Michigan State Brakes Certification
Q1: Mrs. Chen, age 68, is enrolled in a Medicare Advantage HMO plan. She is diagnosed with terminal
cancer and wants to elect hospice care. Which statement is correct regarding her coverage?
A. Her MA plan will cover all hospice services, including room and board in a hospice facility
B. She must disenroll from her MA plan to receive hospice benefits under Original Medicare
C. Hospice remains covered under Original Medicare (Part A), but she can stay enrolled in her MA plan
for other services [CORRECT]
D. Her MA plan will cover hospice, but only if she obtains prior authorization from her PCP
Correct Answer: C
Rationale: Medicare Advantage plans are required to cover all services under Original Medicare Parts A
and B except hospice care, which remains under Original Medicare Part A per 42 CFR § 422.101. Mrs.
Chen can remain in her MA plan and receive non-hospice services through the plan while getting
hospice through Original Medicare.
A is wrong: MA plans do NOT cover hospice; this is explicitly carved out to Original Medicare.
B is wrong: Disenrollment is NOT required; beneficiaries can stay in their MA plan for non-
hospice services.
D is wrong: Prior authorization for hospice is irrelevant because MA plans simply do not cover it.
AHIP Exam Tip: Remember the "Hospice Exception" — MA covers everything Part A & B covers EXCEPT
hospice. This is a favorite trick question on the exam.
Year-specific note: Unchanged for 2025/2026; hospice has always been the MA carve-out.
Q2: Mr. Thompson, age 72, has a Medicare Advantage Special Needs Plan (SNP) for chronic heart
failure. His income recently dropped below 135% of the Federal Poverty Level, and he now qualifies
for Medicaid. What type of SNP should he transition to?
A. C-SNP (Chronic Condition Special Needs Plan)
B. D-SNP (Dual Eligible Special Needs Plan) [CORRECT]
C. I-SNP (Institutional Special Needs Plan)
D. He cannot have an SNP if he has both Medicare and Medicaid
Correct Answer: B
,Rationale: A D-SNP serves individuals who are dual eligible — enrolled in both Medicare and Medicaid.
Since Mr. Thompson now qualifies for Medicaid, he meets the eligibility requirement for a D-SNP. C-
SNPs serve specific chronic conditions (like his heart failure), but D-SNPs are designed specifically for
dual eligibles.
A is wrong: He already has a C-SNP for heart failure, but his new Medicaid eligibility makes him
eligible for a D-SNP, which may offer better integrated benefits.
C is wrong: I-SNPs serve individuals requiring institutional-level care (nursing home, long-term
care facility), which does not apply here.
D is wrong: D-SNPs exist specifically for dual-eligible beneficiaries.
AHIP Exam Tip: SNP types = "CDI" — Chronic, Dual, Institutional. Match the beneficiary's situation to the
letter.
Q3: During the Annual Election Period (AEP), Mrs. Davis wants to switch from her current Medicare
Advantage PPO to a different MA HMO plan. Which statement is correct?
A. She can make the change during AEP (Oct 15–Dec 7), with coverage effective January 1 [CORRECT]
B. She must wait until the Open Enrollment Period (OEP) in January
C. She can switch plans anytime during AEP, but coverage begins the first of the month after she enrolls
D. She must stay in her current plan until the next calendar year because she already used her one MA
switch
Correct Answer: A
Rationale: The Annual Election Period (AEP) runs October 15 – December 7 each year. Changes made
during AEP take effect January 1 of the following year. This is the primary enrollment period for MA plan
changes.
B is wrong: The OEP (Jan 1–Mar 31) is for MA-to-MA or MA-to-Original Medicare changes, but
AEP is the correct and primary period for this switch.
C is wrong: AEP changes are NOT first-of-month effective; they are all January 1 effective.
D is wrong: There is no "one MA switch" limit during AEP; beneficiaries can make multiple
changes, with the last one submitted by Dec 7 taking effect Jan 1.
AHIP Exam Tip: AEP = Oct 15-Dec 7 → Jan 1 effective. OEP = Jan 1-Mar 31 → first of month after request
effective. Don't confuse the two!
