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AHIP 2020 FINAL EXAM WITH VERFIED
ANSWERS UPDATED AND NEWLY
RELEASED
...
Davies is turning 65 next month
...
What should you tell him about how a Medicare Cost Plan might
fit his needs? - CorreCt Answers -a
...

Choose one answer
...
A Cost Plan only if it does not offer drug coverage
...
A MA PPO plan only if it does not offer drug

coverage
...
A MA PPO plan that offers drug coverage if she

chooses not to enroll in it
...
A Cost Plan that does not offer drug coverage or a

Cost Plan that does offer drug coverage if she chooses not to enroll in it
...
Wu was primarily a homemaker and employed in jobs that provided
taxable income only sporadically
...
She has heard that to qualify for Medicare Part
A she has to have worked and paid Medicare taxes for a sufficient time
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question45 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mrs
...
What could you tell her? CorreCt Answers -

Choose one answer
...
All Medicare Health Plans offer cost-sharing that is

lower than Original Medicare for all Part A and Part B covered services, but
the maximum out-of-pocket limit is higher than in Original Medicare
...
Medicare Health Plans may offer extra benefits that

Original Medicare does not offer such as vision, hearing, and dental
services and must include a maximum out-of-pocket limit on Part A and
Part B services
...
Medicare Health Plans do not necessarily have to

cover all of the Original Medicare Part A and Part B services, but must
include a maximum out-of-pocket limit
...
Medicare Health Plans are not permitted to offer any

benefits beyond those available under the Original Medicare program and
must have the same maximum out-of-pocket limit on Part A and Part B
services as FFS Medicare
...
Murphy is an agent
...
What should Mr
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question47 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mrs
...
What should you tell her? - CorreCt Answers -

Choose one answer
...
Medicaid beneficiaries are not eligible for enrollment

into a PFFS plan
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...
Andrews joins a PFFS plan, the State will not

cover any of her medical expenses because she will be using only Medicare
providers
...
She makes a permanent move across the
country and wonders what her options are for continuing MA-PD coverage
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...
She can choose an

effective date of up to three months after the month in which the
enrollment form is received by the new plan, but the effective date may not
be earlier than the date of her permanent move
...
She is likely to qualify for a SEP
...


- CorreCt Answers -d
...


Question49 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mr
...
He would like to enroll in a Medicare Part D
prescription drug plan but is concerned that he will have to sign up for Part
B as well in order to qualify for enrollment in a Part D plan
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...
He must only be
aged 65 to qualify for enrollment in Part D, so he can go ahead and enroll in
a Part D prescription drug plan
...
He will have to enroll in Part B before he can enroll

in a Part D prescription drug plan
...
He does not have to enroll in Part B but, must pay a

penalty for his failure to do so when he first turned 65
...


Question50 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mrs
...
She wants to know what
she will have to do to enroll in a Medicare Advantage (MA) plan as soon as
possible
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...
Therefore, before
enrolling in an MA plan, she must first use a Medigap plan to supplement
her Original Medicare coverage
...
Ms
...
- CorreCt Answers -Ms
...
MarketCo has a contract with BestCare health
plan, a Medicare Advantage (MA) organization, to offer marketing services
through its contracted agents and agencies
...
Lopez returns calls to
individuals who contact MarketCo in response to its mailers promoting

BestCare health plan
...
Lopez?

a
...
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
...
Ms
...


c
...
Lopez no longer needs to be concerned about state licensure since
she is marketing an MA product subject to federal rules
...
Ms
...


Mr
...
He has
hired a magician at a cost of $200 to entertain attendees
...
He can do this because the estimated number of attendees is
based on the venue size and response rate and the value of the gift does not
exceed $15
...
Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care
...
Mrs
...


Julia Harris is turning 66 in July, at which time she will retire
...
How should you respond? CorreCt Answers -c
...


Mr
...
He decides to enroll in a Medicare
Advantage (MA) PPO plan
...
How much The doctor may only collect
from Mr
...
may the doctor collect from Mr
...
Rivera the cost sharing allowable under
the state's Medicaid program
...
Sullivan's home, she tells you that she
has heard about a type of Medicare health plan known as Private Fee-forService (PFFS)
...
What
should you tell her about PFFS plans? - CorreCt Answers -

Choose one answer
...
A PFFS plan is a type of Medicare Supplement plan

and she may enroll in one if it is available in her area
...
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
...
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
...
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
...
Peters asked his agent to describe a
stand-alone prescription drug plan (Part D plan) that his neighbor told him
about
...
- CorreCt Answers -

- CorreCt Answers -a
...
Peters requested a description of the Part

D plan, his agent must leave the Part D plan brochure, but not an
enrollment form, and would have to schedule another appointment after at
least 48 hours have passed to discuss the Part D plan with Mr
...


