AHIP 2022 Questions and Answers(Highly recommended test) 100% Correct Verified Answers

AHIP 2022 Questions and

Answers(Highly recommended test)

Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but

is not sure about what type of plan designs are available through this program. What

should you tell him about the types of health plans that are available through the

Medicare Advantage program? Correct answer- They are Medicare health plans such

as HMOs, PPOs, PFFS, SNPs, and MSAs

(W) Mr. Wells is trying to understand the difference between Original Medicare and

Medicare Advantage. What would be a correct description? Correct answer- Medicare

Advantage is a way of covering all of the Original Medicare benefits through private

health insurance companies.

During a sales presentation in Ms. Sullivan's home, she tells you that she has heard

about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She

wants to know if this would be available to her. What should you tell her about PFFS

plans? Correct answer- A PFFS plan is one of various types of Medicare Advantage

plans offered by private entities and she may enroll in one if it is available in her area.

(W) Mrs. Radford asks whether there are any special eligibility requirements for

Medicare Advantage. What should you tell her? Correct answer- Mrs. Radford must be

entitled to Part A and enrolled in Part B to enroll in Medicare Advantage

Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has

recently stopped paying his Part B premium. He would like to enroll in a Medicare

Advantage (MA) plan and is still covered by Part A. What should you tell him? Correct

answer- He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in

Medicare Part B

(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago.

Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What

options does Mrs. Billings have in regard to her MA plan during the next open

enrollment season? Correct answer- She may remain in her ABC MA plan or enroll in a

Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her

area

Mr. Kumar is considering a Medicare Advantage HMO and has questions about his

ability to access providers. What should you tell him? Correct answer- In most Medicare

Advantage HMOs, Mr. Kumar must obtain his services only from providers who have a

contractual relationship with the plan (except in an emergency).

Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which

providers she can go to for her health care. What should you tell her? Correct answerMrs. Ramos can obtain care from any provider who participates in Original Medicare,

but generally will be charged a lower co-payment if she goes to one of the plan's

preferred providers.

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? Correct answerSNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and

they provide prescription drug coverage that could be very helpful as well

(W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable income

from his investments. He has a friend enrolled in a Medicare Advantage Special Needs

Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing

amounts and Mr. Greco would like to join that plan. What should you tell him? Correct

answer- SNPs limit enrollment to certain sub-populations of beneficiaries. Given his

current situation, he is unlikely to qualify and would not be able to enroll in the SNP.

(W) 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? Correct answer- Most 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.

(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by

the Social Security Administration and has been receiving disability payments. He is

wondering whether he can obtain coverage under Medicare. What should you tell him?

Correct answer- After receiving such disability payments for 24 months, he will be

automatically enrolled in Medicare, regardless of age.

(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social

Security Administration for 12 months. Can you sell him a Medicare Advantage or Part

D Prescription Drug policy? Correct answer- No, he cannot purchase a Medicare

Advantage or Part D policy because he has not received Social Security or Railroad

Retirement disability benefits for 24 months.

(W) Ms. Henderson believes that she will qualify for Medicare coverage when she turns

65, without paying any premiums, because she has been working for 40 years and

paying Medicare taxes. What should you tell her? Correct answer- In order to obtain

Part B coverage, she must pay a standard monthly premium, though it is higher for

individuals with higher incomes

(W) Mr. Diaz continued working with his company and was insured under his employer's

group plan until he reached age 68. He has heard that there is a premium penalty for

those who did not sign up for Part B when first eligible and wants to know how much he

will have to pay. What should you tell him? Correct answer- Mr. Diaz will not pay any

penalty because he had continuous coverage under his employer's plan.

(W) Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next

year. She heard she must enroll in Part B at the beginning of the year to ensure no gap

in coverage. What can you tell her? Correct answer- She may enroll at any time while

she is covered under her employer plan, but she will have a special eight-month

enrollment period that differs from the standard general enrollment period, during which

she may enroll in Medicare Part B

(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is considering

enrollment in a Medicare health plan. What should you advise her to do before she will

be able to enroll into a Medicare health plan? Correct answer- In order to join a

Medicare health plan, she also must enroll in Part B

Mrs. Park has a low, fixed income. What could you tell her that might be of assistance?

