AHIP 2024 FINAL EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS

Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance? - Answer She
should contact her state Medicaid agency to see if she qualifies
forprograms that can help with Medicare costs for which she is
responsible.

Madeline Martinez was widowed several years ago. Her husband

worked for many years and contributed into the Medicare system. He
also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked
part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should
you tell her? - Answer You should tell Madeline that she will be able to
enroll in Medicare Part A without paying monthly premiums due to her
husband's long work record and participation in the Medicare system.
You should also tell Madeline that she will pay Part B premiums at more
than the standard lowest rate but less than the highest rate due her
substantial income.

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 - Answer After receiving
such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
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? - Answer Part 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. 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? -
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.

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? - Answer Tell prospect Jerry
Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.

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? - Answer The penalty will be a permanent 10%
increase in his Part B premium for every 12-month period that passed
during which he could have enrolled and did not.
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? - Answer
Medicare is a program for people age 65 or older and those under age 65
with certain disabilities, end-stage renal disease, and Lou Gehrig's
disease so she will be eligible for Medicare.

Mildred Savage enrolled in Allcare Medicare Advantage plan several

years ago. Mildred recently learned that she is suffering from inoperable
cancer and has just a few months to live. She would like to spend these
final months in hospice care. Mildred's family asks you whether hospice
benefits will be paid for under the Allcare Medicare Advantage plan.
What should you say? - Answer Mildred may remain enrolled in Allcare
and make a hospice election. Hospice benefits will be paid for by
Original Medicare under Part A and Allcare will continue to pay for any
non-hospice services.

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? - Answer He may receive health care services from
any doctor allowed to bill Medicare, as long as he shows the doctor the
plan's identification card and the doctor agrees to accept the PFFS plan's
payment terms and conditions, which could include balance billing.

Mr. Kelly wants to know whether he is eligible to sign up for a Private

fee-for-service (PFFS) plan. What questions would you need to ask to
determine his eligibility? - Answer You would need to ask Mr. Kelly if
he is enrolled in Part A and Part B and if he lives in the PFFS plan's
service area.

Mrs. Wang wants to know generally how the benefits under Original
Medicare might compare to the benefits package of a Medicare
Advantage Plan before she starts looking at specific plans. What could
you tell her? - Answer Medicare Advantage Plans may offer extra
benefits that Original Medicare does not offer such as vision, hearing,
and dental services. It must include a maximum out-of-pocket limit on
Part A and Part B services.

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

B but has recently stopped paying his Part B premium. Mr. Castillo is
still covered by Part A. He would like to enroll in a Medicare Advantage
(MA) plan and is still covered by Part A. What should you tell him? -
Answer He is not eligible to enroll in a Medicare Advantage plan until
he re-enrolls in Medicare Part B.

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? - Answer You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
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? - Answer Mrs.
Chi may enroll in a MA MSA plan and remain in her current standalone
Part D prescription drug plan.

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? - Answer Mrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will have a
higher cost-sharing amount if she sees a provider who/that is not a part
of the PPO network.

Mr. Wells is trying to understand the difference between Original

Medicare and Medicare Advantage. What would be a correct
description? - Answer Medicare Advantage is a way of covering all the
Original Medicare benefits through private health insurance companies.

Juan Hernandez is turning 65 next month, Juan legally entered the

United States over twenty years ago but is not a citizen. Since his entry
into the country, Juan has worked at Smallcap Incorporated and
contributed to the Medicare system. Juan suffers from diabetes. He will
soon retire and asks you if he can enroll in a Medicare Advantage plan
that you represent. How would you respond? - Answer Juan is eligible to
enroll in a Medicare Advantage as long as he is entitled to Part A and
enrolled in Part B. Juan should go to the Social Security website to
enroll in Medicare Part A and B if he has not done so already. Once he is
enrolled, he can choose a Medicare Advantage plan.

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?
- Answer He will need to enroll in a Medicare prescription drug plan
upon becoming eligible for the program in order to avoid a premium
penalty. To reduce his expenses, he should look for a plan with a zero
premium.

Mr. Schultz 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.
Schultz has lost his employer group coverage within the last two weeks.
How would you advise him? - Answer Mr. Schultz should enroll in a
Part D plan before he has a 63-day break in coverage in order to avoid a
premium penalty.

Mrs. Fields wants to know whether applying for the Part D low income
subsidy will be worth the time to fill out the paperwork. What could you
tell her? - Answer The Part D low income subsidy could substantially
lower her overall costs. She can apply by contacting her state Medicaid
office, or calling the Social Security Administration.

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? - Answer If she
does not sign up for a Medicare prescription drug plan as soon as she is
eligible to do so, if she does sign up at a later date, her premium will be
permanently increased by 1% of the national average premium for every
month that she was not covered.