- CorreCt Answers -b
...
Peters requested a description of the Part

D plan, his agent must have Mr
...
Peters can compare plans and make an informed enrollment choice
during the appointment
...
Since Mr
...
Peters that he can only sign up for the
MA-PD plan and cannot receive a brochure or any other information about
the Part D plan now because he did not agree in advance to discuss that
plan

- CorreCt Answers -d
...
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
...


Question9 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mr
...
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
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...
As a result, this method of payment is no longer an option for
Part D premium payments

- CorreCt Answers -d
...


Question10 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Since 2004 Ms
...
She has recently received a letter from her Medigap carrier
informing her that her drug coverage is not "creditable
...
What should you tell her? - CorreCt Answers -

Choose one answer
...
The letter is to inform her that her Medigap drug

coverage must be supplemented by purchasing coverage under a Part D
plan
...


- CorreCt Answers -b
...
If she does not have such creditable coverage during periods
when she is first eligible for the Part D program, she will face a premium
penalty if she enrolls in a Part D plan at a later date
...
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
...

Eisenberg will have to select a different Medigap plan if she wants drug
coverage
...
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
...


Question11 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Richard is a licensed agent who represents Spartan Health Plan and its
Medicare Advantage (MA) plans
...
Alice will soon turn 65 and retire
...
Bob had health
coverage through Spartan but dropped the coverage when he retired early
to travel overseas
...
Charlotte, who will turn 65 next month, has coverage
through Athena Health plan - a company Richard also represents
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question12 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Under what conditions can a Medicare prescription drug plan reduce its
coverage for a given drug during the first 60 days of the year? - CorreCt
Answers -

Choose one answer
...
When a formulary change is in response to a drug's

removal from the market
...
When the Part D plan can demonstrate to CMS that

no enrollee has accessed the medication in the past six months, generally
the plan can remove the drug from its formulary within the first 60 days of
the year
...
Under no conditions can a Medicare Part D

prescription drug plan reduce its coverage for a given drug at any point
during the year
...
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
...
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
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...
The employer will have to tell its retirees to call you
...
The hospital administration
expresses some hesitation about allowing marketing in a health care
facility
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question15 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mrs
...
She has recently developed
diabetes and has suffered from heart disease for several years
...
Mrs
...
How would you respond? - CorreCt Answers -

Choose one answer
...
The SNP would select her primary care provider

(PCP) but she could file a grievance within 90 days if the PCP proved
incapable
...
Mrs
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question16 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mr
...
He would like to
enroll in a standalone Part D prescription drug plan that is available in his

area
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question17 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

If a beneficiary is enrolled in a stand-alone prescription drug plan and
wants to keep that plan, what type of Medicare health plan could the
individual also enroll in, without being automatically disenrolled from the
stand-alone prescription drug plan? - CorreCt Answers -

Choose one answer
...
The beneficiary could only choose a Medicare

Medical Savings Account (MSA) plan
...
The beneficiary could only stay in a stand-alone

prescription drug plan if he or she has original fee-for-service Medicare

- CorreCt Answers -c
...
The beneficiary could only choose an 1876 Cost Plan
...
Sanchez lives in a state located near Canada
...
One of her friends has told her that she needs to be aware of
something called TrOOP
...
- CorreCt Answers -

- CorreCt Answers -a
...
In some instances,
amounts not directly paid by the enrollee (like manufacturer discounts)
count toward TrOOP
...
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
...
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
...
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
...
Walters is entitled to Part A and has medical coverage without drug
coverage through an employer retiree plan
...

Since the employer plan does not cover prescription drugs, she wants to
enroll in a Medicare prescription drug plan
...
- CorreCt Answers -

- CorreCt Answers -a
...
Walters must drop the employer

coverage prior to enrolling in a Medicare prescription drug plan
...
No
...
Walters will have to enroll in Part B in

order to qualify for enrollment into the Medicare prescription drug
program
...
No
...
Walters cannot enroll
in a Medicare prescription drug plan
...
Yes
...
Walters must be entitled to Part A or

enrolled in Part B to be eligible for coverage under the Medicare
prescription drug program
...
Roberts has Original Medicare and would like to enroll in a Private
Fee-for-Service (PFFS) plan
...
Which options could Mrs
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question21 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mr
...
He has limited financial resources but
failed to qualify for the Part D low-income subsidy
...
- CorreCt Answers -

- CorreCt Answers -a
...
Wu has no alternative but to liquidate his

remaining assets and apply for coverage through his state's Medicaid
program
...
Mr
...


- CorreCt Answers -c
...
Wu may still qualify for help in paying for Part D

costs through the Federal Pharmaceutical Assistance Program
...
Mr
...


