,
but the effective date may not be earlier than the date of her permanent move.
Which of the following individuals is most likely to be eligible to enroll in a part d
plan? - ANSWER: 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? - ANSWER: 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? - ANSWER: 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.
,2|Pag e
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? - ANSWER: 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? - ANSWER: 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)? - ANSWER: 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?
- ANSWER: 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?
,3|Pag e
- ANSWER: 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? - ANSWER: 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? - ANSWER: 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? - ANSWER: 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? - ANSWER: 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.
, 4|Pag e
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 Original Medicare? - ANSWER: Under Original Medicare,
there is a single deductible amount due for the first 60 days of any inpatient
hospital stay, after which it converts into a per-day amount through day 90. After
day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for all
costs
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her? - ANSWER: Mrs. Duarte should file and appeal of this initial
determination within 120 days of the date she received the MSN in the mail
Your friend's mother just moved to an assisted living facility and he asked if you
could present a program for the residents about the MA-PD plans you market.
What could you tell him? - ANSWER: You appreciate the opportunity and would
be happy to schedule an appointment with anyone at their request.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs? - ANSWER: Mr. Wu may still qualify for help in paying
Part D costs through his State Pharmaceutical Assistance Program.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell
him? - ANSWER: After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
AHIP FINAL EXAM/ AHIP MODULE 1, 2, 3, 4, 5
PRACTICE EXAM/ AHIP STUDY GUIDE OVER
1100+ QUESTIONS AND 100% CORRECT
ANSWERS/ MOST RECENT AND VERIFIED
EDITION GRADED A+| BRAND NEW!!!!
Alice is enrolled in a MA-PD plan. She makes a permanent move across the
country and wonders what her options are for continuing MA-PD coverage. What
would you say to her in regard to a special enrollment period (SEP)? - ANSWER:
She is likely to qualify for a SEP. She can choose an effective date of up to three
months after the month in which the enrollment form is received by the new plan,
but the effective date may not be earlier than the date of her permanent move.
Which of the following individuals is most likely to be eligible to enroll in a part d
plan? - ANSWER: 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? - ANSWER: 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? - ANSWER: 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.
,2|Pag e
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? - ANSWER: 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? - ANSWER: 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)? - ANSWER: 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?
- ANSWER: 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?
,3|Pag e
- ANSWER: 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? - ANSWER: 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? - ANSWER: 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? - ANSWER: 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? - ANSWER: 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.
, 4|Pag e
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 Original Medicare? - ANSWER: Under Original Medicare,
there is a single deductible amount due for the first 60 days of any inpatient
hospital stay, after which it converts into a per-day amount through day 90. After
day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for all
costs
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What advice
would you give her? - ANSWER: Mrs. Duarte should file and appeal of this initial
determination within 120 days of the date she received the MSN in the mail
Your friend's mother just moved to an assisted living facility and he asked if you
could present a program for the residents about the MA-PD plans you market.
What could you tell him? - ANSWER: You appreciate the opportunity and would
be happy to schedule an appointment with anyone at their request.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs? - ANSWER: Mr. Wu may still qualify for help in paying
Part D costs through his State Pharmaceutical Assistance Program.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell
him? - ANSWER: After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
