AHIP Final Exam 2025 QUESTIONS AND CORRECT DETAILED ANSWERS || GRADED A+
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Course
AHIP 2025
Institution
AHIP 2025
AHIP Final Exam 2025 QUESTIONS
AND CORRECT DETAILED
ANSWERS || GRADED A+
Mr. Anderson is a very organized individual and has filled out and
brought to you an enrollment form on October 10 for a new plan
available on January 1 next year. He is currently enrolled in
Original ...
AHIP 2025 Final Exam: Latest
Updates on Questions and
Guaranteed Accurate Answers
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in
Part B. She is considering enrollment in a Medicare Advantage
plan (Part C). What should you advise her to do before she can
enroll in a Medicare Advantage plan? - ANSWER ✔ To join a
Medicare Advantage plan, she also must enroll in Part B.
Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be the correct
description? - ANSWER ✔ Medicare Advantage is a way of
covering all the Original Medicare benefits through private health
insurance companies.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO
plan that you represent. It is one of three plans operated by the
same organization in Mr. Lombardi's area. The MA PPO plan
does not include drug coverage, but the other two plans do. Mr.
Lombardi likes the PPO plan that does not include drug coverage
and intends to obtain his drug coverage through a stand-alone
Medicare prescription drug plan. What should you tell him about
this situation? - ANSWER ✔ He could enroll either in one of the
MA plans that include prescription drug coverage or Original
Medicare with a Medigap plan and standalone Part D prescription
drug coverage, but he cannot enroll in the MA-only PPO plan and
a stand-alone prescription drug plan.
, Mrs. Wang wants to know generally how the benefits under
Original Medicare might compare to the benefits package of a
Medicare Advantage Plan before she starts looking at specific
plans. What could you tell her? - ANSWER ✔ Medicare
Advantage Plans may offer extra benefits that Original Medicare
does not offer such as vision, hearing, and dental services. It
must include a maximum out-of-pocket limit on Part A and Part B
services.
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.
Mr. Lopez has heard that he can sign up for a product called
"Medicare Advantage" but is not sure about what type of plan
designs are available through this program. What should you tell
him about the types of health plans that are available through the
Medicare Advantage program? - ANSWER ✔ There are Medicare
health plans such as HMOs, PPOs, PFFS, and MSAs.
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.
, Mrs. Walters is enrolled in her state's Medicaid program in
addition to Medicare. What should she be aware of when
considering enrollment in a Medicare Advantage (MA) plan? -
ANSWER ✔ She cannot enroll in an MA Medical Savings Account
(MSA) plan.
Mr. Shapiro gets by on a very small amount of fixed income. He
has heard there may be extra help paying for Part D prescription
drugs for Medicare beneficiaries with limited income. He wants to
know whether he might qualify. What should you tell him? -
ANSWER ✔ The extra help is available to beneficiaries whose
income and assets do not exceed annual limits specified by the
government.
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? - ANSWER ✔ Medicare 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.
Mr. Wingate is a newly enrolled Medicare Part D beneficiary and
one of your clients. In addition to drugs on his plan's formulary, he
takes several other medications. These include a prescription
drug not on his plan's formulary, over-the-counter medications for
colds and allergies, vitamins, and drugs from an Internet-based
Canadian pharmacy to promote hair growth and reduce joint
swelling. His neighbor recently told him about a concept called
TrOOP and he asks you if any of his other medications could
count toward TrOOP should he ever reach the Part D catastrophic
limit. What should you say. - ANSWER ✔ None of the costs of Mr.
, Wingate's other medications would currently count toward TrOOP
but he may wish to ask his plan for an exception to cover the
prescription, not on its formulary.
What types of tools can Medicare Part D prescription drug plans
use that affect the way their enrollees can access medications? -
ANSWER ✔ Part D plans do not have to cover all medications. As
a result, their formularies, or lists of covered drugs, will vary from
plan to plan. In addition, they can use cost containment
techniques such as tiered co-payments and step therapy.
Mrs. Mulcahy, age 65, is concerned that she may not qualify for
enrollment in a Medicare prescription drug plan because,
although she is entitled to Part A, she is not enrolled under
Medicare Part B. What should you tell her? - ANSWER ✔ An
individual who is entitled to Part A or enrolled under Part B is
eligible to enroll in a Medicare prescription drug plan. As long as
Mrs. Mulcahy is entitled to Part A, she does not need to enroll
under Part B before enrolling in a prescription drug plan.
Mr. Hutchinson has drug coverage through his former employer's
retiree plan. He is concerned about the Part D premium penalty if
he does not enroll in a Medicare prescription drug plan, but does
not want to purchase extra coverage that he will not need. What
should you tell him? - ANSWER ✔ If the drug coverage he has is
not expected to pay, on average, at least as much as Medicare's
standard Part D coverage expects to pay, then he will need to
enroll in Medicare Part D during his initial eligibility period to avoid
the late enrollment penalty.
Mr. Jacob understands that there is a standard Medicare Part D
prescription drug benefit, but when he looks at information on
various plans available in his area, he sees a wide range in what
they charge for deductibles, premiums, and cost sharing. How
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