2022-2023 AHIP Final Exam With Answers (249 Solved Questions)

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AHIP FinalExam Test Questions and Answers(2022/2023) Rated A+ Answers Correct/VerifiedMr., Moy’s, wife,has,a,Medicare,Advantage,plan,,but,he,wants,to,understand,whatcoverage,Medicare,Supplemental,Insurance,provides,since,his,health,care,needs,are,different,from,his,wife's,needs.,What,could,you,tell,Mr.,Moy?correct,answersMedicare,Supplemental,Insurance,would,help,cover,his,Part,A,and,Part,B,deductibles,orcoinsurance,in,Original,Fee-for-Service,(FFS),Medicare,as,well,as,possibly,someservices,that,Medicare,does,not,cover.Mrs.,Peňa,is,66,years,old,,has,coverage,under,an,employer,plan,,and,will,retire,nextyear.,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-monthenrollment,period,after,the,last,month,on,her,employer,plan,that,differs,from,the,standard,general,enrollment,period,,during,which,she,may,enroll,in,Medicare,Part,B.Mrs.,Chen,will,be,65,soon,,has,been,a,citizen,for,twelve,years,,has,been,employed,fulltime,,and,paid,taxes,during,that,entire,period.,She,is,concerned,that,she,will,not,qualify,for,coverage,under,part,A,because,she,was,not,born,in,the,United,States.,What,should,you,tell,her?correct,answersMost,individuals,who,are,citizens,and,age,65,or,over,arecovered,under,Part,A,by,virtue,of,having,paid,Medicare,taxes,while,working,,thoughsome,may,be,covered,as,a,result,of,paying,monthly,premiums.

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Mrs.,Gonzalez,is,enrolled,in,Original,Medicare,and,has,a,Medigap,policy,as,well,,but,itprovides,no,drug,coverage.,She,would,like,to,keep,the,coverage,she,has,but,replaceher,existing,Medigap,plan,with,one,that,provides,drug,coverage.,What,should,you,tell,her?correct,answersMrs.,Gonzalez,cannot,purchase,a,Medigap,plan,that,covers,drugs,,but,she,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,fromarthritis,through,massage,therapy.,She,is,concerned,about,whether,or,not,Medicare,will,cover,these,items,and,services.,What,should,you,tell,her?correct,answersMedicaredoes,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,retirementwhen,he,turns,66.,He,wants,to,understand,the,health,care,costs,he,might,be,exposed,to,under,Medicare,if,he,were,to,require,hospitalization,as,a,result,of,an,illness.,In,generalterms,,what,could,you,tell,him,about,his,costs,for,inpatient,hospital,servicesunder,Original,Medicare?correct,answersUnder,Original,Medicare,,there,is,a,singledeductible,amount,due,for,the,first,60,days,of,any,inpatient,hospital,stay,,after,which,itconverts,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,forall,costs.Ms.,Henderson,believes,that,she,will,qualify,for,Medicare,Coverage,when,she,turns,65,,without,paying,any,premiums,,because,she,has,been,working

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,for,40,years,and,paying,Medicare,taxes.,What,should,you,tell,her?correct,answersTo,obtain,Part,B,coverage,she,must,pay,a,standard,monthly,premium,,though,it,is,higher,for,individuals,with,higher,incomes.Mr.,Alonso,receives,some,help,paying,for,his,two,generic,prescription,drugs,from,hisemployer's,retiree,coverage,,but,he,wants,to,compare,it,to,a,Part,D,prescription,drugplan.,He,asks,you,what,costs,he,would,generally,expect,to,encounter,when,enrollinginto,a,standard,MedicarePart,D,prescription,drug,plan.,What,should,you,tell,him?correct,answers,He,generally,would,pay,a,monthly,premium,,annual,deductible,,and,per-prescription,cost-sharing.Mr.,Davis,is,52,years,old,and,has,recently,been,diagnosed,with,end-stage,renal,disease,(ESRD),and,will,soon,begin,dialysis.,He,is,wondering,if,he,can,obtain,coverage,underMedicare.,What,should,you,tell,him?correct,answersHe,may,sign-up,for,Medicare,atany,time,however,coverage,usually,begins,on,the,fourth,month,after,dialysis,treatmentsstart.Juan,Perez,,who,is,turning,age,65,next,month,,intends,to,work,for,several,more,years,at,Smallcap,,Incorporated.,Smallcap,has,a,workforce,of15,employees,and,offersemployer-sponsored,healthcare,coverage.,Juan,is,a,naturalized,citizen,and,hascontributed,to,the,Medicare,system,for,over,20,years.,Juan,asks,you,if,he,will,beentitled,to,Medicare,and,if,he,enrolls,how,that,will,impact,his,employer-sponsoredhealthcare,coverage.,How,would,you,respond?correct,answersJuan,is,likely,to,beeligible,for,Medicare,once,he,turns,age,65,and,if,he,enrolls,Medicare,would,become,the,primary,payor

