AHIP 2022 Exam - Questions And Answers
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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct
Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct
Ans - 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?
Correct Ans - 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?
Correct Ans - 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? Correct Ans - 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.
Correct Ans - I, II, and III only
Ms. Brooks has an aggressive cancer and would like to k Correct Ans - 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? Correct
Ans - 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. Correct Ans - I and II, only
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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct
Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct
Ans - 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?
Correct Ans - 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?
Correct Ans - 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? Correct Ans - 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.
Correct Ans - I, II, and III only
Ms. Brooks has an aggressive cancer and would like to k Correct Ans - 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? Correct
Ans - 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. Correct Ans - I and II, only
