Page 1 of 44
AHIP CERTIFICATION EXAM NEWEST
QUESTIONS AND CORRECT
DETAILED SOLUTIONS TESTED AND
GRADED A+
Mrs. Robles is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care. What
should you tell her? - ✔✔✔ Correct Answer > Mrs. Robles can obtain care
from any provider who participates in Original Medicare, but generally
will have a higher cost-sharing amount if she sees a provider who/that is
not a part of the PPO network.
Mr. Bryant 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 some services and items he thought would be
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fully covered. He called you to ask what he could do? What could you
tell him? - ✔✔✔
Correct Answer > You can offer to review the plans appeal process to help
him ask the plan to review the coverage decision.
Mrs. Nelson likes a Private Fee-for-Service (PFFS) plan available in her
area that does not include drug coverage. She wants to enroll in the plan
and enroll in a stand-alone prescription drug plan. What should you tell
her? - ✔✔✔ Correct Answer > An individual enrolled in an MA PFFS plan
that does not include a Part D benefit may enroll in a stand-alone Part D
prescription drug plan.
Raymond 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? - ✔✔✔ Correct Answer > C-SNP
Henrietta Ross is an elderly individual enrolled in a fully integrated
dual-eligible (FIDE) special needs plan (SNP). Henrietta's daughter
Gladys asks you to explain what a FIDE-SNP offers her mother. What
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do you say? - ✔✔✔ Correct Answer > FIDESNPs provide individuals access
to Medicare and Medicaid benefits under a single organization that has
both a Medicare Advantage and Medicaid managed care contract with
CMS.
Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in
Part B. She is considering enrolling in a Medicare Advantage plan (Part
C). What should you advise her to do before she can enroll in a
Medicare Advantage plan? - ✔✔✔ Correct Answer > To join a Medicare
Advantage plan, she also must enroll in Part B.
Mr. Barrow 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 Answer
> SNPs have special programs for enrollees with chronic conditions, like
Mr. Barrow, and they provide prescription drug coverage that could be
very helpful as well.
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John Cohen is a Medicare beneficiary who suffers from diabetes. Mr.
Cohen is considering enrollment in an MA-PD plan that you represent.
He asks you whether his insulin costs will be covered.
What should you say? - ✔✔✔ Correct Answer > Mr. Cohen's insulin costs for
a one-month supply cannot be more than $35 in any coverage phase.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MAPD
plan you represent. Her neighbor recently suffered from a painful case of
shingles. Mrs. Avila hopes to avoid such an illness through vaccination.
She asks you whether the cost of the shingles vaccination will be
covered under the plan you represent. What should you say? - ✔✔✔
Correct Answer > Yes, there is no cost sharing for the shingles vaccine even
in the deductible phase of her prescription drug plan because it is an
adult vaccine recommended by the Advisory Committee on
Immunization Practices (AICP).
What types of tools can Medicare Part D prescription drug plans use that
affect the way their enrollees can access medications? -
✔✔✔ Correct Answer > Part D plans do not have to cover all medications. As
a result, their formularies, or lists of covered drugs, will vary from plan
AHIP CERTIFICATION EXAM NEWEST
QUESTIONS AND CORRECT
DETAILED SOLUTIONS TESTED AND
GRADED A+
Mrs. Robles is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care. What
should you tell her? - ✔✔✔ Correct Answer > Mrs. Robles can obtain care
from any provider who participates in Original Medicare, but generally
will have a higher cost-sharing amount if she sees a provider who/that is
not a part of the PPO network.
Mr. Bryant 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 some services and items he thought would be
,Page 2 of 44
fully covered. He called you to ask what he could do? What could you
tell him? - ✔✔✔
Correct Answer > You can offer to review the plans appeal process to help
him ask the plan to review the coverage decision.
Mrs. Nelson likes a Private Fee-for-Service (PFFS) plan available in her
area that does not include drug coverage. She wants to enroll in the plan
and enroll in a stand-alone prescription drug plan. What should you tell
her? - ✔✔✔ Correct Answer > An individual enrolled in an MA PFFS plan
that does not include a Part D benefit may enroll in a stand-alone Part D
prescription drug plan.
Raymond 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? - ✔✔✔ Correct Answer > C-SNP
Henrietta Ross is an elderly individual enrolled in a fully integrated
dual-eligible (FIDE) special needs plan (SNP). Henrietta's daughter
Gladys asks you to explain what a FIDE-SNP offers her mother. What
,Page 3 of 44
do you say? - ✔✔✔ Correct Answer > FIDESNPs provide individuals access
to Medicare and Medicaid benefits under a single organization that has
both a Medicare Advantage and Medicaid managed care contract with
CMS.
Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in
Part B. She is considering enrolling in a Medicare Advantage plan (Part
C). What should you advise her to do before she can enroll in a
Medicare Advantage plan? - ✔✔✔ Correct Answer > To join a Medicare
Advantage plan, she also must enroll in Part B.
Mr. Barrow 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 Answer
> SNPs have special programs for enrollees with chronic conditions, like
Mr. Barrow, and they provide prescription drug coverage that could be
very helpful as well.
, Page 4 of 44
John Cohen is a Medicare beneficiary who suffers from diabetes. Mr.
Cohen is considering enrollment in an MA-PD plan that you represent.
He asks you whether his insulin costs will be covered.
What should you say? - ✔✔✔ Correct Answer > Mr. Cohen's insulin costs for
a one-month supply cannot be more than $35 in any coverage phase.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MAPD
plan you represent. Her neighbor recently suffered from a painful case of
shingles. Mrs. Avila hopes to avoid such an illness through vaccination.
She asks you whether the cost of the shingles vaccination will be
covered under the plan you represent. What should you say? - ✔✔✔
Correct Answer > Yes, there is no cost sharing for the shingles vaccine even
in the deductible phase of her prescription drug plan because it is an
adult vaccine recommended by the Advisory Committee on
Immunization Practices (AICP).
What types of tools can Medicare Part D prescription drug plans use that
affect the way their enrollees can access medications? -
✔✔✔ Correct Answer > Part D plans do not have to cover all medications. As
a result, their formularies, or lists of covered drugs, will vary from plan
