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NEW AHIP FINAL EXAM
TEST WITH COMPLETE
SOLUTIONS QUESTIONS
AND ANSWERS ALL
VERIFIED LATEST EXAM….
coverage
Medicare
Supplemental Insurance provides since his health care
needs are different from his wife's needs. What could
you tell Mr. Moy?correct answersMedicare
would help cover his Part A and Part B
deductibles or
coinsurance in Original Fee-for-
Service
(FFS) Medicare as well as
possibly some
services that Medicare does not
cover.
Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire
next year.
She heard she must enroll in Part B at the beginning of the year
to ensure no gap
in
coverage. What can you tell her?correct answersShe may enroll
at any time while
she
is
covered under her employer plan, but she will have a
special eight-month
enrollme
nt
standard general
enrollment period,
during which she may enroll in Medicare Part B.
time,
and
paid taxes during that entire period. She is concerned that she will not qualify
for
[Type here] [Type here] [Type here]
Mr. Moy's wife has a Medicare Advantage plan, but he wants to
understand what
Supplemental
Insurance
period after the last month on her employer plan that
differs from the
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has
been employed full
you tell
her?correct answersMost individuals who are citizens and age 65
or over are
Part A by virtue of having paid Medicare taxes while
working, though
some may be
covered
as a result of paying monthly premiums.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,
but it
her her?
correct
answersMrs. Gonzalez cannot purchase a Medigap plan that covers
drugs,
could keep her Medigap policy and enroll in a Part D prescription drug plan.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief
from
arthritis through massage therapy. She is concerned about whether or not
Medicare
will does
not
cover massage therapy, or, in general, glasses or dentures.
Mr. Patel is in good health and is preparing a budget in anticipation
of his retirement
whe
n
he turns 66. He wants to understand the health care costs he
might be exposed to
unde
r
Medicare if he were to require hospitalization as a result of an
illness. In genera
lterms,
what
could you tell him about his costs for inpatient hospital services
under Original Medicare?correct answersUnder Original Medicare, there is a
single
deductible amount due for the first 60 days of any inpatient hospital stay, after
which it
converts into a per-day coinsurance amount through day 90. After day
90, he would pay
a
daily amount up to 60 days over his lifetime, after which he would be
responsible for
all
coverage under part A because she was not born in the United
States. What should covered
under
provides no drug coverage. She would like to keep the coverage she
has but replace existing Medigap plan with one that provides drug coverage. What
should you tell but
she
cover these items and services. What should you tell her?correct
answersMedicare
annual flu shots.
her
Medicare Summary Notice (MSN) and disagrees with a determination that
partially
one of her claims for services. What advice would
you give her?
correct answersMrs.
Duarte
should file an appeal of this initial determination within 120 days of the date
she received
the MSN in the mail.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan
to pick up costs not covered by that plan.
What should you tell
him?
correct answersIt is illegal for you to sell Mr.
Capadona a
Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works
with
Original Medicare.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income.
What could you tell
Mrs
Park that might be of
assistance?
correct answersShe should contact her state
Medicaid
agency to see if she qualifies for one of several programs that can help with
Medicare costs
for which she is responsible.
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?correct
answersMedicare
will
cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entire
lifetime.
Mr. Schmidt would like to plan for retirement and has asked you what is
covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him?
correct answersP
art
A,
which covers hospital, skilled nursing facility, hospice, and home health
services and Part B,
which covers professional services such as those provided by a doctor are
covered under
Original Medicare.
Agent John Miller is meeting with Jerry Smith, a new prospect.
Jerry is currently
enrolled
in
Medicare Parts A and B. Jerry has also purchased a Medicare
Supplement
(Medigap)
plan
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed denie
d
drug benefits. How
would you advise Agent John Miller to
proceed?correct a
nswersTell prospect Jerry
Smith that
he should consider adding a standalone Part D prescription drug coverage
policy to his
present coverage.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by
the
Social Security Administration and has been receiving disability payments. He is
him?
correct
ans
wersAfter receiving such disability payments for 24
months, he will be
automatically enrolled in Medicare, regardless of age.
Mr. Buck has several family members who died from different
cancers. He wants to
Medicare covers cancer screening.
What should you tell him?correct answersMedicare covers the periodic
performance of
range of screening tests that are meant to provide early detection of disease.
Mr.
Buck will need to check specific tests before obtaining them to see if they will
be covered.
Which of the following statement
is/are
correct about a Medicare Savings
Account (MSA)
Plans?
I.
An individual who is
enrolled in an
MSA plan is
responsible for a minimal deductible of
$500 indexed for inflation.
Non-network providers must accept the same amount that Original Medicare would pay
them as payment in full.correct answersI, II, and IV only
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
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 tel
lhim about this
situation?
[Type here] [Type here] [Type here]
which he has had for several years. However, the plan does
not provide
wondering whether he can obtain coverage under Medicare. What
should you tell
know
if
a
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.
plan does not include drug coverage, but the other two plans do.
Mr. Lombardi
providers she can go to for her health care. What should you
tell her?corre
ct
answersMrs.