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,of,his,healthcare,claims,and,Smallcap,does,not,have,to,continue,to,offerhim,coverage,comparable,to,those,under,age,65,under,its,employer-sponsored,group,health,plan.Ms.,Moore,plans,to,retire,when,she,turns,65,in,a,few,months.,She,is,in,excellent,healthand,will,have,considerable,income,when,she,retires.,She,is,concerned,that,her,incomewill,make,it,impossible,for,her,to,qualify,for,Medicare.,What,could,you,tell,her,to,address,her,concern?correct,answersMedicare,is,a,program,for,people,age,65,or,older,andthose,under,age,65,with,certain,disabilities,,end-stage,renal,disease,,and,Lou,Gehrig'sdisease,so,she,will,be,eligible,for,Medicare.Mr.,Xi,will,soon,turn,age,65,and,has,come,to,you,for,advice,as,to,what,services,areprovided,under,Original,Medicare.,What,should,you,tell,Mr.,Xi,that,best,describes,thehealth,coverage,provided,to,Medicare,beneficiaries?correct,answersBeneficiaries,under,Original,Medicare,have,no,cost-sharing,for,most,preventive,services,which,includeimmunizations,such,as,annual,flu,shots.

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Mrs.,Duarte,is,enrolled,in,Original,Medicare,Parts,A,and,B.,She,has,recently,reviewedher,Medicare,Summary,Notice,(MSN),and,disagrees,with,a,determination,that,partiallydenied,one,of,her,claims,for,services.,What,advice,would,you,give,her?correctanswersMrs.,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,stateMedicaid,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,ofan,inpatient,psychiatric,hospital,stay,that,Medicare,will,cover?correct,answersMedicarewill,cover,a,total,of,190,days,of,inpatient,psychiatric,care,during,Mr.,Rainey's,entirelifetime.

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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

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,tell,him?correct,answersPart,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,arecovered,under,Original,Medicare.Agent,John,Miller,is,meeting,with,Jerry,Smith,,a,new,prospect.,Jerry,is,currentlyenrolled,in,Medicare,Parts,A,and,B.,Jerry,has,also,purchased,a,Medicare,Supplement(Medigap),plan,which,he,has,had,for,several,years.,However,,the,plan,does,not,provide,drug,benefits.,How,would,you,advise,Agent,John,Miller,to,proceed?correct,answersTellprospect,Jerry,Smith,that,he,should,consider,adding,a,standalone,Part,D,prescriptiondrug,coverage,policy,to,his,present,coverage.Mr.,Bauer,is,49,years,old,,but,eighteen,months,ago,he,was,declared,disabled,by,theSocial,Security,Administration,and,has,been,receiving,disability,payments.,He,is,wondering,whether,he,can,obtain,coverage,under,Medicare.,What,should,you,tellhim?correct,answersAfter,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,know,if,Medicare,covers,cancer,screening.

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What,should,you,tell,him?correct,answersMedicare,covers,the,periodic,performance,of,a,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.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.,III.,An,individual,who,is,enrolled,in,an,MSA,plan,is,responsible,for,a,minimal,deductibleof,$500,indexed,for,inflation.IV.,Non-network,providers,must,accept,the,same,amount,that,Original,Medicare,would,pay,them,as,payment,in,full.,correct,answers,I,,II,,and,IV,onlyMr.,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.,TheMA,PPO,plan,does,not,include,drug,coverage,,but,the,other,two,plans,do.,Mr.,Lombardi,likes,the,PPO,plan,that,does,not,include,drug,coverage,and,intends,to,obtain,his,drugcoverage,through,a,stand-alone,Medicare,prescription,drug,plan.,What,should,you,tellhim,about,this,situation?correct,answersHe,could,enroll,either,in,one,of,the,MA,plansthat,include,prescription,drug,coverage,or,Original,Medicare

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,with,a,Medigap,plan,andstandalone,Part,D,prescription,drug,coverage,,but,he,cannot,enroll,in,the,MA-only,PPOplan,and,a,stand-alone,prescription

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,drug,plan.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?correctanswersMrs.,Ramos,can,obtain,care,from,any,provider,who,participates,in,OriginalMedicare,,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-sponsoredretiree,group,health,plan,that,includes,drug,coverage,with,nominal,copays.,He,heardabout,a,neighbor's,MA-PD,plan,that,you,represent,and,because,he,takes,numerousprescription,drugs,,he,is,considering,signing,up,for,it.,What,should,you,tell,him?correctanswersHe,should,compare,the,benefits,in,his,employer-sponsored,retiree,group,health,plan,with,the,benefits,in,his,neighbor's,MA-PD,plan,to,determine,which,one,will,providesufficient,coverage,for,his,prescription,needs.Dr.,Elizabeth,Brennan,does,not,contract,with,the,ABC,PFFS,plan,but,accepts,the,plan's,terms,and,conditions,for,payment.,Mary,Rodgers,sees,Dr.,Brennan,for,treatment.,Howmuch,may,Dr.,Brennan,charge?correct,answersDr.,Brennan,can,charge,Mary,Rogersno,more,than,the,cost,sharing,specified,in,the,PFFS,plan's,terms,and,condition,ofpayment,which,may,include,balance,billing,up,to,15%,of,the,Medicare,rate.

