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AHIP Final Exam Final Actual Exam Questions and Correct Answers 2024
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AHIP Final Exam Final Actual Exam Questions and Correct Answers 2024 Mr. D is 52 years old & has recently been diagnosed with ESRD & will soon begin dialysis. He is wondering if he can get coverage under Medicare. What should you tell him? - ANSWER-He may sign up for Medicare at anytime, however coverage usually begins on the 4th month after dialysis tx begins.
Mr. H believes that she will qualify for Medicare when she turns 65 without paying any premiums bc she has worked 40 years & paid Medicare taxes. What should you tell her? - ANSWER-To get Pt B coverage, she must pay a standard monthly premium, though it is higher for people with higher incomes. Mr. C would like to purchase a MA plan & a Medigap plan. what should you tell him? - ANSWER-It is illegal for you to sell Mr. C a Medigap plan if he is enrolled in an MA plan. Plus Medigap only works with OG Medicare Mr. R has been experiencing delusions & his physician feels that he should be hospitalized. What should you tell Mr. R/ his rep about the length of an inpatient hospital stay that Medicare will cover? - ANSWER-Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. R's entire lifetime
be automatically enrolled in Medicare, regardless of age Mr. X will soon turn 65 & is asking what services are provided under OG Medicare. What should you tell him? - ANSWER- Beneficiaries under OG Medicare have no cost- sharing for most preventative services which include immunizations like annual flu shots Mr. J is turning 65 next month & his employer (consisting of 15 employees) offers healthcare. He asks if he will be entitled to Medicare & if he enrolls how will that impact his employer healthcare coverage. What would you tell him?
Mr. S is enrolled in Medicare Pt A & B & also has Medigap, however the plan does not provide drug benefits. What would you tell him?
Mr. K is considering MA HMO & has questions about his ability to access providers. What should you tell him? - ANSWER-In most MA HMO plans, Mr. K must obtain his services only from providers within the network plan (except in an emergency where care is unavailable within the network) Dan is middle-income Medicare beneficiary. He has chronic bronchitis. Which type of SNP is likely to be most appropriate for him? - ANSWER-C-SNP This is a statement about Medicare Savings Account Plans (MSA) - ANSWER-MSA's either have a partial network, full network, or not networks of providers, MSA plans cover Part A & B benefits but not PDPs, & non-network providers must accept the same amount that OG Medicare would pay them as payment in full
Mr. G is in excellent health, lives alone, & has a sizeable income. He has a friend enrolled in a MA SNP & would like to join the plan. What should you tell him? - ANSWER-SNPs limit enrollment to certain subpopulations of beneficiaries & with his current situation, he is unlikely to qualify for an SNP. Mrs. R asks whether there are any requirements for MA, what should you tell her?
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? - ANSWER-b. 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. Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and requested a meeting so that she can learn about Medicare and the products you represent. How should you respond? - 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? - 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? - ANSWER- Choose one answer. - ANSWER-
Marks: 1 - ANSWER- During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor told him about. What should his agent do? - ANSWER- Choose one answer. - ANSWER-
have Mr. Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan so Mr. Peters can compare plans and make an informed enrollment choice during the appointment.
method of Part D premium payment and withholding will begin the month after his savings account is exhausted.
Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has recently received a letter from her Medigap carrier informing her that her drug coverage is not "creditable." She wants to know what this means. What should you tell her? - ANSWER- Choose one answer. - ANSWER-
Marks: 1 - 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? - ANSWER-
Choose one answer. - ANSWER-
