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AHIP Module 1 - 5 ( Latest 2024 / 2025 ) Actual Questions and Answers 100% Correct
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AHIP Module 1 - 5 ( Latest 2024 / 2025 ) Actual Questions and Answers 100% Correct
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AHIP Module 1 - 5By ExamNavigator
, AHIP Module 1 - 5
1. Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP), buthe lost the paper
that explains what he could do during the SEP. What can youtell him?
Answer: If the SEP is for MA coverage, he will generally have one opportunity tochange his
MA coverage.
2. Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through
an employer retiree plan. She is not enrolled in Part B. Sincethe employer plan does not cover
prescription drugs, she wants to enroll in aMedicare prescription drug plan. Will she be able to?
Answer: Yes. Mrs. Walters must beentitled to Part A or enrolled in Part B to be eligible for
coverage under the Medicareprescription drug program.
3. Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period.In mid-January
of the following year, she wants to switch back to Original Medicare and enroll in a stand-
alone prescription drug plan. What should youtell her?
Answer: During the MA Open Enrollment Period, from January 1 - March 31, shemay
disenroll from the MA-PD plan into Original Medicare and also may add a stand-alone
prescription drug plan.
4. 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?
Answer: If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not
offer drug coverageor a Medical Savings Account plan, Mrs. Berkowitz can do this.
5. Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's service area
next month. She is worried that she will not be able to enroll in another plan available in her
new residence until the Annual Election Period.What should you tell her?
Answer: She is eligible for a Special Election Period that beginseither the month before her
permanent move, if the plan is notified in advance, or themonth she provides notice of the
move, and this period typically lasts an additionaltwo months.
6. You are doing a sales presentation for Mrs. Pearson. You know that Medicaremarketing
guidelines prohibit certain types of statements. Apply those guide-lines to the following
statements and identify which would be prohibited.
Answer: "If you're not in very good health, you will probably do better with a different
product."
7. Mr. Anderson is a very organized individual and has filled out and brought toyou an
enrollment form on October 10 for a new plan available January 1 nextyear. He is currently
enrolled in Original Medicare. What should you do?
Answer: TellMr. Anderson that you cannot accept any enrollment forms until the annual
electionperiod begins.
,8. You are visiting with Mr. Tully and his daughter at her request. He has advanced
Alzheimer's and is incapable of understanding the implications of
choosing a Medicare Advantage or prescription drug plan. Can his daughter fill out the
enrollment form and sign it for him?
Answer: Mr. Tully's daughter can do so only, if she is authorized under state law as a court-
appointed legal guardian, has a durable power of attorney for health care decisions, or is
authorized under statesurrogate consent laws to make health decisions.
9. Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D during the
Annual Enrollment Period (AEP). At the beginning of January,her neighbor told her about the
Medicare Advantage (MA) plan he selected. He also told her there was an open enrollment
period that she might be able to use to enroll in a MA plan. Ms. Gonzales comes to you for
advice shortly after speaking to her neighbor. What should you tell her?
Answer: There is a MA OpenEnrollment Period (OEP) that takes place between January 1 and
March 31, but Ms.Gonzales cannot use it because eligibility to use the OEP is available only
to MA enrollees.
10. Ms. Claggett is sixty-six (66) years old. She has been covered under Original Medicare
for the last six years due to her disability and has never been enrolled in a Medicare
Advantage or a Part D plan before. She wants toenroll in a Part D plan. She knows that there is
such a thing as the "Part D InitialEnrollment Period" (IEP) and has concluded that, since she has
never enrolledin such a plan before, she should be eligible to enroll under this period. What
should you tell her about how the Part D Initial Enrollment Period applies to hersituation?
Answer: Ms. Claggett has had two IEPs and missed them both. The first occurredthree months
before and three months after the month when she was first entitled toPart A OR enrolled in Part
B. Because she was eligible for Medicare before age 65,Ms. Claggett had a second IEP based
on turning age 65, which has also expired.
11. Mary Samuels recently suffered a stroke while visiting her daughter and
grandchildren. As a result, Mary has been admitted to a rehabilitation hospitalwhere she is
expected to reside for several months.The rehabilitation hospitalis located outside the
geographic area served by her current Medicare Advantage (MA) plan. What options are
available to Mary regarding her health plan coverage?
Answer: Mary may make an unlimited number of MA enrollment requests and may disenroll
from her current MA plan.
12. Mrs. Pierce would like to enroll in a Medicare Cost plan that offers Part D prescription
drug coverage. She comes to you for advice about when she canenroll in a plan you have
previously discussed. What should you tell her?
Answer: Enrollment in Cost plans offering Part D coverage is available only during
enrollment periods under the Part D program, and Cost plans must accept enrollments during
these periods.
13. Mr. Ford enrolled in an MA-only plan in mid-November during the AnnualElection
Period (AEP). On December 1, he calls you up and says that he has changed his mind and
, would like to enroll into a MA-PD plan. What enrollmentrules would apply in this case?
Answer: He can make as many enrollment changes as helikes during the Annual Election
Period and the last choice made prior to the end ofthe period will be the effective one as of
January 1.
14. Which of the following individuals is most likely to be eligible to enroll in a Medicare
Advantage (MA) or Part D Plan?
Answer: Jose, a grandfather who was grantedasylum and has worked in the United States for
many years.
15. Which of the following individuals are likely to qualify for a special enrollment period
(SEP) for either a MA and/or Part D due to a change of residence?
I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood
in his existing plan's service area.II. Fiona (enrolled in MA andPart D) moves cross-country to
an area outside her existing plan's service area.III. Gilbert moves into a plan service area
where there is now a Part D plan available to him from a service area where no Part D plan was
available.IV.Henry makes a permanent move to a new state providing him with new MA andPart
D options.
Answer: II, III, and IV only
16. Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service
(PFFS) plan. What questions would you need to ask to deter-mine his eligibility?
Answer: You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if
he lives in the PFFS plan's service area.
17. Mrs. Schneider has Original Medicare Parts A and B and has just qualifiedfor her state's
Medicaid program, so the state is now paying her Part B premium and she is considered a dual
eligible. Will gaining eligibility for thisprogram affect her ability to enroll in a Medicare
Advantage or Medicare Pre-scription Drug plan?
Answer: Yes. Qualifying for this state program gives Mrs. Schneideraccess to a Special
Enrollment Period that allows her to make changes to her MA and/or Part D enrollment
during the first 9 months of each calendar year.
18. Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge
of BestCare's efforts to facilitate electronic enrollment in its Medicare Advantage plans. In
setting up the enrollment site, which of thefollowing must Phiona consider?
I. If a legal representative is completing an electronic enrollment request, heor she must first
upload proof of his or her authority.
II. All data elements required to complete an enrollment request must becaptured.
III. The mechanism must advise each individual at the beginning of the processthat he or she is
completing an actual enrollment request.
IV.The mechanism must capture an accurate time and date stamp at the timethe applicant
enters the online site.
Answer: II and III only
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