AHIP Final Exam Test Questions and Verified AnswerS Best Rated 2023/2024 Guaranteed A+, Exams of Nursing

Download AHIP Final Exam Test Questions and Verified AnswerS Best Rated 2023/2024 Guaranteed A+ and more Exams Nursing in PDF only on Docsity! AHIP Final Exam Test Questions and Verified AnswerS Best Rated 2023/2024 Guaranteed A+ Question1 Marks: 1 Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee- for-Service (PFFS) plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts consider before selecting a PFFS plan? Choose one answer. Question2 Marks: 1 Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce. How would you advise him as he budgets for Medicare premiums? Choose one answer. b. A stand-alone prescription drug plan in combination with a PFFS plan or a c. A PFFS plan offering only medical benefits or a PFFS Medigap Suppleme d. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combin benefits and Part D prescription drug coverage, a PFFS plan offering only m benefits, or PFFS Medigap Supplemental Insurance plan. Insurance plan. Medigap Supplemental Insurance plan. a. A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combin benefits and Part D prescription drug coverage, a PFFS plan offering only m benefits, or a PFFS plan in combination with a stand-alone prescription drug b. Due to his participation in the workforce he will not have to pay premiu c. Due to the provisions of MACRA, his Part B and D coverage will be co d. Due to his participation in the workforce he will not have to pay premiu A but he will pay higher premiums for Part B and Part D due to the amou income. covered through a low-cost Medigap policy to supplement his Part A cove A and will pay reduced premiums for Part B and Part D. a. Due to his participation in the workforce he will not have to pay premiu A and he will pay the lowest monthly premium rates for Part B and Part D Question3 Marks: 1 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 SNP is likely to be most appropriate for him? Choose one answer. Question4 Marks: 1 You are doing a sales presentation for Ms. Duarte and her son. Ms. Duarte has some cognitive impairment and her son informs you that he has power of attorney to make financial decisions for her. Can he execute the enrollment for her? Choose one answer. c. FIDE-SNP d. I-SNP b. C-SNP a. D-SNP b. Yes, he can execute the enrollment for her. He can do so because he is a c. Yes, he can execute the enrollment for her. A financial power of attorney i immediate family member. No power of attorney is necessary. a. No, he cannot execute the enrollment for her. Only Ms. Duarte can sign t regardless of her mental capacities. plans? Choose one answer. Question10 Marks: 1 Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell her? Choose one answer. Question11 Marks: 1 Agent Willis had several clients who disenrolled from the plans he represents during the AEP to try new Medicare Advantage plans. 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). What can agent Willis do? Choose one answer. b. States often volunteer to review marketing materials on behalf of the Med c. Obtaining approval of her materials from the State Department of Insuran d. Materials for marketing Medicare health plans to individuals are subject to uniform national requirements. They do not need to be reviewed by the state company she represents must obtain approval from the Medicare agency (C materials she uses. practice and she should continue it with materials for the Medicare health pl represents. agency. She should check with her Department of Insurance to see if such a available and would satisfy CMS requirements. a. Materials need only be reviewed and approved by the company(s) she re b. During the MA Open Enrollment Period, from January 1 – March 31, s c. During the MA Open Enrollment Period, from January 1 – March 31, s d. During the MA Open Enrollment Period, from January 1 – March 31, s drop a MA or MA-PD plan and go back to Original Medicare, but she ma in a stand-alone prescription drug plan if she also purchases a Medigap only add or drop Part D coverage, so she cannot switch back to Original only disenroll from a MA or MA-PD plan, but cannot enroll in a stand-alo plan. a. During the MA Open Enrollment Period, from January 1 – March 31, s disenroll from the MA-PD plan into Original Medicare and also may add alone prescription drug plan. a. He can send them information about the MA-OEP along with a flyer o he represents. Question12 Marks: 1 This year you decide to focus your efforts on marketing to employer and union groups. Which of the following statements best describes what you can and cannot do in order to stay in compliance? Choose one answer. Question13 Marks: 1 Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the use of specific drugs. She has heard about a technique called “step therapy” and is wondering if you can explain what that is. What should you tell her? Choose one answer. c. He can wait until October and send them information about the plans d. He can call them to let them know that if they do not like their new pl can change back during