AHIP FINAL EXAM PREP KIT WITH COMPLETE QUESTIONS AND CORRECT ANSWERS RATED A+
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AHIP
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AHIP
AHIP FINAL EXAM PREP KIT WITH
COMPLETE QUESTIONS AND CORRECT
ANSWERS RATED A+
Mrs. Kendrick is in good health, has worked for many years and is
six months away from turning 65. She wants to know what she
will have to do to enroll in a Medicare Advantage (MA) plan as
soon as possible. Wha...
AHIP FINAL EXAM PREP KIT WITH
COMPLETE QUESTIONS AND CORRECT
ANSWERS RATED A+
Mrs. Kendrick is in good health, has worked for many years and is
six months away from turning 65. She wants to know what she
will have to do to enroll in a Medicare Advantage (MA) plan as
soon as possible. What could you tell her? Correct Answer She
may enroll in an MA plan beginning three months immediately
before her first entitlement to both Medicare Part A and Part B.
Mrs. Reynolds is in her Medicare initial coverage election period
(ICEP) and the date of her entitlement to Part A and B has
already occurred. Mrs. Reynolds has just signed up for a
Medicare Advantage plan on the second of the month. She is
leaving for vacation in two weeks and wants to know if her new
coverage will start before she leaves. What should you tell her?
Correct Answer Typically, her coverage would begin on the first
day of the next month, so she should not expect her coverage to
begin before she leaves.
Mr. Robinson was quite ill recently and forgot to pay his monthly
premium for his MA-PD plan. He is worried that he will lose his
coverage now when he needs it the most. He is certain his plan
will disenroll him because that is what happened to a friend of his
in a similar type of plan. What can you tell Mr. Robinson about his
situation? Correct Answer Plan sponsors have the option to do
nothing when a plan member does not pay their premiums or
disenroll the member after a grace period and notice.
Mrs. Johnson calls to tell you she has not received her new plan
ID card yet, but she needs to see a doctor. What can she expect
to receive from the plan after the plan has received her enrollment
,form? Correct Answer Evidence of plan membership, information
on how to obtain services, and the effective date of coverage.
Mr. Anderson is a very organized individual and has filled out and
brought to you an enrollment form on October 10 for a new plan
available January 1 next year. He is currently enrolled in Original
Medicare. What should you do? Correct Answer Tell Mr.
Anderson that you cannot accept any enrollment forms until the
annual election period begins.
Mr. Wendt suffers from diabetes which has gotten progressively
worse during the last year. He is currently enrolled in Original
Medicare (Parts A and B) and a Part D prescription drug plan and
did not enroll in a Medicare Advantage (MA) plan during the last
annual open enrollment period (AEP) which has just closed. Mr.
Wendt has heard certain MA plans might provide him with more
specialized coverage for his diabetes and wants to know if he
must wait until the next annual open enrollment period (AEP)
before enrolling in such a plan. What should you tell him? Correct
Answer If there is a special needs plan (SNP) in Mr. Wendt's area
that specializes in caring for individuals with diabetes, he may
enroll in the SNP at any time under a special election period
(SEP)
Richard is a licensed agent who represents Spartan Health Plan
and its Medicare Advantage (MA) plans. Richard has several
clients who have recently come to him for help who are in their
initial coverage election period (ICEP) and are interested in
enrolling in one of Spartan Health Plan's MA plans. Alice will soon
turn 65 and retire. Alice has coverage through Spartan Health
Plan offered by her employer. Bob had health coverage through
Spartan but dropped the coverage when he retired early to travel
overseas. Bob, who has just turned age 65, is now back in the
United States. Charlotte, who will turn 65 next month, has
coverage through Athena Health plan - a company Richard also
,represents. Who qualifies for the opt-in simplified enrollment
mechanism? Correct Answer Alice because she will not have a
break between her non-Medicare and Medicare coverage through
Spartan Health Plan.
You would like to offer gifts of nominal value to potential enrollees
who call for more information about a plan you represent. You
would then like to offer additional gifts if they come to a marketing
event. Each of the gifts meets the CMS definition of nominal
value, but together, the gifts are more than the nominal value. Is
this permissible? Correct Answer No, the total value of the gifts
given to an enrollee in a year cannot exceed the CMS definition of
nominal value.
You are doing a sales presentation for Ms. Duarte and her son.
Ms. Duarte has some cognitive impairment and her son informs
you that he has power of attorney to only make financial not
health care decisions for her. Can he execute the enrollment for
her? Correct Answer No, he cannot execute the enrollment for
her. He must have a legal authorization, under state law that
explicitly allows him to make health care decisions for his mother.
Agent Willis had several clients who disenrolled from the plans he
represents during the AEP to enroll in Medicare Advantage plans
that are competitors of his. Agent Willis believes that the choices
they made are not ideal for them and would like to get their
business back during the Medicare Advantage Open Enrollment
Period (MA-OEP). What can agent Willis do? Correct Answer He
can call them to let them know that if they do not like their new
plans, they can change back during the MA-OEP.
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 the various types of
Medicare Advantage plans offered by private entities and she
may enroll in one if it is available in her area.
Mrs. Sanchez lives in a state located near Canada. She has
recently become eligible for Medicare and is considering
enrollment in Part D prescription drug coverage. One of her
friends has told her that she needs to be aware of something
called TrOOP. What should you tell her when she asks you about
TrOOP? Correct Answer TrOOP are out-of-pocket costs that
count toward the annual out-of-pocket threshold to move into
catastrophic coverage and generally include the annual
deductible(s) and costs for drugs on the plan's formulary
purchased at a plan's participating pharmacy. In some instances,
amounts not directly paid by the enrollee (like manufacturer
discounts) count toward TrOOP.
Mr. Polanski likes the cost of an HMO plan available in his area
but would like to be able to visit one or two doctors who aren't
participating providers. He wants to know if the Point of Service
(POS) option available with some HMOs will be of any help in this
situation. What should you tell him? Correct Answer The POS
option might be a good solution for him as it will allow him to visit
out-of-network providers, generally without prior approval.
However, he should be aware that it is likely he will have to pay
higher cost-sharing for services from out-of-network providers.
Mr. Landry is approaching his 65th birthday. He has signed up for
Medicare Part A, but he did not enroll in Part B because he has
employer-sponsored coverage and intends to keep working for
several more years. But he is considering enrolling in Part D
prescription drug coverage because he believes it is superior to
his employer plan. How would you advise him? Correct Answer
Mr. Landry is eligible for Part D since he has Part A, and his initial
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