AHIP EXAM PAPER COMPREHENSIVE
REVIEW GUIDE WITH VERIFIED ANSWERS
◉ Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? ANSWER: 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?
ANSWER: 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? ANSWER:
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?
ANSWER: 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? ANSWER: 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?
ANSWER: 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? ANSWER: 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?
, ANSWER: 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?
ANSWER: If the Medicare Advantage plan is a Private Fee-for-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. ANSWER: I, II, and III only
◉ Ms. Brooks has an aggressive cancer and would like to k ANSWER:
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
REVIEW GUIDE WITH VERIFIED ANSWERS
◉ Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? ANSWER: 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?
ANSWER: 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? ANSWER:
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?
ANSWER: 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? ANSWER: 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?
ANSWER: 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? ANSWER: 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?
, ANSWER: 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?
ANSWER: If the Medicare Advantage plan is a Private Fee-for-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. ANSWER: I, II, and III only
◉ Ms. Brooks has an aggressive cancer and would like to k ANSWER:
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