the MA-OEP. represents. b. He can e-mail them in January and ask them to let him know if they a happy with their new plans. b. You do not need to complete a scope of appointment, but CMS can ask you c. You are not required to submit communication and marketing materials spe d. You do not need to take an annual test, but you must not provide potential e more than light snacks at presentations. those employer plans to CMS at the time of use, but CMS may request and re if employee complaints occur. reconstruct one if there is a subsequent employee complaint. a. You can make unsolicited contacts but you cannot cross-sell other products b. Step therapy involves slow changes in the dosages of a given drug in or c. Step therapy involves using one or more lower priced drugs before tryin d. Step therapy involves taking somewhat larger doses but skipping every resulting in lower overall consumption of the drug. expensive drug when all are used to treat the same condition. discover the correct amount. a. Step therapy refers to incentives plans can provide to enrollees to enga walking in order to reduce their need for medications treating heart and ch problems. Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his coverage will no longer be creditable. He has come to you for advice. What advice would you give Mr. Rockwell about special enrollment periods (SEPs)? Choose one answer. Question17 Marks: 1 Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage? Choose one answer. Question18 Marks: 1 You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To be in compliance with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans? Choose one answer. b. Mr. Rockwell must wait until the next annual election period (AEP) to c. Mr. Rockwell is eligible for a SEP that begins in June and ends three d. Mr. Rockwell is eligible for a SEP that begins three months before the which he receives notice of loss of creditable coverage and ends three that month. later, during which he may enroll, disenroll, and reenroll in Part D plans, selection considered binding. Part D prescription drug coverage. a. Mr. Rockwell is eligible for a SEP due to his involuntary loss of credita coverage; the SEP begins in June and ends September 1 - two months loss of creditable coverage. b. She can enroll in the PPO and if she decides that she wants drug cov c. She can enroll in the PPO and purchase drug coverage through a sta d. She can enroll in the PPO, but she will not be able to purchase a stan Medicare Part D prescription drug plan. Medicare Part D prescription drug plan. will be able to drop her PPO at any time in favor of a Medicare Advantag includes such drug coverage. a. She can enroll in the PPO and purchase drug coverage through a Me b. Ms. Adams, a healthy early retiree who has just begun to collect Social Sec c. Ms. Davis who recently turned age 65 and is eligible for Part A and has just d. Ms. Bradley is currently living abroad for a multi-year job assignment. Part B. 62. a. Mr. Charles, an undocumented immigrant, entered the country illegally. Question19 Marks: 1 Who is most likely to be eligible to enroll in a Part D prescription drug plan? Choose one answer. Question20 Marks: 1 Mr. Kelly has substantial financial means. He enrolled in Original Medicare and purchased a Medigap policy many years ago that offered prescription drug coverage. The prescription drug coverage has not been comparable to that offered by Medicare Part D for several years and despite notification, Mr. Kelly took no action. Which of the following statements best describes what will occur if Mr. Kelly now decides to enroll in Medicare Part D? Choose one answer. b. Because the Medicare health plans are important federal programs for b c. You will have to avoid calling any potential client unless he or she initiate d. As long as you market only health-related products, you can make an ini any beneficiary, but then must honor "do not call again" requests. with you and specifically asks that you give him or her a call. federal law regarding the "Do Not Call" registry is waived so you will be abl enroll beneficiaries over the telephone. a. You only need to comply with the requirements of federal and state “Do registries. b. He will not be able to enroll in Part D unless he decides to also enroll in a c. He will incur a one-time financial penalty equal to 30 percent of the annual d. He will incur a late enrollment penalty. premium. Advantage plan. a. He will avoid any financial penalty or late enrollment fee under the grandfat provisions of Medicare Part D. Choose one answer. Question24 Marks: 1 Which of the following is a correct statement about state laws as they pertain to marketing representatives? Choose one answer. Question25 Marks: 1 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? Choose one answer. b. She is unlikely to qualify for a SEP but will be automatically covered by O c. She is unlikely to qualify for a SEP and should remain on her current pla d. She is likely to qualify for a SEP. She can choose an effective date of up months after the month in which the enrollment form is received