Correct answer- She should contact her state Medicaid agency to see if she qualifies for

one of several programs that can help with Medicare costs for which she is responsible

(W) Mr. Yu has limited income and resources so you have encouraged him to see if he

qualifies for some type of financial assistance. Mr. Yu is not sure it is worth the trouble

to apply and wants to know what the assistance could do for him if he qualifies. What

could you tell him? Correct answer- He might qualify for help with Part D prescription

drug costs and help paying Part A and/or Part B premiums, deductibles, and/or cost

sharing.

(W) Mr. Patel is in good health and is preparing a budget in anticipation of his retirement

when he turns 66. He wants to understand the health care costs he might be exposed to

under Medicare if he were to require hospitalization as a result of an illness. In general

terms, what could you tell him about his costs for inpatient hospital services under

Original Medicare? Correct answer- Under Original Medicare, there is a single

deductible amount due for the first 60 days of any inpatient hospital stay, after which it

converts into a per-day amount through day 90. After day 90, he would pay a daily

amount up to 60 days over his lifetime, after which he would be responsible for all costs

(W) 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

answer- Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.

Rainey's entire lifetime.

Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being

successfully treated for that condition. However, she and her physicians feel that after

AHIP Final Exam Test Questions and Answers

1. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him?

2. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. How would you respond?

3. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife's needs. What could you tell Mr. Moy?

4. Mrs. Pe?a is 66 years old, has coverage under an employer plan, and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her?

5. 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?

6. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her?

7. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through massage therapy. She is concerned about whether or not Medicare will cover these items and services. What should you tell her?

8. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization as a result of an illness. In general terms, what could you tell him about his costs for inpatient hospital servicesunder Original Medicare?

9. Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her?

10. Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would generally expect to encounter when enrolling into a standard MedicarePart D prescription drug plan. What should you tell him?

11. Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern?

12. 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?

13. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for services. What advice would you give her?

14. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not covered by that plan. What should you tell him?

15. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of assistance?

16. 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?

17. 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?

18. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed?

19. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him?

20. Mr. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening.

21. Which of the following statement is/are

22. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What should you tell him about this situation?

23. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. What should you tell her?

24. Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him?

25. 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?

27. 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.

28. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him?

29. Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description?

30. Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi?

31. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him?

32. Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. What could you tell her?

32. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him?

33. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?

34. Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since she receives some assistance for her health care costs from the State. What should you tell her?

36. Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. In mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season?

37. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him?

38. Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him?

39. 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?

40. Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program?

41. Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?

42. Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do?

43. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him?

44. 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?

45. Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition to drugs on his plan's formulary he takes several other medications. These include a prescription drug not on his plan's formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you say?

 46. Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you advise her?

47. Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. 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?

48. Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. What should you tell her?

49. Mrs. Quinn has just turned 65, is in excellent health and has a relatively high income. She uses no medications and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage. She currently does not have creditable coverage. What could you tell her about the implications of such a decision?

50. 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 within the last two weeks. How would you advise him

51. Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her?

52. What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees can access medications

53. All plans must cover at least the standard Part D coverage or its actuarial equivalent. Which of the following statements best describes some of the costs a beneficiary would incur for prescription drugs under the standard coverage

54. Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he looks at information on various plans available in his area, he sees a wide range in what they charge for deductibles, premiums, and cost sharing. How can you explain this to him?

55. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage. What should you tell him?

56. Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?correct answersJose, a grandfather who was granted asylum and has worked in the United States for many years.

57. Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but does not want to purchase extra coverage that he will not need. What should you tell him?

58. Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well. What can she expect will happen to her drug coverage?

59. Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically enrolled in one available in her area.

60. 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?

61. Which of the following statements about Medicare Part D are correct?

62. Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. What should you tell him?

63. You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation?

64. Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same marketing requirements as the plans themselves. How should you respond to such a statement?

65. Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage plan. She agreed to sign a scope of appointment form and meet with you on October 15. During the appointment, what are you permitted to do?

66. One of your colleagues argues that it is better to focus your time and energy exclusively in neighborhoods with single-family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond?

67. A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss her options under the Medicare Advantage program. Before engaging in such a discussion, what should you do?

68. Your friend's mother just moved to an assisted living facility and he asked if you could present a program for the residents about the MA-PD plans you market. What could you tell him?

69. Melissa Meadows is a marketing representative for Best Care which has recently introduced a Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Best Care has not submitted any potential posts to CMS for approval.Melissa would like to use the power of social media to reach potential prospects. What advice would you give her?

70. Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings distributes materials that are solely educational. However, she gives a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been advertised as educational?

71. Agent Martinez wishes to solicit M