AHIP 2024 Final Exam - Latest Actual Exam Questions and Correct Detailed Answers, Verified, Exams of Nursing

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AHIP 202 4 Final Exam

NEWEST 2024 ACTUAL EXAM

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Mrs. Wu was primarily a homemaker and employed in jobs that provided taxable income only sporadically. Her husband worked full-time throughout his long career. She has heard that to qualify for Medicare Part A she has to have worked and paid Medicare taxes for a sufficient time. What should you tell her? - CORRECT ANSWER- Choose one answer. - CORRECT ANSWER-

• CORRECT ANSWER-a. She will have to obtain a job and work enough years to qualify for Medicare Part A.
• CORRECT ANSWER-b. She will have to pay the monthly Part A premium in order to obtain the coverage.
• CORRECT ANSWER-c. Because her husband paid Medicare taxes, and she rarely did, she will have to pay Part A premiums but will do so at a reduced rate.
• CORRECT ANSWER-d. Since her husband paid Medicare taxes during the entire time he was working, she will automatically qualify for Medicare Part A without having to pay any premiums.

• CORRECT ANSWER-b. TrOOP is calculated on a cumulative basis and consists of the sum of an enrollee's out-of-pocket deductibles from the date of his or her enrollment in Part D plus outlays for over-the-counter drugs.
• CORRECT ANSWER-c. TrOOP is calculated on an annual basis and consists of an enrollee's out-of-pocket deductible plus any amounts paid on behalf of an enrollee by Medicaid.
• CORRECT ANSWER-d. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include, in addition to the annual deductible, costs for drugs not on the Part D plan's formulary and drugs purchased outside the United States. Question19 - CORRECT ANSWER- Marks: 1 - CORRECT ANSWER- 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. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare

prescription drug plan. Will she be able to? - CORRECT ANSWER- Choose one answer. - CORRECT ANSWER-

• CORRECT ANSWER-a. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan.
• CORRECT ANSWER-b. No. Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program.
• CORRECT ANSWER-c. No. As long as her employer offers coverage that is equivalent to that available through Medicare, Mrs. Walters cannot enroll in a Medicare prescription drug plan.
• CORRECT ANSWER-d. Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. Question20 - CORRECT ANSWER-

• CORRECT ANSWER-d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a PFFS plan offering only medical benefits, or PFFS Medigap Supplemental Insurance plan. Question21 - CORRECT ANSWER- Marks: 1 - CORRECT ANSWER- Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not want to be limited in terms of where he obtains his care. What should you tell him about how a Medicare Cost Plan might fit his needs? - CORRECT ANSWER-a. Cost plan enrollees can choose to receive Medicare covered services under the plan's benefits by going to plan network providers and paying plan cost sharing, or may receive services from non-network providers and pay cost-sharing due under Original Medicare. b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using

only approved call scripts. - CORRECT ANSWER-Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing organization. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following best describes the responsibilities of Ms. Lopez? a. Ms. Lopez is considered a marketing representative of BestCare but is exempt from the marketing rules regarding approved call scripts because she works directly for MarketCo. b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with CMS marketing requirements, including those regarding using only approved call scripts. c. Ms. Lopez no longer needs to be concerned about state licensure since she is marketing an MA product subject to federal rules.

that she can learn about Medicare and the products you represent. How should you respond? - CORRECT ANSWER- c. Tell Julia that you will meet with her to explain Medicare and should she be interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying her for a special enrollment period. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program.may the doctor collect from Mr. Rivera? - CORRECT ANSWER-The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program. During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be available to her. What should you tell her about PFFS plans? - CORRECT ANSWER- Choose one answer. - CORRECT ANSWER-

• CORRECT ANSWER-a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available in her area.
• CORRECT ANSWER-b. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she may enroll in one if it is available in her area.
• CORRECT ANSWER-c. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage she wants, she may enroll in one if it is available in her area.
• CORRECT ANSWER-d. A PFFS plan is one of the various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is available in her area. Question8 - CORRECT ANSWER- Marks: 1 - CORRECT ANSWER- During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr. Peters asked

the Part D plan now because he did not agree in advance to discuss that plan

• CORRECT ANSWER-d. Since Mr. Peters requested a description of the Part D plan, his agent must discuss both the Part D and the MA-PD plans and return after at least 48 hours to complete the Part D plan enrollment form with Mr. Peters. Question9 - CORRECT ANSWER- Marks: 1 - CORRECT ANSWER- Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. What should you tell him? - CORRECT ANSWER- Choose one answer. - CORRECT ANSWER-

• CORRECT ANSWER-a. In general, he must select a single Part D premium payment mechanism that will be used throughout the year.
• CORRECT ANSWER-b. As long as he fills out the paperwork to begin withholding from his Social Security check at least 63 days before such withholding should begin, he can change his method of Part D premium payment and withholding will begin the month after his savings account is exhausted.
• CORRECT ANSWER-c. During 2017, many people experienced significant problems with deductions from their Social Security check for their Part D premium. As a result, this method of payment is no longer an option for Part D premium payments
• CORRECT ANSWER-d. In general, to pay his Part D premium, he only can have automatic withdrawals made from a checking account, so he will need to transfer the funds prior to beginning such withdrawals. Question10 - CORRECT ANSWER-

• CORRECT ANSWER-c. The letter is to inform her that her Medigap plan's coverage has been determined by the Federal government to be inadequate and the plan must therefore discontinue offering such coverage. Ms. Eisenberg will have to select a different Medigap plan if she wants drug coverage.
• CORRECT ANSWER-d. The letter is to inform her that Medicare Part D prescription drug coverage is available, but there is no need for her to change her drug coverage since it is just as good as Part D. She may keep her current coverage through the Medigap plan. Question11 - CORRECT ANSWER- Marks: 1 - CORRECT ANSWER- Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage

through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism? - CORRECT ANSWER- Choose one answer. - CORRECT ANSWER-

• CORRECT ANSWER-a. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan Health Plan.
• CORRECT ANSWER-b. Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election period (ICEP).
• CORRECT ANSWER-c. Alice and Bob because each of them has had coverage through Spartan Health Plan.

• CORRECT ANSWER-c. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any point during the year.
• CORRECT ANSWER-d. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for the Part D plan and the Medicare program, generally the plan may make such a change. Question13 - CORRECT ANSWER- Marks: 1 - CORRECT ANSWER- This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected. What should you do? - CORRECT ANSWER- Choose one answer. - CORRECT ANSWER-

• CORRECT ANSWER-a. You may only contact the retirees after the employer has notified them that they will be receiving a call.
• CORRECT ANSWER-b. You may call them but must record every call.
• CORRECT ANSWER-c. You may go ahead and call them.
• CORRECT ANSWER-d. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its retirees to call you. Question14 - CORRECT ANSWER- Marks: 1 - CORRECT ANSWER- You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some hesitation about allowing marketing in a health care facility. What should you tell them? - CORRECT ANSWER-