by the new the effective date may not be earlier than the date of her permanent move. her current plan’s out-of-network benefits. Medicare and a standalone Part D prescription drug plan. a. She is likely to qualify for a SEP. She can choose an effective date of up months after the month in which the enrollment form is received by the new the effective date may not be earlier than 30 days prior to the date of her m b. Medicare health plans must comply with requests for information from state c. Plan sponsors can use any marketing representative, as long as they are lic d. Plans must contract only with marketing representatives who reside in the st they intend to work. least one state. departments investigating complaints about a marketing representative. a. State licensure laws are pre-empted and do not apply to marketing represen marketing MA and Part D plans b. Ms. Lopez no longer needs to be concerned about state licensure since sh marketing an MA product subject to federal rules. a. Ms. Lopez is considered a marketing representative of BestCare and thus to comply with CMS marketing requirements, including those regarding using approved call scripts. Question26 Marks: 1 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? Choose one answer. Question27 Marks: 1 Mrs. Fields wants to know whether applying for the Part D low income subsidy will be worth the time to fill out the paperwork. What could you tell her? Choose one answer. d. Ms. Lopez is considered a marketing representative of BestCare but is exe the marketing rules regarding approved call scripts because she works direct MarketCo. c. Ms. Lopez needs to maintain state licensure, but because she is working f party marketing organization she is exempt from CMS training requirements BestCare captive agents. b. Mrs. Ramos should be aware that generally plan providers can decid c. Mrs. Ramos can obtain care from any provider who participates in Ori d. In general, Mrs. Ramos can obtain care from any provider who partici Original Medicare, but will have to pay the difference between the plan’s amount and the provider’s usual and customary charge. Medicare, but generally will have a higher cost-sharing amount if she se provider who/that is not a part of the PPO network. case-by-case basis, whether they will treat her. a. In general, Mrs. Ramos will need a referral to see specialists. b. Those who qualify for the Part D low income subsidy pay nothing for any of c. The Part D low income subsidy will not help her once she reaches the cove d. The Part D low income subsidy could substantially lower her overall costs. apply by contacting her state Medicaid office or calling the Social Security Ad she need not take the time to apply. medications. She should definitely apply if she believes there is any chance of qualifying. a. The Part D low income subsidy is designed for Medicare beneficiaries who for Medicaid. If she does not qualify for Medicaid, she would likely not qualify f help and therefore should not take the time to apply. Question28 Marks: 1 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? Choose one answer. Question34 Marks: 1 Which of the following statements is correct about the appeal and grievance processes? I. Enrollees have a right to obtain a review (appeal) of certain decisions about prescription drug coverage. II. The grievance process is used for reviews of coverage decisions on plan benefits. III. Plans must provide a link to the Medicare.gov website where an enrollee can enter a complaint. IV.Enrollees have a right to file complaints (sometimes called grievances) about the quality of their care. Choose one answer. Question35 Marks: 1 Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a prescription for helping to regrow his hair. They are anxious to have their Medicare prescription drug plan cover these drug needs. What should you tell them? b. Tell Julia that you are happy to meet with her once this year’s open enroll c. Tell Julia that you will meet with her to explain Medicare and should she b d. Tell Julia that she must first complete a questionnaire providing her healt that you can recommend an appropriate product before submitting an enroll application, since she qualifies for a special enrollment period. you can accept and submit an enrollment request, since this is an initial enr qualifying her for a special enrollment period. on October 15th. a. Tell Julia that you will meet with her at a time of her convenience within th week, when you can accept a completed enrollment application to be subm October 15th. c. I and II only d. I and III only b. I, III, and IV only a. II and IV only Choose one answer. Question36 Marks: 1 Mr. Landry is approaching his 65th birthday. He has signed up for Medicare Part A, but he did not enroll in Part B because he has employer-sponsored coverage and intends to keep working for several more years. But he is considering enrolling in Part D prescription drug coverage because he believes it is superior to his employer plan. How would you advise him? Choose one answer. Question37 Marks: 1 Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently told her that there is an excellent Medicare Advantage (MA) plan with a five-star rating serving her area. On January 15 she comes to you for advice as to what options, if any, she has. What should you say regarding special enrollment periods (SEPs)? Choose one answer. b. Mr. Vaughn’s hair growth medication would only be covered under Part D if c. Medicare prescription drug plans are not permitted to cover the prescription d. The vitamins the Vaughns are taking will be covered under Part D because physician suggested they should take vitamins, but the hair loss medication c covered. the Vaughns are interested in under Part D coverage, however, plans may cov supplemental benefits and the Vaughn’s could look into that possibility. resulted from an illness or was a side effect of a treatment such as chemother a. Medicare prescription drug plans are permitted to cover vitamins, but not dr cosmetic purposes. b. Mr. Landry must enroll in Part B to enroll in Part D, and he still has c. Mr. Landry must wait until the next annual open enrollment period b d. Mr. Landry must enroll in Part B to enroll in Part D, but his initial en period for Part B lapsed when he enrolled in Part A. initial enrollment period for Part D lapsed when he enrolled in Part A. so. a. Mr. Landry is eligible for Part D since he has Part A, and his initial e period (IEP) for Part D will continue for three months after his 65th bir b. Mrs. Wellington is eligible for a two- month SEP that began on Janu c. Mrs. Wellington is eligible for a SEP that may be used once until Nov she should act quickly if she wishes to enroll in the MA five-star plan. a. Mrs. Wellington must first enroll in a standalone PDP before she is e SEP to enroll in the MA five-star plan. Agent Chan is conducting a sales presentation on senior issues where he hopes to enroll some attendees in the Medicare Advantage (MA) plans he represents. What action(s) may Agent Chan take during the event? Choose one answer. Question43 Marks: 1 Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice services in case she needs them. What should you tell her? Choose one answer. Question44 Marks: 1 Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare Advantage (MA) health plans. This year she has decided to focus on non-MA products. What advice would you give Melanie if she wishes to continue to receive renewal fees? Choose one answer. Question45 Marks: 1 c. Indicate that in order participate attendees must provide their contact i d. Discuss plan specific information such as premiums and benefits. b. Conduct free health screenings as part of the event. a. Sell personal information obtained as part of a raffle to a third-party m b. Medicare does not cover hospice services. Hospice services are only availa c. The Federal government facilitates competition between hospice programs d. Medicare covers hospice services and they will be available for her. price of their services for Medicare beneficiaries, but does not offer coverage f services through the Medicare program. state Medicaid programs, if the state offers such coverage. a. Hospice services are currently only offered under a limited demonstration p Whether they will eventually become available nationally depends on the outc demonstration. d. All that she needs to do is avoid being terminated for cause. c. Melanie must remain trained, tested, licensed, and appointed, regardless she is actively selling MA products. b. All that she needs to do is meet state licensure requirements moving forw a. Melanie will need to do nothing to continue receiving renewal fees since t sale was made when she met all requirements. 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? Choose one answer. Question46 Marks: 1 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 may the doctor collect from Mr. Rivera? Choose one answer. Question47 Marks: 1 Mrs. Chou likes a PFFS plan available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her? Choose one answer. b. A PFFS plan is a type of Medicare Supplement plan and she may enro c. A PFFS plan is exactly the same as Original Medicare, only offered by d. A PFFS plan is one of the various types of Medicare Advantage plans private entities and she may enroll in one if it is available in her area. entity and she may enroll in one if it is available in her area. is available in her area. a. PFFS plans are designed to cover only prescription drugs and if that is coverage she wants, she may enroll in one if it is available in her area. b. The doctor may only collect the amount allowable under Medicare p c. The doctor may only collect from Mr. Rivera the cost sharing allowa d. The doctor may only collect the amount allowable under Medicare A (MA) PPO plan cost sharing for non-QMB enrollees. the state’s Medicaid program. percent balance billing. a. The doctor may only collect the amount allowable under Medicare p percent balance billing. b. She could enroll in a PFFS plan and a stand-alone Medicare prescrip a. She could enroll in the PFFS plan and a Medigap plan that offers drug but not in a stand-alone Medicare prescription drug plan.