(Answered) 2022 AHIP Exam Vertion 2
(aswers below every question)
Mr. Chen is enrolled in his employer's group health plan and will be
retiring soon. He would like to know his options since he has decided to
drop his retiree coverage and is eligible for Medicare. What should you
tell him? Mr. Chen can disenroll from his employer-sponsored
coverage to elect a Medicare Advantage or Part D plan within 2 months
of his disenrollment.
Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? 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?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? 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? 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? 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?
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? 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? 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? 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. I, II, and III only
Ms. Brooks has an aggressive cancer and would like to k 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 this
event, what should you do? You must ensure that the advertisements
indicate it is an educational event, otherwise it will be considered a
marketing event.
Which of the following statement is/are correct about a Medicare
Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network
of providers.
II. MSA plans cover Part A and Part B benefits but not Part D
prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a
minimal deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original
Medicare would pay them as payment in full. I and II, only
Mr. Sinclair 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? SNPs have special programs for enrollees
with chronic conditions, like Mr. Sinclair, and they provide prescription
drug coverage that could be very helpful as well.
Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr.
Xi that best describes the health coverage provided to Medicare
beneficiaries? .
Beneficiaries under Original Medicare have no cost-sharing for most
preventive services which include immunizations such as annual flu
shots.
(aswers below every question)
Mr. Chen is enrolled in his employer's group health plan and will be
retiring soon. He would like to know his options since he has decided to
drop his retiree coverage and is eligible for Medicare. What should you
tell him? Mr. Chen can disenroll from his employer-sponsored
coverage to elect a Medicare Advantage or Part D plan within 2 months
of his disenrollment.
Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? 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?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? 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? 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? 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?
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? 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? 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? 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. I, II, and III only
Ms. Brooks has an aggressive cancer and would like to k 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 this
event, what should you do? You must ensure that the advertisements
indicate it is an educational event, otherwise it will be considered a
marketing event.
Which of the following statement is/are correct about a Medicare
Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network
of providers.
II. MSA plans cover Part A and Part B benefits but not Part D
prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a
minimal deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original
Medicare would pay them as payment in full. I and II, only
Mr. Sinclair 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? SNPs have special programs for enrollees
with chronic conditions, like Mr. Sinclair, and they provide prescription
drug coverage that could be very helpful as well.
Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr.
Xi that best describes the health coverage provided to Medicare
beneficiaries? .
Beneficiaries under Original Medicare have no cost-sharing for most
preventive services which include immunizations such as annual flu
shots.
