AHIP 2023 FINAL EXAM FINAL PAPER 2026
QUESTIONS WITH ANSWERS GRADED A+
◉b. Ms. Lopez is considered a marketing representative of BestCare and
thus is obligated to comply with CMS marketing requirements,
including those regarding using only approved call scripts. ANSWER: -
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?
a. Ms. Lopez is considered a marketing representative of BestCare but is
exempt from the marketing rules regarding approved call scripts because
she works directly for MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and
thus is obligated to comply with CMS marketing requirements,
including those regarding using only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about state licensure since
she is marketing an MA product subject to federal rules.
,d. Ms. Lopez needs to maintain state licensure, but because she is
working for a third-party marketing organization she is exempt from
CMS training requirements that apply to BestCare captive agents.
◉Mr. Edwards, a marketing representative of the ACME Insurance
Company, scheduled a marketing event and expects about 40 people to
attend. He has hired a magician at a cost of $200 to entertain attendees.
Can he do this in a way that complies with guidance from the Medicare
agency? ANSWER: - a. He can do this because the estimated number of
attendees is based on the venue size and response rate and the value of
the gift does not exceed $15.
◉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? ANSWER: - b. Mrs. 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.
◉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? ANSWER: - c. Tell Julia that you will meet with her to explain
Medicare and should she be interested you can accept and submit an
enrollment request, since this is an initial enrollment qualifying her for a
special enrollment period.
◉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 The doctor
may only collect from Mr. Rivera the cost sharing allowable under the
state's Medicaid program.may the doctor collect from Mr. Rivera?
ANSWER: - The doctor may only collect from Mr. Rivera the cost
sharing allowable under the state's Medicaid program.
◉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? ANSWER: -
◉Choose one answer. ANSWER: -
◉ ANSWER: - a. A PFFS plan is a type of Medicare Supplement plan
and she may enroll in one if it is available in her area.
◉ ANSWER: - b. A PFFS plan is exactly the same as Original
Medicare, only offered by a private entity and she may enroll in one if it
is available in her area.
◉ ANSWER: - c. PFFS plans are designed to cover only prescription
drugs and if that is the type of coverage she wants, she may enroll in one
if it is available in her area.
, ◉ ANSWER: - d. A PFFS plan is one of the various types of Medicare
Advantage plans offered by private entities and she may enroll in one if
it is available in her area.
◉Question8 ANSWER: -
◉Marks: 1 ANSWER: -
◉During an appointment scheduled to discuss a Medicare Advantage
Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe
a stand-alone prescription drug plan (Part D plan) that his neighbor told
him about. What should his agent do? ANSWER: -
◉Choose one answer. ANSWER: -
◉ ANSWER: - a. Since Mr. Peters requested a description of the Part D
plan, his agent must leave the Part D plan brochure, but not an
enrollment form, and would have to schedule another appointment after
at least 48 hours have passed to discuss the Part D plan with Mr. Peters.
◉ ANSWER: - b. Since Mr. Peters requested a description of the Part D
plan, his agent must have Mr. Peters sign a new scope of appointment
form that includes Part D, and then the agent may discuss the Part D
plan so Mr. Peters can compare plans and make an informed enrollment
choice during the appointment.
QUESTIONS WITH ANSWERS GRADED A+
◉b. Ms. Lopez is considered a marketing representative of BestCare and
thus is obligated to comply with CMS marketing requirements,
including those regarding using only approved call scripts. ANSWER: -
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?
a. Ms. Lopez is considered a marketing representative of BestCare but is
exempt from the marketing rules regarding approved call scripts because
she works directly for MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and
thus is obligated to comply with CMS marketing requirements,
including those regarding using only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about state licensure since
she is marketing an MA product subject to federal rules.
,d. Ms. Lopez needs to maintain state licensure, but because she is
working for a third-party marketing organization she is exempt from
CMS training requirements that apply to BestCare captive agents.
◉Mr. Edwards, a marketing representative of the ACME Insurance
Company, scheduled a marketing event and expects about 40 people to
attend. He has hired a magician at a cost of $200 to entertain attendees.
Can he do this in a way that complies with guidance from the Medicare
agency? ANSWER: - a. He can do this because the estimated number of
attendees is based on the venue size and response rate and the value of
the gift does not exceed $15.
◉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? ANSWER: - b. Mrs. 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.
◉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? ANSWER: - c. Tell Julia that you will meet with her to explain
Medicare and should she be interested you can accept and submit an
enrollment request, since this is an initial enrollment qualifying her for a
special enrollment period.
◉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 The doctor
may only collect from Mr. Rivera the cost sharing allowable under the
state's Medicaid program.may the doctor collect from Mr. Rivera?
ANSWER: - The doctor may only collect from Mr. Rivera the cost
sharing allowable under the state's Medicaid program.
◉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? ANSWER: -
◉Choose one answer. ANSWER: -
◉ ANSWER: - a. A PFFS plan is a type of Medicare Supplement plan
and she may enroll in one if it is available in her area.
◉ ANSWER: - b. A PFFS plan is exactly the same as Original
Medicare, only offered by a private entity and she may enroll in one if it
is available in her area.
◉ ANSWER: - c. PFFS plans are designed to cover only prescription
drugs and if that is the type of coverage she wants, she may enroll in one
if it is available in her area.
, ◉ ANSWER: - d. A PFFS plan is one of the various types of Medicare
Advantage plans offered by private entities and she may enroll in one if
it is available in her area.
◉Question8 ANSWER: -
◉Marks: 1 ANSWER: -
◉During an appointment scheduled to discuss a Medicare Advantage
Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe
a stand-alone prescription drug plan (Part D plan) that his neighbor told
him about. What should his agent do? ANSWER: -
◉Choose one answer. ANSWER: -
◉ ANSWER: - a. Since Mr. Peters requested a description of the Part D
plan, his agent must leave the Part D plan brochure, but not an
enrollment form, and would have to schedule another appointment after
at least 48 hours have passed to discuss the Part D plan with Mr. Peters.
◉ ANSWER: - b. Since Mr. Peters requested a description of the Part D
plan, his agent must have Mr. Peters sign a new scope of appointment
form that includes Part D, and then the agent may discuss the Part D
plan so Mr. Peters can compare plans and make an informed enrollment
choice during the appointment.
