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

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    AHIP Final Exam Test Questions and Answers (2022/2023) Rated A+ Answers Correct/Verified Mr. , Moy’s , wife , has , a , Medicare , Advantage , plan, , but , he , wants , to , understand , what coverage , 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 , or coinsurance , in , Original , Fee - for - Service , (FFS) , Medicare , as , well , as , possibly , some services , that , Medicare , does , not , cover. Mrs. , Peňa , is , 66 , years , old, , has , coverage , under , an , employer , plan, , and , will , retire , next year. , 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 - month enrollment , 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 , full time, , 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 , are covered , under , Part , A , by , virtue , of , having , paid , Medicare , taxes , while , working, , though some , 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 , it provides , no , drug , coverage. , She , would , like , to , keep , the , coverage , she , has , but , replace her , 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 , from arthritis , through , massage , therapy. , She , is , concerned , about , whether , or , not , Medicare , will , cover , these , items , and , services. , What , should , you , tell , her?correct , answersMedicare does , 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 , retirement when , 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 , general terms, , what , could , you , tell , him , about , his , costs , for , inpatient , hospital , services under , Original , Medicare?correct , answersUnder , Original , Medicare, , there , is , a , single deductible , amount , due , for , the , first , 60 , days , of , any , inpatient , hospital , stay, , after , which , it converts , 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 , for all , 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 , his employer's , retiree , coverage, , but , he , wants , to , compare , it , to , a , Part , D , prescription , drug plan. , He , asks , you , what , costs , he , would , generally , expect , to , encounter , when , enrolling into , 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 , under Medicare. , What , should , you , tell , him?correct , answersHe , may , sign - up , for , Medicare , at any , time , however , coverage , usually , begins , on , the , fourth , month , after , dialysis , treatments start. 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 , offers employer - sponsored , healthcare , coverage. , Juan , is , a , naturalized , citizen , and , has contributed , to , the , Medicare , system , for , over , 20 , years. , Juan , asks , you , if , he , will , be entitled , to , Medicare , and , if , he , enrolls , how , that , will , impact , his , employer - sponsored healthcare , coverage. , How , would , you , respond?correct , answersJuan , is , likely , to , be eligible , 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 , offer him , 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 , health and , will , have , considerable , income , when , she , retires. , She , is , concerned , that , her , income will , 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 , and those , under , age , 65 , with , certain , disabilities, , end - stage , renal , disease, , and , Lou , Gehrig's disease , 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 , are provided , under , Original , Medicare. , What , should , you , tell , Mr. , Xi , that , best , describes , the health , coverage , provided , to , Medicare , beneficiaries?correct , answersBeneficiaries , under , Original , Medicare , have , no , cost - sharing , for , most , preventive , services , which , include immunizations , such , as , annual , flu , shots.

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    Mrs. , Duarte , is , enrolled , in , Original , Medicare , Parts , A , and , B. , She , has , recently , reviewed her , Medicare , Summary , Notice , (MSN) , and , disagrees , with , a , determination , that , partially denied , one , of , her , claims , for , services. , What , advice , would , you , give , her?correct answersMrs. , 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 , state Medicaid , 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 , of an , inpatient , psychiatric , hospital , stay , that , Medicare , will , cover?correct , answersMedicare will , cover , a , total , of , 190 , days , of , inpatient , psychiatric , care , during , Mr. , Rainey's , entire lifetime.

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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 , are covered , under , Original , Medicare. Agent , John , Miller , is , meeting , with , Jerry , Smith, , a , new , prospect. , Jerry , is , currently enrolled , 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 , answersTell prospect , Jerry , Smith , that , he , should , consider , adding , a , standalone , Part , D , prescription drug , coverage , policy , to , his , present , coverage. Mr. , Bauer , is , 49 , years , old, , but , eighteen , months , ago , he , was , declared , disabled , by , the Social , Security , Administration , and , has , been , receiving , disability , payments. , He , is , wondering , whether , he , can , obtain , coverage , under , Medicare. , What , should , you , tell him?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 , deductible of , $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 , only Mr. , 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. , The MA , 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 , drug coverage , through , a , stand - alone , Medicare , prescription , drug , plan. , What , should , you , tell him , about , this , situation?correct , answersHe , could , enroll , either , in , one , of , the , MA , plans that , include , prescription , drug , coverage , or , Original , Medicare

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    , with , a , Medigap , plan , and standalone , Part , D , prescription , drug , coverage, , but , he , cannot , enroll , in , the , MA - only , PPO plan , 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?correct answersMrs. , 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. Mr. , Romero , is , 64, , retiring , soon, , and , considering , enrollment , in , his , employer - sponsored retiree , group , health , plan , that , includes , drug , coverage , with , nominal , copays. , He , heard about , a , neighbor's , MA - PD , plan , that , you , represent , and , because , he , takes , numerous prescription , drugs, , he , is , considering , signing , up , for , it. , What , should , you , tell , him?correct answersHe , 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 , provide sufficient , 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. , How much , may , Dr. , Brennan , charge?correct , answersDr. , Brennan , can , charge , Mary , Rogers no , more , than , the , cost , sharing , specified , in , the , PFFS , plan's , terms , and , condition , of payment , 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 , has an , attractive , premium. , He , wants , to , know , if , he , must , use , doctors , in , a , network , as , his current , 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 , he shows , 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 , and Medicare , Advantage. , What , would , be , the , correct , description?correct , answersMedicare Advantage , 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. , She wishes , to , enroll , in , a , MA , MSA , plan , that , she , heard , about , from , her , neighbor. , She , also wants , to , have , prescription , drug , coverage , since , her , doctor , recently , prescribed , several expensive , 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 , him at , 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 , and was , disappointed , with , the , service , she , received , from , her , primary , care , physician because , she , was , told , she , would , have , to , wait , five , weeks , to , get , an , appointment , when she , was , feeling , ill. , She , called , you , to , ask , what , she , could , do , so , she , would , not , have , to put , up , with , such , poor , access , to , care. , What , could , you , tell , her?correct , answersShe could , 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 , amounts and , Mr. , Greco , would , like , to , join , that , plan. , What , should , you , tell , him?correct answersSNPs , limit , enrollment , to , certain , subpopulations , of , beneficiaries. , Given , his current , 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 , Medicare Advantage. , 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 , has recently , 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 , Medicare Advantage , 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 , next open , 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) , for individuals , suffering , from , ESRD , if , one , is , available , in , her , area. Mr. , Kumar , is , considering , a , Medicare , Advantage , HMO , and , has , questions , about , his ability , to , access , providers. , What , should , you , tell , him?correct , answersIn , most , Medicare , Advantage , HMOs, , Mr. , Kumar , must , generally , obtain , his , services , only , from , providers within , the , plan's , network , (except , in , an , emergency , or , where , care , is , unavailable , within the , 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 , and expected , that , he , would , have , certain , services , and , items

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