AHIP 2025 Updated Exams STUDY BUNDLE WITH
SOLUTIONS Qs & As| 100% Correct| Grade A (Verified
Answers)
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at
risk of misusing or abusing frequently abused drugs? - ANSWERI. Identifying at risk
individuals by using criteria that includes the number of opioid prescriptions the
beneficiary has and the number of prescribers who have written those prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - ANSWERMedicare does
not cover acupuncture, or, in general, glasses or dentures.
Which statement best describes PACE plans? - ANSWERIt includes comprehensive
medical and social service delivery systems using an interdisciplinary team approach
in an adult day health center, supplemented by in-home and referral services.
Mr. Shultz was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility
period, he decided not to enroll because he was satisfied with his drug coverage. It is
now a year later and Mr. Shultz has lost his employer group coverage. How would
you advise him? - ANSWERMr. Schultz should enroll in a Part D plan before he has a
63-day break in coverage in order to avoid a premium penalty.
For which of the following individuals would a Cost Plan be most appropriate? -
ANSWERMs. Baker who is enrolled in Medicare Part B and is willing to continue
paying Part B premiums plus any plan premiums.
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? - ANSWERIf the Medicare Advantage
plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a
Medical Savings Account, Mrs. Berkowitz can do this.
Ms. Goldstein is required by the plan she represents to obtain enrollment forms that
have carbon copies in the back. She gives one to the beneficiary, sends another to
the plan and retains the third. What should she do with her copies of the enrollment
forms? - ANSWERShe should make every effort to safeguard the beneficiary
information on those enrollment forms.
Mr. Lopez takes several high cost prescription drugs. He would like to enroll in a
standalone Part D prescription drug plan that is available in his area. In what type of
, Medicare Health Plan can he enroll? - ANSWERPrivate Fee-for-Service (PFFS) plan
that does not include drug coverage.
Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that
offers better coverage than that available through his MA-PD plan and in addition
has a low premium. It won't cost him much more and, because he has the means to
do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his
MA-PD plan. What should you tell him? - ANSWERIf Mr. Block enrolls in the stand-
alone Medicare prescription drug plan, he will be disenrolled from the Medicare
Advantage plan.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed
full time, and paid taxes during that entire period. She is concerned that she will not
qualify for coverage under part A because she was not born in the United States.
What should you tell her? - ANSWERMost individuals who are citizens and over age
65 are covered under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has recently lost
creditable coverage previously available through her husband's employer. She is
interested in enrolling in a Medicare Part D prescription drug plan (PDP). What
should you tell her? - ANSWERIf a Part D benefit is offered through her plan she must
enroll in this plan.
Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for-Service (FFS) Medicare? What could you tell him? -
ANSWERPart A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those provided
by a doctor are covered under Original Medicare.
Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently
told her that there is an excellent Medicare Advantage (MA) plan with a five-star
rating serving her area. On January 15 she comes to you for advice as to what
options, if any, she has. What should you say regarding special enrollment periods
(SEPs)? - ANSWERMrs. Wellington is eligible for a SEP that may be used once until
November 30 to enroll in the five-star plan.
Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra
help paying for Part D prescription drugs for Medicare beneficiaries with limited
income. He wants to know whether he might qualify. What should you tell him? -
ANSWERThe extra help is available to beneficiaries whose income and assets do not
exceed annual limits specified by the government.
A client wants to give you an enrollment application on October 1 prior to the
beginning of the Annual Election Period because he is leaving on vacation for two
weeks and does not want to forget about turning it in. What should you tell him? -
SOLUTIONS Qs & As| 100% Correct| Grade A (Verified
Answers)
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at
risk of misusing or abusing frequently abused drugs? - ANSWERI. Identifying at risk
individuals by using criteria that includes the number of opioid prescriptions the
beneficiary has and the number of prescribers who have written those prescriptions.
II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - ANSWERMedicare does
not cover acupuncture, or, in general, glasses or dentures.
Which statement best describes PACE plans? - ANSWERIt includes comprehensive
medical and social service delivery systems using an interdisciplinary team approach
in an adult day health center, supplemented by in-home and referral services.
Mr. Shultz was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility
period, he decided not to enroll because he was satisfied with his drug coverage. It is
now a year later and Mr. Shultz has lost his employer group coverage. How would
you advise him? - ANSWERMr. Schultz should enroll in a Part D plan before he has a
63-day break in coverage in order to avoid a premium penalty.
For which of the following individuals would a Cost Plan be most appropriate? -
ANSWERMs. Baker who is enrolled in Medicare Part B and is willing to continue
paying Part B premiums plus any plan premiums.
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? - ANSWERIf the Medicare Advantage
plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a
Medical Savings Account, Mrs. Berkowitz can do this.
Ms. Goldstein is required by the plan she represents to obtain enrollment forms that
have carbon copies in the back. She gives one to the beneficiary, sends another to
the plan and retains the third. What should she do with her copies of the enrollment
forms? - ANSWERShe should make every effort to safeguard the beneficiary
information on those enrollment forms.
Mr. Lopez takes several high cost prescription drugs. He would like to enroll in a
standalone Part D prescription drug plan that is available in his area. In what type of
, Medicare Health Plan can he enroll? - ANSWERPrivate Fee-for-Service (PFFS) plan
that does not include drug coverage.
Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that
offers better coverage than that available through his MA-PD plan and in addition
has a low premium. It won't cost him much more and, because he has the means to
do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his
MA-PD plan. What should you tell him? - ANSWERIf Mr. Block enrolls in the stand-
alone Medicare prescription drug plan, he will be disenrolled from the Medicare
Advantage plan.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed
full time, and paid taxes during that entire period. She is concerned that she will not
qualify for coverage under part A because she was not born in the United States.
What should you tell her? - ANSWERMost individuals who are citizens and over age
65 are covered under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has recently lost
creditable coverage previously available through her husband's employer. She is
interested in enrolling in a Medicare Part D prescription drug plan (PDP). What
should you tell her? - ANSWERIf a Part D benefit is offered through her plan she must
enroll in this plan.
Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for-Service (FFS) Medicare? What could you tell him? -
ANSWERPart A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those provided
by a doctor are covered under Original Medicare.
Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently
told her that there is an excellent Medicare Advantage (MA) plan with a five-star
rating serving her area. On January 15 she comes to you for advice as to what
options, if any, she has. What should you say regarding special enrollment periods
(SEPs)? - ANSWERMrs. Wellington is eligible for a SEP that may be used once until
November 30 to enroll in the five-star plan.
Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra
help paying for Part D prescription drugs for Medicare beneficiaries with limited
income. He wants to know whether he might qualify. What should you tell him? -
ANSWERThe extra help is available to beneficiaries whose income and assets do not
exceed annual limits specified by the government.
A client wants to give you an enrollment application on October 1 prior to the
beginning of the Annual Election Period because he is leaving on vacation for two
weeks and does not want to forget about turning it in. What should you tell him? -