Mrs. Imelda Diaz is a Medicare beneficiary enrolled in a MA-PD plan

you represent. Her neighbor recently suffered from a painful case of
shingles. Mrs. Diaz hopes to avoid such an illness through vaccination.
She asks you whether the cost of shingles vaccination will be covered
under the plan you represent. What should you say? - Answer Yes, there
is no cost sharing for the shingles vaccine even in the deductible phase
of her prescription drug plan because it is an adult vaccine recommended
by the Advisory Committee on Immunization Practices (AICP).

Mrs. Walters is entitled to Part A and has medical coverage without drug
coverage through an employer retiree plan. She is not enrolled in Part B.
Since the employer plan does not cover prescription drugs, she wants to
enroll in a Medicare prescription drug plan. Will she be able to? -
Answer Yes. Mrs. Walters must be entitled to Part A or enrolled in Part
B to be eligible for coverage under the Medicare prescription drug
program.

Mr. Shapiro gets by on a very small amount of 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? - Answer The extra help is
available to beneficiaries whose income and assets do not exceed annual
limits specified by the government.

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

Answer I, II, and III only
-I. Part D plans must enroll any eligible beneficiary who applies
regardless of health status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a
pharmacy network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA)
plan may only obtain Part D benefits through a standalone PDP.

Mrs. Roberts has Original Medicare and would like to enroll in a Private
Fee-for-Service (PFFS) plan. All types of PFFS plans are available in
her area. Which options could Mrs. Roberts consider before selecting a
PFFS plan? - Answer A Medicare Advantage Prescription Drug (MA-
PD) PFFS plan that combines medical benefits and Part D prescription
drug coverage, a PFFS plan offering only medical benefits, or a PFFS
plan in combination with a stand-alone prescription drug plan.

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? - Answer You may provide
her with the required enrollment materials and take her completed
enrollment application.
Agent Daniel Webber has properly set up a sales appointment to meet
with client Edward Young at Agent Webber's office. At the agreed upon
appointment time, Mr. Young arrives with his elderly neighbor - Clara
Burton, who wants to learn about her Medicare Advantage options.
What should Agent Daniel Webber do? - Answer

You have been providing a pre-Thanksgiving meal during sales

presentations in November for many years and your clients look forward
to attending this annual event. When marketing Medicare Advantage
and Part D plans, what are you permitted to do with respect to meals? -
Answer You may provide light snacks, but a Thanksgiving style meal
would be prohibited, regardless of who provides or pays for the meal.

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? - Answer
b.
It must obtain a HIPAA compliant authorization from an enrollee that
indicates the plan or plan sponsor may use their information for
marketing purposes.

Wendy Park becomes eligible for Medicare for the first time in July.
With the help of Agent James Chan, she enrolls in FeelBetter Medicare
Advantage plan with an effective date of July 1st. Which statement best
describes how Agent Chan may be compensated under CMS rules? -
Answer FeelBetter will pay Agent Chan initial year compensation for
the months July through December. Renewal amounts will be paid
starting in January if Ms. Park remains enrolled the following year.
You have sought permission from a hospital to place brochures for your
product in their gift shop and cafeteria. The hospital administration
expresses some hesitation about allowing marketing in a health care
facility. What should you tell them? - Answer Marketing in health care
facilities is an acceptable practice, as long as it takes place in common
areas where patients are not receiving or waiting to receive health care
and as long as the hospital displays materials for all plans that provide
them to the hospital.

Hector Hernandez is an independent agent. Hector sells plans on behalf

of three Medicare Advantage organizations that offer a total of 10 plans
but does not represent all Medicare Advantage organizations offering
plans that are available in his area. Which of the following statements
best describes any steps Hector is required to take? - Answer During the
first minute of a sales call, Hector must send an email to the prospect
stating that "I represent 3 plans but not every plan available in your area.
Please contact Medicare.gov to get information on all your options.

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? - Answer You appreciate
the opportunity and would be happy to schedule an appointment with
anyone at their request.

Agent Martinez wishes to solicit Medicare Advantage prospects through

e-mail and asks you for advice as to whether this is possible. What
should you tell her? - Answer Marketing representatives may initiate
electronic contact through e-mail but an opt-out process must be
provided.

You are doing a sales presentation for Mrs. Pearson. You know that
Medicare marketing guidelines prohibit certain types of statements.
Apply those guidelines to the following statements and identify which
would be prohibited. - Answer "If you're not in very good health, you
will probably do better with a different product."

Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan

and her MA Initial Coverage Election Period (ICEP) has just begun.
Which of the following can she not do during the ICEP? - Answer She
can enroll in a Medigap plan to supplement the benefits of the MA plan
that she's also enrolling in.

Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives
in an area that has suffered from major flooding that has been declared a
major disaster by both the Federal government and her state. As a result
of dealing with the flooding issues and being evacuated from her home,
Edna missed her chance to enroll in MA during her Initial Coverage
Election Period. Felix lives in an area with a Medicare Advantage plan
with a 4-star rating that he would like to join. George dropped his
Medigap policy six months ago when he first enrolled in a Medicare
Advantage plan. He now wants to return to Original Medicare. Harriet
has recently developed diabetes and would like to enroll in a Medicare
Advantage plan that focuses on care for those with that disease. Which,
if any, of these individuals would qualify for a special election period
(SEP)? - Answer Edna would qualify for a SEP because government
officials have declared a major disaster for her area and she did not
enroll in MA during her ICEP due to the emergency. George would
qualify for an SEP because he enrolled in Medicare Advantage (MA)
plan for the first time and would now like to return to Original Medicare
within the first 12 months of his enrollment. Harriet would also qualify
for a SEP to enroll in a C-SNP because she has developed a chronic
condition. Felix would not qualify for a SEP since he seeks to enroll in a
4-star not a 5-star MA plan.

Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he

continues to work and is covered by an employer health plan, he has not
enrolled in Part B or Part D. He receives a notice on June 1 that his
employer is cutting back on prescription drug benefits and that as of July
1 his coverage will no longer be creditable. He has come to you for
advice. What advice would you give Mr. Rockwell about special
election periods (SEPs)? - Answer Mr. Rockwell is eligible for a SEP
due to his involuntary loss of creditable drug coverage; the SEP begins
in June and ends September 1 - two months after the loss of creditable
coverage.

A client wants to give you an enrollment application on October 1

before 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? - Answer You must tell him you are not
permitted to take the form. If he sends the form directly to the plan, the
plan will process the enrollment on the day the Annual Election Period
begins.

Mrs. Kumar would like her daughter, who lives in another state, to meet
with you during the Annual Election Period to help her complete her
enrollment in a Part D plan. She asked you when she should have her
daughter plan to visit. What could you tell her? - Answer Her daughter
should come in November.

When Myra first became eligible for Medicare, she enrolled in Original
Medicare (Parts A and B). She is now 67 and will turn 68 on July 1. She
would now like to enroll in a Medicare Advantage (MA) plan and
approaches you about her options. What advice would you give her? -
Answer She should remain in Original Medicare until the annual
election period running from October 15 to December 7, during which
she can select an MA plan.

Mr. Garrett has just entered his MA Initial Coverage Election Period
(ICEP). What action could you help him take during this time? - Answer
He will have one opportunity to enroll in a Medicare Advantage plan

Mr. Roberts is enrolled in an MA plan. He recently suffered

complications following hip replacement surgery. As a result, he has
spent the last three months in Resthaven, a skilled nursing facility. Mr.
Roberts is about to be discharged. What advice would you give him
regarding his health coverage options? - Answer His open enrollment
period as an institutionalized individual will continue for two months
after the month he moves out of the facility.

If a beneficiary is enrolled in a stand-alone prescription drug plan and

wants to keep that plan, what type of Medicare health plan could the
individual also enroll in, without being automatically disenrolled from
the stand-alone prescription drug plan? - Answer The beneficiary could
enroll in a private fee-for-service (PFFS) plan that does not include
prescription drug coverage; a cost plan; or a Medicare Medical Savings
Account (MSA) plan.

Since 2004 Ms. Eisenberg has had a Medigap plan that provides some
drug coverage. She has recently received a letter from her Medigap
carrier informing her that her drug coverage is not "creditable." She
wants to know what this means. What should you tell her? - Answer The
letter is to inform her that the drug coverage offered through her
Medigap plan does not offer drug coverage that is at least comparable to
that provided under the Medicare Part D prescription drug program. If
she does not have such creditable coverage during periods when she is
first eligible for the Part D program, she will face a premium penalty if
she enrolls in a Part D plan at a later date.

Mr. Albert has heard about something called the Star Rating system for
Medicare Advantage plans. He asks you to explain it to him since he is
interested in enrolling in a plan that is newly available in his area. After
you explain that it is the way for consumers to judge plan performance,
what else would you say? - Answer New plans and Part D sponsors that
do not have any Star Rating are not required to provide Star Rating
information until the next contract year.

Ms. Brooks has an aggressive cancer and would like to know if

Medicare will cover hospice services in case she needs them. What
should you tell her? - Answer Medicare covers hospice services and they
will be available for her.

Mr. Lee was intending to enroll in MaxCare's Medicare Advantage plan

this year. However, due to his current medical condition, his daughter
Debbie has been appointed as his legal representative over both health
and financial matters. Debbie would like to ensure that her father is still
able to enroll in MaxCare's plan, but she is unsure what her role is to
help with his enrollment request. What advice can you give her? -
Answer Debbie can submit an telephonic enrollment request on Mr.
Lee's behalf as long as she attests that she has the legal authority to do so