AHIP Medicare case studies
AHIP Medicare · Put your knowledge to work in context.
The AHIP Medicare certification is the industry-recognized credential that agents and brokers complete before selling Medicare Advantage and Part D plans. AHIP describes it as its "Medicare + Fraud, Waste, and Abuse Training," and the homepage notes that "More than 100,000 agents and brokers choose AHIP each year for training that respects their time and supports their business." It is aimed at licensed agents, brokers, and plan staff who need annual Medicare and FWA training, and it is also relevant to compliance and operations staff who support enrollment. The AHIP Medicare case studies are 5 cases and about 2,598 words.
1The Late-Enrolling Snowbird
On March 3, a licensed agent meets Ruth, who turned 65 in November and has had Original Medicare Parts A and B since then. Ruth also has creditable employer retiree drug coverage and never enrolled in a Part D plan.
632 words, about 3 min2The $0-Premium Pitch at the Senior Center
An agent is invited to speak at a senior center luncheon. The organizer asks the agent to give a 20-minute presentation and to bring lunch.
552 words, about 3 min3The Suspicious Pharmacy Refill Pattern
A Part D plan's fraud unit notices that a pharmacy in a strip mall submits claims for a 90-day supply of a high-cost topical for 40 different beneficiaries, many of whom live more than 60 miles away. Several beneficiaries' addresses match the pharmacy's own address.
494 words, about 2 min4The Dual-Eligible Beneficiary Choosing Coverage
Alvarez is 68, has Medicare Parts A and B, and is also eligible for full Medicaid. He takes seven medications, including one brand drug and one that requires prior authorization.
511 words, about 3 min5The Agent's Commission and the Unverified Enrollment
A licensed agent enrolls a beneficiary, Ms. Lee, into an MA-PD by phone on December 5.
409 words, about 2 min