[Type here] [Type here] [Type here]
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.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-
sponsored
prescription a neighbor's MA-PD plan that you represent and because he
takes numerous
drugs, he is considering signing up for it. What should
you tell him?
correct answersHe
should
[Type here] [Type here] [Type here]
may Dr. Brennan charge?
correct
answersDr. 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. Gomez notes that a Private Fee-for-Service (PFFS) plan available
in his area has
an
current
HMO plan requires him to do. What should
you tell him?
correct answersHe may
receive
health care services from any doctor allowed to bill Medicare, as long as he
shows the
doctor the plan's identification card and the doctor agrees to accept the PFFS
plan's
payment terms and conditions, which could include balance billing.
[Type here] [Type here] [Type here]
attractive premium. He wants to know if he must use doctors in a
network as his
Medicare
Advantage. What would be the correct
description?correct
answersMedicare
Advantage is a
way of covering all the Original Medicare benefits through private health
insurance
companies.
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
expensive medications. Currently, she is enrolled in Original Medicare and a
standalone
How would you advise
Mrs. Chi?
correct answersMrs. Chi may enroll in a MA MSA
plan and
remain in her current standalone Part D prescription drug plan.
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
likely to be
most
appropriate for him?correct
answers.
C-SNP
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 w
ould not have to put up with
such poor
Mr. Wells is trying to understand the difference between Original
Medicare and
have prescription drug coverage since her doctor recently
prescribed several Part D
plan.
SNP
is
Mrs. Burton is a retiree with substantial income. She is enrolled in an
MA-PD plan and
another
MA plan in her service area, or enroll in a Special Needs
Plan (SNP) for
individuals
suffering
from ESRD if one is available in her area.
ability to
access
providers. What should you tell him?correct answersIn 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
clients, Lauren Nichols, has heard about a Medica
Mr. Barker enjoys a comfortable retirement income. He recently
had surgery and
expecte
d
minimal out-of-
However, when he
received
the bill, he was surprised to see large charges in
excess of
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?correct answersYou can offer to
review the
plans appeal process to help
him ask
the plan to review the coverage
decision.
enrollment season?correct answersShe may remain in her ABC MA
plan, enroll in
Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his
the
network).ur
that he would have certain services and items covered by
the plan with pocket costs because his MA-PD coverage has been
very good.
his maximum out-of-
pocket limit
has
received
under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him?correct
answersSNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they
prescription drug coverage that could be very helpful as well.
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
shoul
d
Medicare
Advantage program?correct answersThey are Medicare health
plans such as
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?correct answersHe will have to enroll
in Part B.
Mr. Zachow has a condition for which three drugs are available. He
has tried two but
had
an
allergic reaction to them. Only the third drug works for him and
it is not on his
Part D
plan's
formulary. What could you tell him to do?correct answersMr.
Zachow has
a right to
request
physician could
obtain the standardized request form on the plan's
website, fill it out, plan.
Mr. Bickford did not quite qualify for the extra help low-income
subsidy under the
Medicar
e
option he has for
obtaining help
with his considerable drug costs. What should you tell him?
correct answersHe could check with the manufacturers of his
medications to see if
assistance program to help people with limited means
to obtain the
medications they
need.
Alternatively, he could check to see whether his
state has a
pharmacy assistance
program
[Type here] [Type here] [Type here]
Mr. Sinclair has diabetes and heart trouble and is generally satisfied
with the care he
provid
e
you tell him about the types of health plans that are available
through the HMOs,
PPOs,
a formulary exception to obtain coverage for his Part D
drug. He or his and submit it to
his
Part D Prescription Drug program and he is wondering if
there is any other
they offer
an
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently
lost
interested in
enrolling in a Medicare Part D prescription drug plan (PDP). What
should
correct answersIf a Part D benefit is offered through her
plan she may
choose to
enroll in
that plan or a standalone PDP.
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
availabl
e
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 tel
lher?
correct
answersMedicare 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.
Mrs. Quinn has just turned 65, is in excellent health and has a relatively high
income. She
uses no medications and sees no reason to spend money
on a Medicare
prescription
drug
plan if she does not need the coverage. She currently
does not have
creditable
coverage.
[Type here] [Type here] [Type here]
creditable coverage previously available through her husband's
employer. She is you tell
her?
decision?correct answersIf she
does
not
sign up for a Medicare prescription
drug plan will be permanently
increased by 1%
of the national average premium for every month
Mr. Shultz was still working when he first qualified for
Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D
eligibility period,
decided not to enroll because he was satisfied with his drug
coverage. It is now a
year
later
weeks. How would
you advise him?correct answersMr. Schultz should
enroll in a Part D
day break in coverage in order to avoid a premium penalty.
Mrs. Mulcahy, age 65, is concerned that she may not qualify for
enrollment in a
Medicar
e
enrolled under
Medicare Part B. What should you tell her?correct
answersAn individual
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.
What types of tools can Medicare Part D prescription drug plans use that affect
the way
cover all
medications. As a
result, their formularies, or lists of covered drugs, will vary co-payments
and prior authorization.
What could you tell her about the implications
of such a as soon as she is eligible to
do so, and if she does sign up at a later date, her
premium
that she was not
covered.
he
and Mr. Shultz has lost his employer group coverage within
the last two plan before he has
a 63-
prescription drug plan because, although she is entitled to Part
A, she is not who is entitled
to
their enrollees can access medications?correct answersPart D plans
do not have to from plan
to plan. In addition, they can use cost containment techniques
such as tiered