Question22 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Ms
...
She wants to be sure
she also has coverage for prescription drugs
...
- CorreCt Answers -

- CorreCt Answers -a
...
All SNPs are required to provide Part D

coverage for prescription drugs
...
Yes, but only if she qualifies for Part D prescription

drug coverage under her state Medicaid program
...
Maybe
...


- CorreCt Answers -d
...
Medicare beneficiaries who enroll in an SNP

must always obtain their drug coverage through a stand-alone Part D
Medicare prescription drug plan that they sign up for independent of their
enrollment in the SNP
...
Edwards is enrolled in a Medicare Advantage plan that includes
prescription drug plan (PDP) coverage
...
How would you advise her? CorreCt Answers -

Choose one answer
...
She may fill one prescription out-of-network per year

and it will be fully covered
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question24 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Last year Agent Melanie Meyers marketed and enrolled several clients in
Medicare Advantage (MA) health plans
...
What advice would you give Melanie if she wishes to
continue to receive renewal fees? - CorreCt Answers -

Choose one answer
...
All that she needs to do is avoid being terminated for

cause
...
All that she needs to do is meet state licensure

requirements moving forward
...
Melanie will need to do nothing to continue receiving

renewal fees since the initial sale was made when she met all requirements
...
Melanie must remain trained, tested, licensed, and

appointed, regardless of whether she is actively selling MA products
...
What action(s) may Agent Chan take during the event? CorreCt Answers -

Choose one answer
...
Sell personal information obtained as part of a raffle

to a third-party marketeer
...
Discuss plan specific information such as premiums

and benefits
...
Indicate that in order participate attendees must

provide their contact information
...
Conduct free health screenings as part of the event
...
Decaro has looked at Medicare prescription drug plans available in his
area and noted a wide range in premiums
...
What should you tell
him? - CorreCt Answers -

Choose one answer
...
Medicare permits plans that have the highest quality

services to reduce their premiums below the standard amount in order to
increase their market share
...


- CorreCt Answers -b
...
He could look at plan designs to see if one of
the enhanced plans would serve his needs better than a plan based on the
standard design
...
The premiums differ because some plans intend to

market to sicker beneficiaries and have set their premiums to reflect
expected greater costs
...
All drug plans must offer exactly the same coverage

model
...


Question27 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mrs
...
She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with
a determination that partially denied one of her claims for services
...
- CorreCt Answers -

- CorreCt Answers -a
...
Duarte should file an appeal of this initial

determination within 120 days of the date she received the MSN in the
mail
...
Mrs
...

If she still disagrees with Medicare Administrative Contractor's (MAC's)
further decision she should request a reconsideration by a qualified
independent party within 10 days
...
Mrs
...


- CorreCt Answers -d
...
Duarte should request a reconsideration of the

decision by a qualified independent party within 60 days of the date she
received the MSN in the mail
...
Hernandez has marketed several different types of insurance products
in her home state and has typically sought approval of her materials from
her State Department of Insurance
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...
They
do not need to be reviewed by the state, but the company she represents
must obtain approval from the Medicare agency (CMS) for any materials
she uses
...
Materials need only be reviewed and approved by the

company(s) she represents
...
States often volunteer to review marketing materials

on behalf of the Medicare agency
...


Question29 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mr
...
He has heard
there may be extra help paying for Part D prescription drugs for Medicare
beneficiaries with limited income
...
What should you tell him? - CorreCt Answers -

Choose one answer
...
He must apply for the extra help at the same time he

applies for enrollment in a Part D plan
...


- CorreCt Answers -b
...
He should apply for coverage
under his state's Medicaid program to access the extra help with his drug
costs
...
The government pays a per-beneficiary dollar

amount to the Medicare Part D prescription drug plans, to offset premiums
for their low-income enrollees in accordance with the plan's set criteria
...

Shapiro should check with his plan to see if he qualifies
...
The extra help is available to beneficiaries whose

income and assets do not exceed annual limits specified by the government
...
Fitzgerald is selling his home to permanently move into a retirement
facility near his daughter in a neighboring state
...
He doesn't know what he should do
...
- CorreCt Answers -

- CorreCt Answers -a
...
He will have a special election
period to select a new plan
...
Since he is moving before the Annual Election

Period, he will need to continue using the prescription drug plan but should
get his prescriptions filled through the plan's mail order service
...
He can keep his plan indefinitely because

prescription drug plans must be available to all beneficiary's regardless of
where they live
...
Since he is moving before the Annual Election

Period, he should request an exception to continue using the plan for
several more months until the AEP when he can enroll in a new plan
...
Agent
Willis believes that the choices they made are not ideal for them and would
like to get their business back during the Medicare Advantage Open
Enrollment Period (MA-OEP)
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question32 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mr
...
He wants to know what makes them
different from an HMO or a PPO
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...
S
...


