AHIP Final Exam 2022 (Answered)
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon.
He would like to know his options since he has decided to drop his retiree
coverage and is eligible for Medicare. What should you tell him?
Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare
Advantage or Part D plan within 2 months of his disenrollment.
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 generally obtain his services only
from providers within the plan's network (except in an emergency or where care is
unavailable within the network).
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?
XXXIt must obtain a HIPAA complaint authorization from an enrollee that indicates the
plan or plan sponsor may use their information for marketing purposes.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription
drug coverage that was offered to company retirees. The company told Mr. Yoo
that, because he was affected by this change, he would qualify for a Special
election period. Mr. Yoo contacted you to find out more about what this means.
What can you tell him?
It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part D
prescription drug plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge?
Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing up to
15% of the Medicare rate.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he
should be hospitalized. What should you tell Mr. Rainey (or his representative)
about the length of an inpatient psychiatric hospital stay that Medicare will
cover?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare
Advantage (MA) and Part D plans that Agent Smith sells at the regular Tuesday
brunch the neighbors have for senior citizens. What should Agent Tom Smith tell
Mr. Moreno about the kinds of food that can be provided to potential enrollees
who attend the sales presentation?
A meal cannot be provided, but light snacks would be permitted.
, You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her
concerns?
Tell her that Medicare guidelines allow you to conduct marketing activities in common
areas of a provider's facility.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day.
Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious
to have their Medicare prescription drug plan cover these drug needs. What
should you tell them?
Medicare prescription drug plans are not permitted to cover the prescription medications
the Vaughns are interested in under Part D coverage, however, plans may cover them
as supplemental benefits and the Vaughn's could look into that possibility.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription
drug plan. Under what circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not
offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
Which of the following is/are most likely to be characterized as an involuntary
disenrollment from a Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to substantially improved
health.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment
period.
I, II, and III only
Ms. Brooks has an aggressive cancer and would like to k
Medicare covers hospice services and they will be available for her.
You are working several plans and community organizations to sponsor an
educational event. When putting together advertisements for this event, what
should you do?
You must ensure that the advertisements indicate it is an educational event, otherwise it
will be considered a marketing event.
Which of the following statement is/are correct about a Medicare Savings
Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of
providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug
benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal
deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare
would pay them as payment in full.
I and II, only
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon.
He would like to know his options since he has decided to drop his retiree
coverage and is eligible for Medicare. What should you tell him?
Mr. Chen can disenroll from his employer-sponsored coverage to elect a Medicare
Advantage or Part D plan within 2 months of his disenrollment.
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 generally obtain his services only
from providers within the plan's network (except in an emergency or where care is
unavailable within the network).
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?
XXXIt must obtain a HIPAA complaint authorization from an enrollee that indicates the
plan or plan sponsor may use their information for marketing purposes.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription
drug coverage that was offered to company retirees. The company told Mr. Yoo
that, because he was affected by this change, he would qualify for a Special
election period. Mr. Yoo contacted you to find out more about what this means.
What can you tell him?
It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part D
prescription drug plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge?
Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing up to
15% of the Medicare rate.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he
should be hospitalized. What should you tell Mr. Rainey (or his representative)
about the length of an inpatient psychiatric hospital stay that Medicare will
cover?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare
Advantage (MA) and Part D plans that Agent Smith sells at the regular Tuesday
brunch the neighbors have for senior citizens. What should Agent Tom Smith tell
Mr. Moreno about the kinds of food that can be provided to potential enrollees
who attend the sales presentation?
A meal cannot be provided, but light snacks would be permitted.
, You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her
concerns?
Tell her that Medicare guidelines allow you to conduct marketing activities in common
areas of a provider's facility.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day.
Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious
to have their Medicare prescription drug plan cover these drug needs. What
should you tell them?
Medicare prescription drug plans are not permitted to cover the prescription medications
the Vaughns are interested in under Part D coverage, however, plans may cover them
as supplemental benefits and the Vaughn's could look into that possibility.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription
drug plan. Under what circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not
offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
Which of the following is/are most likely to be characterized as an involuntary
disenrollment from a Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to substantially improved
health.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment
period.
I, II, and III only
Ms. Brooks has an aggressive cancer and would like to k
Medicare covers hospice services and they will be available for her.
You are working several plans and community organizations to sponsor an
educational event. When putting together advertisements for this event, what
should you do?
You must ensure that the advertisements indicate it is an educational event, otherwise it
will be considered a marketing event.
Which of the following statement is/are correct about a Medicare Savings
Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of
providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug
benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal
deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare
would pay them as payment in full.
I and II, only
