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AHIP Exam 2024: Comprehensive Practice Questions with Detailed Answers for Effective Preparation and Successful Certification in Health Insurance and Policy$23.99
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AHIP Exam 2024: Comprehensive Practice Questions with Detailed Answers for Effective Preparation and Successful Certification in Health Insurance and Policy
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AHIP Exam 2024: Comprehensive Practice Questions with Detailed Answers for Effective Preparation and Successful Certification in Health Insurance and Policy.
AHIP 2022 Comprehensive Questions
from World-Class Academics Solutions for
Every Question Tailored for Top Grades
Tested and Proven Exam Strategies
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree
group health plan that includes drug coverage with nominal copays. He heard about a neighbor's
MA-PD plan that you represent and because he takes numerous prescription drugs, he is
considering signing up for it. What should you tell him?
a.When possible, it is always the best option to have both the employer's plan and the MA-PD,
so he would have no out-of-pocket expenses.
b.Generally, employers prefer retirees to enroll in a stand-alone PDP, so he should consider that
instead of the MA-PD.
c.Generally, employers prefer retirees to have both the retiree group plan and the MA-PD plan to
fill in the gaps, but he would be better off with just the MA-PD plan.
d.He should compare the benefits in his employer-sponsored retiree group health plan with the
benefits in his neighbor's MA-PD plan to determine which one will provide suf - -correct ans- -d.
He should compare the benefits in his employer-sponsored retiree group health plan with the
benefits in his neighbor's MA-PD plan to determine which one will provide sufficient coverage
for his prescription needs.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to
enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed several expensive medications.
Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi?
,a.Mrs. Chi may enroll in a MA MSA plan but if she wishes prescription drug coverage it must be a
MSA-PD plan that includes drug coverage.
b.Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D prescription
drug plan.
c.Mrs. Chi is ineligible for a MA MSA plan because she is ineligible for Medicaid due to her
income level.
d.Mrs. Chi may enroll in a MA MSA plan but if she wishes prescription drug coverage she must
also enroll in a Medicare Supplement Plan (Medigap) F that covers the Medicare Part B
deductible a - -correct ans- -b. Mrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D prescription drug plan.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him?
a.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).
b.With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so
long as that provider participates in Original Medicare.
c.Mr. Kumar will be able to obtain routine care outside of the plan's service area but will pay a
higher co-payment (except in an emergency).
d.In Medicare Advantage HMO plans, services provided by primary care physicians are covered
at 100%, but those of specialists are covered at 80%. - -correct ans- -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).
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?
a.They are Medigap Supplemental plans that fill in the gaps not covered by Medicare.
,b.They are major medical policies but are only for low-income beneficiaries with Medicare.
c.They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
d.They are custodial long-term care plans for people with Medicare. - -correct ans- -They are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he
has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do?
a.He will not need to do anything. His entitlement to Part A makes him eligible to enroll in any
Medicare Advantage plan.
b.As long as his employer offers coverage that is equivalent to Medicare's, he cannot enroll in
Part B.
c.He must wait until the next Annual Election Period, at which time he can enroll in a Medicare
Advantage plan.
d.He will have to enroll in Part B. - -correct ans- -d. He will have to enroll in Part B.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers
she can go to for her health care. What should you tell her?
a.In general, Mrs. Ramos can obtain care from any provider who participates in Original
Medicare but will have to pay the difference between the plan's allowed amount and the
provider's usual and customary charge.
b.In general, Mrs. Ramos will need a referral to see specialists.
c.Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case basis,
whether they will treat her.
d.Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but
generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of
the PPO network. - -correct ans- -d. Mrs. Ramos can obtain care from any provider who
, participates in Original Medicare, but generally will have a higher cost-sharing amount if she
sees a provider who/that is not a part of the PPO network.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was
disappointed with the service she received from her primary care physician because she was
told she would have to wait five weeks to get an appointment when she was feeling ill. She
called you to ask what she could do so she would not have to put up with such poor access to
care. What could you tell her?
a.She must write to the plan and wait for a response and then, if she is still dissatisfied, she could
file an appeal with her state Medicaid office requesting transfer to one of its managed care
plans.
b.She should not expect to get in to see her doctor any more quickly since she is a Medicare
patient.
c.She should call the doctor's office to complain since the plan cannot do anything about the
doctor's schedule.
d.She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment. - -correct ans- -d. She could file a grievance with her plan to complain about the
lack of timeliness in getting an appointment.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has
received under Original Medicare, but he would like to know more about Medicare Advantage
Special Needs Plans (SNPs). What could you tell him?
a.SNPs offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will
always be lower than in Original Medicare.
b.SNPs are essentially the same as Original Medicare and are not likely to have a noticeable
impact on how Mr. Sinclair receives his care.
c.Since SNPs don't cover prescription drugs Mr. Sinclair should consider a different option.
d.SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well. - -correct ans- -d. SNPs
have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide
prescription drug coverage that could be very helpful as well.
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