America’s Health Insurance Plans (AHIP) 5 Practice Test

These questions are part of the practice quiz. Start practicing

• The Part D Initial Enrollment Period (IEP) normally lasts seven months around the month you first become entitled to Part A or enrolled in Part B. Which description matches this rule?
• Actuarial value represents what portion of costs?
• Which topics must be discussed with a beneficiary before enrollment in a Medicare Advantage (MA-PD) plan?
• Nunez signing; only Mrs. Nunez can sign.
• Which option best describes an MA-PD plan?
• Which of the following scenarios would trigger a Special Enrollment Period (SEP) for MA and/or Part D due to a change of residence?
• What is the primary purpose of provider directories in MA/Part D plans?
• Who signed the scope of appointment in the described scenario?
• You are meeting with Ms. Berlin and she submitted an enrollment form with illegible handwriting, making the street name appear incorrect. What should you do?
• A client wants to submit an enrollment form on October 1 before the Annual Election Period begins because he is leaving on vacation. What should you tell him?
• What is actuarial value?
• In a Medicare Advantage Prescription Drug plan (MA-PD), how is prescription drug coverage typically provided?
• Bonus Question Placeholder
• Which enrollment method requires a signature element completed via certified mail?
• Which statement describes coinsurance?
• What is the deductible in health insurance?
• During the MA Open Enrollment Period, which option is available for someone who wants better prescription drug coverage?
• Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her ICEP has begun. Which of the following can she not do during the ICEP?
• What information does an Explanation of Benefits provide?
• What is the late enrollment penalty for Part D?
• What does network adequacy mean in MA/Part D plans?
• Enrollment in Cost plans offering Part D coverage is available only during Part D enrollment periods. Which statement is true about such Cost plan enrollments?
• Ms. Thomas can enroll in Part B without a late enrollment penalty at any time while still being covered by her employer group and for how long after the last month of employer coverage?
• If you want Part D coverage, enrollment should occur during which option?
• Signing rules when one spouse is unable to sign.
• If a client brings an enrollment form on Oct 10 for a plan that begins January 1, and you are in Original Medicare, what should you tell them?
• Which statement best describes MA-PD plans in this context?
• Mrs. Margolis August meeting; wait until October to discuss.
• Mr. Wendt has diabetes and a diabetes-focused SNP may be available in his area. Can he enroll in that SNP at any time under a SEP?
• Which scenario describes a valid SEP to switch from MA back to Original Medicare within the first year of MA enrollment?
• What does creditable coverage mean for Part D enrollment?
• Which of the following statements about Medicare Advantage plans is true?
• As described, Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period. If he wants to switch to an MA-PD plan, what enrollment rule applies?
• During the MA ICEP for a newly MA-eligible enrollee, what action is available?
• What is Medicare Advantage (Part C) and how does it relate to Original Medicare?
• Schmidt and Special election period.
• Which plan type gives the greatest flexibility in choosing doctors and hospitals and typically does not require a referral to see a specialist?
• Actuarial value expresses which concept?
• Which statement correctly describes the Medicare Advantage Open Enrollment Period (MA OEP)?
• A creditable drug coverage certificate is used to avoid Part D penalties by demonstrating that you had drug coverage that met Part D standards. Which statement best describes this certificate?
• Why is health insurance literacy important for AHIP exam takers?
• Which statement correctly describes internal grievances versus external appeals?
• To enroll in a MA-PD plan, what is required regarding Medicare Parts A and B?
• How do MA-PD plans typically structure extras beyond Original Medicare?
• Which enrollment options for a Medicare Advantage plan by telephone are considered valid according to the policy guidelines?
• To be eligible for a Medicare prescription drug plan (PDP), what condition must a beneficiary meet?
• What is a formulary in a prescription drug plan?
• In a formulary, what does a tier represent?
• Ms. Gonzales declined MA and learned there is an MA Open Enrollment Period; neighbor told her about it but she is not an MA enrollee. What should you tell her?
• MAPD stands for?
• During Medicare Part D's coverage gap, which statement describes how costs change for beneficiaries?
• What does HIPAA's Privacy Rule protect?
• What is the difference between a Stand-alone Part D plan and a MA-PD plan?
• Regarding hospice services within Medicare, which statement is correct?
• The Special Enrollment Period to move from employer group coverage to a Medicare Advantage plan begins while the employer coverage is in effect and ends how long after the end of coverage?
• Which Medicare Part primarily covers inpatient hospital services?
• Which of the following individuals is most likely eligible to enroll in a Medicare Advantage or Part D plan?
• The plan's list of covered drugs is called what?
• For a new beneficiary turning 65, what is required to enroll in a MA-PD plan with prescription drug coverage?
• Which statement defines actuarial value most accurately?
• During the MA Initial Coverage Election Period, what is the main purpose?
• Which statement is true about enrolling in Cost plans with Part D coverage outside Part D enrollment periods?
• During the Annual Election Period, which statement best describes enrollment changes?