, Q4: Mr. Wilson is enrolled in a 5-star Medicare Advantage plan. He wants to switch to a different plan
in March 2026. What enrollment opportunity does he have?
A. He must wait until the next AEP because he missed the OEP deadline
B. He can use the 5-star Special Enrollment Period (SEP) once from December 8 through November 30 of
the following year [CORRECT]
C. He can switch anytime because all 5-star plans allow unlimited SEPs
D. The 5-star SEP only applies to plans rated 4.5 stars or higher
Correct Answer: B
Rationale: The 5-star SEP allows beneficiaries enrolled in non-5-star plans to switch TO a 5-star plan, OR
beneficiaries already in 5-star plans to switch to another 5-star plan. This SEP can be used once per year
from December 8 through November 30 of the following year.
A is wrong: The 5-star SEP operates independently of OEP; he can use it during its window.
C is wrong: The 5-star SEP can only be used once per year, not unlimited times.
D is wrong: The SEP requires a 5-star rating specifically, not 4.5 stars.
AHIP Exam Tip: 5-star SEP = "Once a year, Dec 8 to Nov 30." It's a one-time annual gift for high-
performing plans.
Q5: A beneficiary asks about Medicare Advantage Medical Savings Account (MSA) plans. Which
statement is correct?
A. MSA plans include Part D prescription drug coverage as a standard benefit
B. MSA plans combine a high-deductible health plan with a medical savings account funded by the plan
[CORRECT]
C. MSA plans operate like HMOs and require referrals to see specialists
D. MSA plans have no deductible and cover all services from day one
Correct Answer: B
Rationale: A Medicare MSA plan is a type of Medicare Advantage plan that combines a high-deductible
health insurance plan with a medical savings account. The plan deposits money into the account, which
the beneficiary can use for healthcare services before meeting the deductible. MSA plans do NOT
include Part D coverage.
A is wrong: MSA plans explicitly do not include Part D; beneficiaries must enroll in a separate
Part D plan if they want drug coverage.
C is wrong: MSAs are NOT HMOs; they do not use referral networks or PCP gatekeeping.
Q1: Mrs. Chen, age 68, is enrolled in a Medicare Advantage HMO plan. She is diagnosed with terminal
cancer and wants to elect hospice care. Which statement is correct regarding her coverage?
A. Her MA plan will cover all hospice services, including room and board in a hospice facility
B. She must disenroll from her MA plan to receive hospice benefits under Original Medicare
C. Hospice remains covered under Original Medicare (Part A), but she can stay enrolled in her MA plan
for other services [CORRECT]
D. Her MA plan will cover hospice, but only if she obtains prior authorization from her PCP
Correct Answer: C
Rationale: Medicare Advantage plans are required to cover all services under Original Medicare Parts A
and B except hospice care, which remains under Original Medicare Part A per 42 CFR § 422.101. Mrs.
Chen can remain in her MA plan and receive non-hospice services through the plan while getting
hospice through Original Medicare.
A is wrong: MA plans do NOT cover hospice; this is explicitly carved out to Original Medicare.
B is wrong: Disenrollment is NOT required; beneficiaries can stay in their MA plan for non-
hospice services.
D is wrong: Prior authorization for hospice is irrelevant because MA plans simply do not cover it.
AHIP Exam Tip: Remember the "Hospice Exception" — MA covers everything Part A & B covers EXCEPT
hospice. This is a favorite trick question on the exam.
Year-specific note: Unchanged for 2025/2026; hospice has always been the MA carve-out.
Q2: Mr. Thompson, age 72, has a Medicare Advantage Special Needs Plan (SNP) for chronic heart
failure. His income recently dropped below 135% of the Federal Poverty Level, and he now qualifies
for Medicaid. What type of SNP should he transition to?
A. C-SNP (Chronic Condition Special Needs Plan)
B. D-SNP (Dual Eligible Special Needs Plan) [CORRECT]
C. I-SNP (Institutional Special Needs Plan)
D. He cannot have an SNP if he has both Medicare and Medicaid
Correct Answer: B
,Rationale: A D-SNP serves individuals who are dual eligible — enrolled in both Medicare and Medicaid.
