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2024 AHIP EXAM WITH VALID ANSWERS
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2024 AHIP EXAM WITH VALID ANSWERS
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2024 AHIP EXAM WITH VALIDANSWERS
Dan is middle-income Medicare beneficiary. He has chronic bronchitis. Which
type of SNP is likely to be most appropriate for him? - CORRECT-ANSWERSC-
SNP
This is a statement about Medicare Savings Account Plans (MSA) - CORRECT-
ANSWERSMSA's either have a partial network, full network, or not networks
of providers, MSA plans cover Part A & B benefits but not PDPs, & non-
network providers must accept the same amount that OG Medicare would
pay them as payment in full
Mr. G is in excellent health, lives alone, & has a sizeable income. He has a
friend enrolled in a MA SNP & would like to join the plan. What should you tell
him? - CORRECT-ANSWERSSNPs limit enrollment to certain subpopulations of
beneficiaries & with his current situation, he is unlikely to qualify for an SNP.
Mrs. R asks whether there are any requirements for MA, what should you tell
her? - CORRECT-ANSWERSMrs. R must be entitled to Pt A & enrolled in Pt B
to enroll in MA
Mr. L is interested in a MA PPO plan & also wants a stand alone Medicare
PDP. What should you tell him? - CORRECT-ANSWERSMr. L could enroll in any
PPO plan in his network's area that include a PDP of OG Medicare with a
Medigap plan & standalone PDP, but he can not enroll in the MA-only PPO & a
stand alone PDP
Mrs. R is considering a MA PPO & has questions about which providers she
can go to for her healthcare. What should you tell her? - CORRECT-
ANSWERSMrs. R can get care from any provider who participates in OG
Medicare, but generally will have a higher cost-sharing amount if she sees a
provider outside of her PPO network
Mr. D enrolled in ABC MA plan years ago. In mid February of 2021, her doctor
confirms she has ESRD. What options will she have regarding her MA plan
during the next OEP? - CORRECT-ANSWERSShe may remain in her AMB MA
plan, enroll in another MA plan in her service area, or enroll in a SNP for
those suffering from ESRD if one is available in her area.
, Mr. L wants to sign up for MA & wants to know what types of plan designs
are available through this program. What should you tell him? - CORRECT-
ANSWERSThere are Medicare health plans like HMOs, PPOs, PFFSs, & MSAs
Mr. C is a citizen, previously enrolled in Medicare Pt B but has recently
stopped paying his Pt B premiums. Mr. C is still covered by Pt A & would like
to enroll in a MA plan while still covered by Pt A. What should you tell him? -
CORRECT-ANSWERSHe is not eligible to enroll in a MA plan until he re-enrolls
in Medicare Pt B
Dr. B does not contract with ABC PFFS plans but accept the plan's terms &
conditions for payment. Mike sees Dr. B for tx. How much may Dr. B charge?
- CORRECT-ANSWERSDr. B can charge Mike no more than the cost-sharing
specified in the PFFS plans terms & conditions of payment which may include
balance billing up to 15% of the Medicare rate.
Mr. G notes that a PFFS plan in his area has an attractive premium. He wants
to know if he can use doctors in a network as his current HMO plan requires.
What should you tell him? - CORRECT-ANSWERSHe may receive healthcare
services from any doctor allowed to bill Medicare, as long as he shows the
doctor the plan's ID card & the doctor agrees to accept the PSSA plan's
payment terms, which could include balance billing.
Mr. S just turned 65 & is entitled to Pt A but has not enrolled in Pt B because
he has coverage through an employer plan. If he wants to enroll in a MA
plan, what does he have to do? - CORRECT-ANSWERSHe will have to enroll in
Pt B
Mr. B is enjoying his retirement income. He recently had surgery & expected
certain items to be covered by the plan with minimal out of pocket costs
because is MAPD plan coverage has been good. But when he got the bill, he
saw large charges in excess of his MOOP limit including some services &
items he thought would be covered. What can he do? - CORRECT-
ANSWERSYou can offer to review the plans appeal process to help him ask
the plan to review the coverage decision.
Mrs. B is a retiree with substantial income. She is enrolled in a MAPD plan &
did not like her service from her PCP because it took 5 weeks to get an appt.
& she didnt feel good. What can she do? - CORRECT-ANSWERSShe could file
a grievance with her plan to complain about the lack of timeliness in getting
an appt.
Mr. S has diabetes & heart trouble & is generally satisfied with his OG
Medicare plan, but he wants to know more about MA SNPs. What could you
tell him? - CORRECT-ANSWERSSNPs have special programs for enrollees with
chronic conditions & they provide PD coverage that could be helpful
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