• What dates define the annual election period during which a beneficiary can enroll in or switch MA and Part D plans?
• If a MA-PD plan member does not pay their monthly premium, what option can plan sponsors legally take after a grace period and notice?
• Which activity would be considered prohibited for a representative when meeting with a younger potential MA plan enrollee who qualifies for Medicare due to disability?
• Which statement correctly describes the eligibility for the opt-in simplified enrollment mechanism?
• A patient with advanced Alzheimer's is unable to understand the implications of Medicare choices. Under what condition can his daughter sign the enrollment form?
• Which statement best describes prior authorization?
• MA Initial Coverage Election Period (ICEP) purpose.
• Which statement best describes emergency services coverage in Marketplace plans?
• How is the out-of-pocket maximum defined?
• When is the annual Medicare open enrollment period for MA/Part D?
• In coverage terms, medical necessity indicates care that is deemed appropriate, while experimental/investigational care may not be covered.
• A beneficiary enrolled in an MA-PD wants to switch back to Original Medicare and enroll in a stand-alone PDP during the annual cycle. When can this be done?
• Which Medicare Part covers outpatient services, physician visits, and preventive care?
• Under what circumstances can a beneficiary enroll in an MA plan that does not include drug coverage and also enroll in a stand-alone PDP?
• Mrs. Kumar's daughter visit timing.
• Mr. Ziegler is turning 65 next month and asks about Part D enrollment. What can you tell him during the Part D Initial Enrollment Period (IEP)?
• What does the Minimum Medical Loss Ratio (MLR) require?
• A beneficiary enrolled in MA-PD plans moving to a new service area; what SPE applies?
• Which option correctly describes the validity period of a scope of appointment signed during the annual open enrollment period?
• After meeting the deductible, what cost-sharing concept determines your share?
• When a participant with a Medicare Advantage plan relocates to a new state, how long can a Private Fee-for-Service (PFFS) MA plan allow continued enrollment if the member is temporarily in a different area?
• What is the purpose of Medicare Part D?
• Mr. Garrett's ICEP action.
• What does the Annual Notice of Change (ANOC) inform members about?
• What is a creditable drug coverage certificate used for?
• How do the Initial Enrollment Period (IEP) and General Enrollment Period (GEP) differ?
• What does the term 'donut hole' refer to in Part D?
• What is the purpose of Premium Tax Credits (APTC) in ACA Marketplace plans?
• Phiona works in the IT Department of BestCare Health Plan and is tasked with facilitating electronic enrollment in Medicare Advantage plans. Which statements must Phiona consider?
• A beneficiary with a chronic condition (such as diabetes) may qualify for a SEP to enroll in a plan focused on that condition. Which plan type is this?
• Balance billing typically occurs when a patient receives services from which type of provider?
• Health insurance literacy helps AHIP exam takers do what?
• Which of the following is commonly included in MA-PD plan extras?
• The scope of appointment (SOA) signed at the start of the annual open enrollment period is valid for how long from the date of signature?
• Which plan is determined by factor of income for ACA premium tax credits eligibility?
• During the MA Open Enrollment Period, a member can switch to which plan type to address prescription drug coverage concerns?
• A dual-eligible individual can enroll in or switch MA/Part D during which timeframe of the calendar year?
• After Mrs. Johnson's enrollment is processed, what will she receive from the plan?
• Myra first became eligible for Medicare and enrolled in Original Medicare. Now 67 and turning 68 on July 1, she wants to enroll in a Medicare Advantage plan. What advice would you give her?
• Essential Health Benefits (EHB) apply to which plans?
• What term describes a fixed amount you pay for a covered service?
• Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. Which questions would you need to ask to determine his eligibility?
• Which status makes an individual most clearly eligible to enroll in Medicare Advantage and Part D plans?
• Which statement describes a deductible?
• Which statement is true about Private Fee-for-Service plans?
• Mrs. Ridgeway enrolled in Original Medicare and Medigap and later switched to a Medicare Advantage plan. What should you tell her about returning to Original Medicare and Medigap?
• After CMS indicates Mrs Garcia's enrollment acceptance, how long does Caring Health have to notify her in writing?
• Mr. White has Medicare Parts A and B with a Part D plan. He was identified as a 'potential at-risk' beneficiary and is now dual eligible. He wants to switch Part D plans during a SEP for dual eligible individuals. Is he able?
• Special Election Period triggers: moving outside service area.
• What is the difference between medical necessity and experimental coverage?
• Which enrollment period occurs annually from January 1 to March 31 if you missed your Initial Enrollment Period?
• What is risk adjustment in MA and Part D designed to do?
• Which statement about MA-PD plans is true in this scenario?
• Balance billing is most likely to occur in which situation?
• What does SOA stand for in this context?
• Which plan type typically requires you to use a primary care physician as a gatekeeper and may require referrals to see specialists?
• Ms. Claggett has Original Medicare due to disability and recently turned 66. She has never enrolled in MA or Part D before and believes she is eligible for a Part D Initial Enrollment Period. What should you tell her?