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Mr.,Gomez,notes,that,a,Private,Fee-for-Service,(PFFS),plan,available,in,his,area,hasan,attractive,premium.,He,wants,to,know,if,he,must,use,doctors,in,a,network,as,hiscurrent,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,heshows,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.Mr.,Wells,is,trying,to,understand,the,difference,between,Original,Medicare,andMedicare,Advantage.,What,would,be,the,correct,description?correct,answersMedicareAdvantage,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.,Shewishes,to,enroll,in,a,MA,MSA,plan,that,she,heard,about,from,her,neighbor.,She,alsowants,to,have,prescription,drug,coverage,since,her,doctor,recently,prescribed,severalexpensive,medications.,Currently,,she,is,enrolled,in,Original,Medicare,and,a,standalone,Part,D,plan.,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,himat,severe,risk,for,pneumonia.,Otherwise,,he,has,no,problems,functioning.,Which,type,of,SNP,is,likely,to,be,most,appropriate,for,him?correct,answers.

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C-SNP

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Mrs.,Burton,is,a,retiree,with,substantial,income.,She,is,enrolled,in,an,MA-PD,plan,andwas,disappointed,with,the,service,she,received,from,her,primary,care,physicianbecause,she,was,told,she,would,have,to,wait,five,weeks,to,get,an,appointment,whenshe,was,feeling,ill.,She,called,you,to,ask,what,she,could,do,so,she,would,not,have,toput,up,with,such,poor,access,to,care.,What,could,you,tell,her?correct,answersShecould,file,a,grievance,with,her,plan,to,complain,about,the,lack,of,timeliness,in,getting,an,appointment.Mr.,Greco,is,in,excellent,health,,lives,in,his,own,home,,and,has,a,sizeable,income,from,his,investments.,He,has,a,friend,enrolled,in,a,Medicare,Advantage,Special,Needs,Plan,(SNP).,His,friend,has,mentioned,that,the,SNP,charges,very,low,cost-sharing,amountsand,Mr.,Greco,would,like,to,join,that,plan.,What,should,you,tell,him?correctanswersSNPs,limit,enrollment,to,certain,subpopulations,of,beneficiaries.,Given,hiscurrent,situation,,he,is,unlikely,to,qualify,and,would,not,be,able,to,enroll,in,the,SNP.Mrs.,Radford,asks,whether,there,are,any,special,eligibility,requirements,for,MedicareAdvantage.,What,should,you,tell,her?correct,answersMrs.,Radford,must,be,entitled,to,Part,A,and,enrolled,in,Part,B,to,enroll,in,Medicare,Advantage.Mrs.,Andrews,asked,how,a,Private,Fee-for-Service,(PFFS),plan,might,affect,her,access,to,services,since,she,receives,some,assistance,for,her,health,care,costs,from,the,State.

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What,should,you,tell,her?correct,answersMedicaid,may,provide,additional,benefits,,but,Medicaid,will,coordinate,benefits,only,with,Medicaid,participating,providers.Mr.,Castillo,,a,naturalized,citizen,,previously,enrolled,in,Medicare,Part,B,but,hasrecently,stopped,paying,his,Part,B,premium.,Mr.,Castillo,is,still,covered,by,Part,A.,He,would,like,to,enroll,in,a,Medicare,Advantage,(MA),plan,and,is,still,covered,by,Part,A.,What,should,you,tell,him?correct,answersHe,is,not,eligible,to,enroll,in,a,MedicareAdvantage,plan,until,he,re-enrolls,in,Medicare,Part,B.Mrs.,Davenport,enrolled,in,the,ABC,Medicare,Advantage,(MA),plan,several,years,ago.In,mid-February,of,2021,,her,doctor,confirms,a,diagnosis,of,end-stage,renal,disease,(ESRD).,What,options,will,Mrs.,Davenport,have,regarding,her,MA,plan,during,the,nextopen,enrollment,season?correct,answersShe,may,remain,in,her,ABC,MA,plan,,enroll,in,another,MA,plan,in,her,service,area,,or,enroll,in,a,Special,Needs,Plan,(SNP),forindividuals,suffering,from,ESRD,if,one,is,available,in,her,area.Mr.,Kumar,is,considering,a,Medicare,Advantage,HMO,and,has,questions,about,hisability,to,access,providers.,What,should,you,tell,him?correct,answersIn,most,Medicare,Advantage,HMOs,,Mr.,Kumar,must,generally,obtain,his,services,only,from,providerswithin,the,plan's,network,(except,in,an,emergency,or,where,care,is,unavailable,withinthe,network).ur,clients,,Lauren,Nichols,,has,heard,about,a,Medica

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Mr.,Barker,enjoys,a,comfortable,retirement,income.,He,recently,had,surgery,andexpected,that,he,would,have,certain,services,and,items

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