Since Mr. Thompson now qualifies for Medicaid, he meets the eligibility requirement for a D-SNP. C-
SNPs serve specific chronic conditions (like his heart failure), but D-SNPs are designed specifically for
dual eligibles.
A is wrong: He already has a C-SNP for heart failure, but his new Medicaid eligibility makes him
eligible for a D-SNP, which may offer better integrated benefits.
C is wrong: I-SNPs serve individuals requiring institutional-level care (nursing home, long-term
care facility), which does not apply here.
D is wrong: D-SNPs exist specifically for dual-eligible beneficiaries.
AHIP Exam Tip: SNP types = "CDI" — Chronic, Dual, Institutional. Match the beneficiary's situation to the
letter.
Q3: During the Annual Election Period (AEP), Mrs. Davis wants to switch from her current Medicare
Advantage PPO to a different MA HMO plan. Which statement is correct?
A. She can make the change during AEP (Oct 15–Dec 7), with coverage effective January 1 [CORRECT]
B. She must wait until the Open Enrollment Period (OEP) in January
C. She can switch plans anytime during AEP, but coverage begins the first of the month after she enrolls
D. She must stay in her current plan until the next calendar year because she already used her one MA
switch
Correct Answer: A
Rationale: The Annual Election Period (AEP) runs October 15 – December 7 each year. Changes made
during AEP take effect January 1 of the following year. This is the primary enrollment period for MA plan
changes.
B is wrong: The OEP (Jan 1–Mar 31) is for MA-to-MA or MA-to-Original Medicare changes, but
AEP is the correct and primary period for this switch.
C is wrong: AEP changes are NOT first-of-month effective; they are all January 1 effective.
D is wrong: There is no "one MA switch" limit during AEP; beneficiaries can make multiple
changes, with the last one submitted by Dec 7 taking effect Jan 1.
AHIP Exam Tip: AEP = Oct 15-Dec 7 → Jan 1 effective. OEP = Jan 1-Mar 31 → first of month after request
effective. Don't confuse the two!
, Q4: Mr. Wilson is enrolled in a 5-star Medicare Advantage plan. He wants to switch to a different plan
in March 2026. What enrollment opportunity does he have?
A. He must wait until the next AEP because he missed the OEP deadline
B. He can use the 5-star Special Enrollment Period (SEP) once from December 8 through November 30 of
the following year [CORRECT]
C. He can switch anytime because all 5-star plans allow unlimited SEPs
D. The 5-star SEP only applies to plans rated 4.5 stars or higher
Correct Answer: B
Rationale: The 5-star SEP allows beneficiaries enrolled in non-5-star plans to switch TO a 5-star plan, OR
beneficiaries already in 5-star plans to switch to another 5-star plan. This SEP can be used once per year
from December 8 through November 30 of the following year.
A is wrong: The 5-star SEP operates independently of OEP; he can use it during its window.
C is wrong: The 5-star SEP can only be used once per year, not unlimited times.
D is wrong: The SEP requires a 5-star rating specifically, not 4.5 stars.
AHIP Exam Tip: 5-star SEP = "Once a year, Dec 8 to Nov 30." It's a one-time annual gift for high-
performing plans.
Q5: A beneficiary asks about Medicare Advantage Medical Savings Account (MSA) plans. Which
statement is correct?
A. MSA plans include Part D prescription drug coverage as a standard benefit
B. MSA plans combine a high-deductible health plan with a medical savings account funded by the plan
[CORRECT]
C. MSA plans operate like HMOs and require referrals to see specialists
D. MSA plans have no deductible and cover all services from day one
Correct Answer: B
Rationale: A Medicare MSA plan is a type of Medicare Advantage plan that combines a high-deductible
health insurance plan with a medical savings account. The plan deposits money into the account, which
the beneficiary can use for healthcare services before meeting the deductible. MSA plans do NOT
include Part D coverage.
A is wrong: MSA plans explicitly do not include Part D; beneficiaries must enroll in a separate
Part D plan if they want drug coverage.
C is wrong: MSAs are NOT HMOs; they do not use referral networks or PCP gatekeeping.