• Which statement about step therapy is true?
• Private Fee-for-Service (PFFS) plans are described as what in the material?
• Mr. Anderson, who submitted an enrollment form on October 10 for a plan that starts January 1, is currently in Original Medicare. What should you do?
• In Medicare, which enrollment period is designed for individuals turning 65 and becoming eligible?
• What is the primary purpose of tiers in a formulary?
• During the Annual Election Period, what changes may a beneficiary make?
• Which statement best defines actuarial value?
• A beneficiary who is already eligible for Part A and Part B and also eligible for Medicaid has a special election period (SEP). When does this SEP allow enrollment or disenrollment from MA plans?
• Mr. Chen's options when dropping retiree coverage.
• Which statement best describes Medicare coverage for annual wellness visits (AWV)?
• For a move between service areas, when does the Special Election Period begin and how long does it typically last?
• In this context, what does IEP stand for?
• During a Special Enrollment Period for Medicare Advantage coverage, a beneficiary generally has how many opportunities to change MA coverage?
• In coverage terms, which statement is accurate about medical necessity and experimental/investigational care?
• If a plan enrollee moves outside the service area, what is the immediate action for the plan, and what election period is provided to select a new plan?
• Which individuals would qualify for a Special Election Period (SEP) due to a major disaster or chronic condition scenarios described in typical MA guidance?
• If a beneficiary enrolls in a stand-alone PDP after already enrolling in an MA plan with drug coverage, what is the effect on the MA plan?
• What does emergency services coverage require in Marketplace plans?
• Which individual enrolled in a plan during a fixed enrollment period?
• Which statement describes the treatment of experimental or investigational care in coverage?
• Which statement about network adequacy is most accurate?
• What is the Annual Notice of Change (ANOC) in Medicare plans?
• Kendrick is six months away from turning 65 and wants to enroll in a Medicare Advantage plan as soon as possible. What should you tell her?
• On what date did Henrik Schultz sign the scope of appointment?
• Which statement about an Explanation of Benefits is true?
• The opt-in simplified enrollment mechanism applies to which two individuals?
• Which date marks when Ms. Morris will turn 65 according to the scenario?
• Which statement accurately reflects emergency services coverage in Marketplace plans?
• When switching from an old MA plan to a new MA-PD during the Annual Election Period, what happens to the member's enrollment in the old MA plan?
• Midler home visit; eligibility questions.
• During which months do Ms. Morris’s Part D initial election period and initial coverage period occur?
• Who are dual eligibles?
• In the ICEP scenario, what is the earliest potential start date for Medicare Advantage coverage after enrollment?
• What is the primary goal of HIPAA's Privacy Rule?
• Which marketing statement would be prohibited under Medicare guidelines?
• Mr. Rockwell's SEP eligibility: When does the SEP begin and end after involuntary loss of creditable drug coverage?
• Mrs. Schneider has Original Medicare Parts A and B and has just qualified for her state's Medicaid program, so the state is now paying her Part B premium and she is considered a dual eligible. Will gaining eligibility for this program affect her ability to enroll in a Medicare Advantage or Medicare Prescription Drug plan?
• What is the function of the Summary of Benefits and Coverage (SBC)?
• Which of the following describes step therapy in prescription drug plans?
• Which statement best describes whether a move within the same neighborhood triggers a Special Enrollment Period for MA and/or Part D?
• What is the purpose of AHIP marketing guidelines?
• Mr. Block is enrolled in an MA plan with drug coverage and finds a stand-alone PDP with better coverage and a lower premium. If he enrolls in the stand-alone PDP, what happens to his MA-PD?
• Mr. Yoo's employer dropped credible drug coverage and he qualifies for a Special Election Period. What does this mean?
• A Medicare beneficiary is in a rehabilitation facility outside the geographic area served by her Medicare Advantage plan. Which option best describes her MA enrollment rights while outside the service area?
• Johannsen Part A/B with Part D subsidy; SEP.
• If a Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan without drug coverage, what option might a beneficiary pursue?
• What does coordination of benefits involve?
• In the Medicare initial coverage election period (ICEP), if a beneficiary signs up for a Medicare Advantage plan on the 2nd of the month, when does the coverage typically begin?
• Which events can trigger a Special Election Period (SEP) to enroll in or switch Medicare plans?
• Which of the following is a direct reason to improve health insurance literacy for AHIP exam takers?
• What is a Special Enrollment Period (SEP) in Medicare?
• What is the late enrollment penalty for Part B?
• What does guaranteed issue mean in health insurance markets?
• Mr. Roberts is enrolled in an MA plan and recently had hip replacement surgery, spending three months in a skilled nursing facility. As he is about to be discharged, what is his open enrollment period as an institutionalized individual?
• Ms. Morris can enroll in an MA-PD plan now because her Part D initial election period and the initial coverage period occur together during which dates?
• Who is the agent mentioned in the scenario?