AHIP 2024 Final
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug
plan you represent and simply give you a check to cover his premiums for the entire year.
What should you tell him? - ANSHe will need to mail in his payment with his enrollment form.
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? - ANSShe could enroll in a PFFS plan and
a stand-alone Medicare prescription drug plan.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify a plan that covers all of
her medications. She does not want to make an abrupt change to new drugs that would be
covered and asks what she should do. What should you tell her? - ANSEvery Part D drug
plan is required to cover a single one-month fill of her existing medications sometime during
a 90-day transition period.
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? - ANSPlan 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. Allen has a rare condition for which two different brand name drugs are the only
available treatment. She is concerned that since no generic prescription drug is available
and these drugs are very high cost, she will not be able to find a Medicare Part D
prescription drug plan that covers either one of them. What should you tell her? -
ANSMedicare prescription drug plans are required to cover drugs in each therapeutic
category. She should be able to enroll in a Medicare prescription drug plan that covers the
medications she needs.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her
neighbors called TrOOP. She asks you to explain it. What do you say? - ANSTrOOP stands
for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and
include not only expenses paid by a beneficiary but also in some instances drug
manufacturer discounts.
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health
Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and
become Medicare eligible for the first time. What issues might she consider about whether to
enroll in a Medicare prescription drug plan? - ANSShe could compare the coverage to see if
the Medicare Part D plan offers better benefits and coverage than the FEHB plan for the
, specific medications she needs and whether any additional benefits are worth the Part D
premium costs on top of her FEHB contribution.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -
ANSMedicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the facility for 100
days.
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? - ANSYou 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.
Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: "We
offer Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if
you would like to learn more." Which of the following best describes the obligation(s) of
Winthrop Brokerage regarding the advertisement? - ANSWinthrop Brokerage does not need
to submit the advertisement to CMS for prior approval because it does not include
information about the plans' benefits structures, cost-sharing, or information about measures
or ranking standards.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at
severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is
likely to be most appropriate for him? - ANSC-SNP
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying
Medicare taxes. What should you tell her? - ANSTo obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
You are scheduled to give a sales presentation at a local senior center at which a drawing
will be held for a prize. At the beginning of the presentation, which of the following must you
do? - ANSClearly state that no obligation exists to enroll if a gift or prize is being offered.
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? -
ANSMedigap plans help beneficiaries cover Original Medicare benefits, but they coordinate
with Original Medicare coverage.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug
plan you represent and simply give you a check to cover his premiums for the entire year.
What should you tell him? - ANSHe will need to mail in his payment with his enrollment form.
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? - ANSShe could enroll in a PFFS plan and
a stand-alone Medicare prescription drug plan.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify a plan that covers all of
her medications. She does not want to make an abrupt change to new drugs that would be
covered and asks what she should do. What should you tell her? - ANSEvery Part D drug
plan is required to cover a single one-month fill of her existing medications sometime during
a 90-day transition period.
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? - ANSPlan 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. Allen has a rare condition for which two different brand name drugs are the only
available treatment. She is concerned that since no generic prescription drug is available
and these drugs are very high cost, she will not be able to find a Medicare Part D
prescription drug plan that covers either one of them. What should you tell her? -
ANSMedicare prescription drug plans are required to cover drugs in each therapeutic
category. She should be able to enroll in a Medicare prescription drug plan that covers the
medications she needs.
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her
neighbors called TrOOP. She asks you to explain it. What do you say? - ANSTrOOP stands
for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit and
include not only expenses paid by a beneficiary but also in some instances drug
manufacturer discounts.
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health
Benefits (FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and
become Medicare eligible for the first time. What issues might she consider about whether to
enroll in a Medicare prescription drug plan? - ANSShe could compare the coverage to see if
the Medicare Part D plan offers better benefits and coverage than the FEHB plan for the
, specific medications she needs and whether any additional benefits are worth the Part D
premium costs on top of her FEHB contribution.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -
ANSMedicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the facility for 100
days.
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? - ANSYou 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.
Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: "We
offer Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if
you would like to learn more." Which of the following best describes the obligation(s) of
Winthrop Brokerage regarding the advertisement? - ANSWinthrop Brokerage does not need
to submit the advertisement to CMS for prior approval because it does not include
information about the plans' benefits structures, cost-sharing, or information about measures
or ranking standards.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at
severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is
likely to be most appropriate for him? - ANSC-SNP
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying
Medicare taxes. What should you tell her? - ANSTo obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
You are scheduled to give a sales presentation at a local senior center at which a drawing
will be held for a prize. At the beginning of the presentation, which of the following must you
do? - ANSClearly state that no obligation exists to enroll if a gift or prize is being offered.
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? -
ANSMedigap plans help beneficiaries cover Original Medicare benefits, but they coordinate
with Original Medicare coverage.
