Ahip 2025 final EXAM NEW VERSION
LATEST UPDATE 2024-2025 WITH
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QUESTIONS
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?
- ANSWER In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
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?
- ANSWER Mr. Zachow has a right to request a formulary exception to obtain
coverage for his Part D drug. He or his physician could obtain the standardized
request form on the plan's website, fill it out, and submit it to his plan.
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?
- ANSWER Gift cards or gift certificates of $15 or less that can be readily converted
to cash.
,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?
- ANSWER You must have her sign a scope of appointment form, indicating which
products she wishes to discuss. You may then proceed with the discussion.
Mrs. Paterson is concerned about the deductibles and co-payments associated
with Original Medicare. What can you tell her about Medigap as an option to
address this concern?
- ANSWER Medigap plans help beneficiaries cover Original Medicare benefits, but
they coordinate with Original Medicare coverage.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare
Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the
Medigap Plan F in which he is enrolled. It not only provides foreign travel
emergency benefits but also covers his Medicare Part B deductible. Anita comes
to you for advice. What should you tell her?
- ANSWER You are sorry to disappoint Anita, but a Medigap F plan is no longer
available to those who turn age 65 after January 1, 2020. Anita might instead
consider other Medigap plans that offer foreign travel benefits but do not cover
the Part B deductible.
about the length of an inpatient psychiatric hospital stay that Medicare will cover?
- ANSWER Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.
Ms. Gibson recently lost her employer group health and drug coverage and now
she wants to enroll in a PPO that does not include drug coverage. What should
you tell her about obtaining drug coverage?
, - ANSWER She can enroll in the PPO, but she will not be able to purchase a stand-
alone Medicare Part D prescription drug plan.
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
- ANSWER Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
in Medicare Advantage.
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.
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?
- ANSWER He will have to enroll in Part B.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does
not include drug coverage. She wants to enroll in the plan and enroll in a stand-
alone prescription drug plan. What should you tell her?
- ANSWER She could enroll in a PFFS plan and a stand-alone Medicare prescription
drug plan.
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