AHIP 2022/2023 BOARD CERTIFICATION PRACTICE
TEST Q&A
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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)I, II,
and III only
Ms. Brooks has an aggressive cancer and would like to k (correct answers)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 answers)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.
TEST Q&A
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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)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 answers)I, II,
and III only
Ms. Brooks has an aggressive cancer and would like to k (correct answers)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 answers)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.