- CorreCt Answers -c
...
S
...
If a PFFS enrollee shows his/her card when

obtaining services from a provider who participates in Original Medicare,
then that provider is required to accept the plan's terms and conditions
...
Which of the following statements best describes what you
can and cannot do in order to stay in compliance? - CorreCt Answers -

Choose one answer
...
You do not need to complete a scope of appointment,

but CMS can ask you to reconstruct one if there is a subsequent employee
complaint
...
You can make unsolicited contacts but you cannot

cross-sell other products
...
You do not need to take an annual test, but you must

not provide potential enrollees with more than light snacks at
presentations
...
You are not required to submit communication and

marketing materials specific only to those employer plans to CMS at the
time of use, but CMS may request and review copies if employee complaints
occur
...
Client
Mildred Jones has expressed interest in a Medicare Advantage plan
...
If you were in Agent Walker's position,
what would you do? - CorreCt Answers -

Choose one answer
...
Tell the client that she cannot speak to her until after

open enrollment begins on January 1st of the following year
...
Inquire whether the client qualifies for a special

enrollment period, and if not, solicit an enrollment application once the
annual open enrollment election period begins on October 15th
...
Solicit and complete the enrollment application in

September and wait until the open enrollment date to submit it so that the
client does not purchase a plan through another agent
...
Tell the client that she should also consider non-

health products (such as cash value life insurance) to meet some of her
health needs and offer to submit a life insurance application to see if client
Jones is insurable
...
Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...
Singh can enroll in a stand-alone prescription

drug plan and continue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare
...
Mr
...


- CorreCt Answers -d
...
Singh will have to enroll in Medicaid if he wishes

to obtain prescription drug coverage through some means other than a
Medicare Advantage plan
...
Duarte and her son
...
Duarte
has some cognitive impairment and her son informs you that he has power
of attorney to make financial decisions for her
...
- CorreCt Answers -

- CorreCt Answers -a
...
He

must have a legal authorization, under state law that explicitly allows him
to make health care decisions for his mother
...
Yes, he can execute the enrollment for her
...


- CorreCt Answers -c
...
He can do

so because he is an immediate family member
...


- CorreCt Answers -d
...
Only

Ms
...


Question37 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mrs
...
This allows Mrs
...
- CorreCt Answers -

- CorreCt Answers -a
...
Tanner can go to non-plan doctors without

receiving prior approval for all services
...
Mrs
...


- CorreCt Answers -c
...
Tanner can go to non-network doctors without

worrying about a cap on the amount of out-of-network services she may
receive
...
Mrs
...


Question38 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Mr
...
What should you tell Mr
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...
Rainey's entire lifetime
...
Medicare will cover, at its allowable amount, as

many stays as are needed throughout Mr
...


Question39 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Ms
...
What
should you tell her about obtaining drug coverage? - CorreCt Answers -

Choose one answer
...
She can enroll in the PPO, but she will not be able to

purchase a stand-alone Medicare Part D prescription drug plan
...
She can enroll in the PPO and purchase drug

coverage through a Medigap plan
...
She can enroll in the PPO and purchase drug

coverage through a stand-alone Medicare Part D prescription drug plan
...
She can enroll in the PPO and if she decides that she

wants drug coverage, she will be able to drop her PPO at any time in favor
of a Medicare Advantage plan that includes such drug coverage
...
Olsen is concerned that a Medicare Advantage plan will not cover the
same range of services that would be covered under Original fee-for-service
Medicare
...
- CorreCt Answers -

- CorreCt Answers -a
...


- CorreCt Answers -b
...


- CorreCt Answers -c
...


- CorreCt Answers -d
...


Question41 - CorreCt Answers -

Marks: 1 - CorreCt Answers -

Ms
...
What should you tell
her? - CorreCt Answers -

Choose one answer
...
The Federal government facilitates competition

between hospice programs to lower the price of their services for Medicare
beneficiaries, but does not offer coverage for hospice services through the
Medicare program
...
Medicare does not cover hospice services
...


- CorreCt Answers -c
...
Whether they will eventually become
available nationally depends on the outcomes of the demonstration
...
Medicare covers hospice services and they will be

available for her
...
Enrollees have a right to obtain a review (appeal) of certain decisions
about prescription drug coverage
...
The grievance process is used for reviews of coverage decisions on plan
benefits
...
Plans must provide a link to the Medicare
...
- CorreCt Answers -

IV
...
- CorreCt Answers -

Choose one answer
...
II and IV only

- CorreCt Answers -b
...
I and III only

- CorreCt Answers -d
...
She would like to enroll
in a standalone Part D prescription drug plan that is available in her area

---