AHIP Final Exam 2023 Practice Test (200 Questions and Answers 100% Correct)(2022/2023) Verified Answers

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AHIP Test (Over 200 Questions & Answers)

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1.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?: They

are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs

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

Medicare and Medicare Advantage. What would be a correct

description?-

: Medicare Advantage is a way of covering all of the Original

Medicare benefits through private health insurance companies.

3.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 Feefor-Ser- vice (PFFS). She wants to know if this would be available to her.

What should you tell her about PFFS plans?: 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.

4.(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her?: Mrs. Radford

must be entitled to Part A and enrolled in Part B to enroll in Medicare

Advantage

5.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?: He is not eligible to enroll in a Medicare

Advantage plan until he re-enrolls in Medicare Part B

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6.(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?: 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

7.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 obtain his services

only from providers who have a contractual relationship with the plan

(except in an emer- gency).

8.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?: Mrs. Ramos can obtain care from any provider who

participates in Original

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Medicare, but generally will be charged a lower co-payment if she

goes to one of the plan's preferred providers.

9.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

10.(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?: 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.

11.(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?: 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.

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

declared disabled by the Social Security Administration and has been

receiving dis- ability payments. He is wondering whether he can obtain

coverage under Medicare. What should you tell him?: After receiving

such disability payments for 24 months, he will be automatically

enrolled in Medicare, regardless of age.

13.(W) Mr. Davis is 49 years old and has been receiving disability

benefits from the Social Security Administration for 12 months. Can you

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sell him

a Medicare Advantage or Part D Prescription Drug policy?: 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.

14.(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?:

In order to obtain Part B coverage, she must pay a standard monthly

premium, though it is higher for individuals with higher incomes