Deeagles - Stuvia US
AHIP FINAL EXAM | 360 QUESTIONS &
100% CORRECT ANSWERS (VERIFIED) |
LATEST UPDATE | GRADED A+ |
ALREADY GRADED
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan,
but does not want to be limited in terms of where he obtains his care. What should you
tell him about how a Medicare Cost Plan might fit his needs?
ANSWER: a. Cost plan enrollees can choose to receive Medicare covered
services under the plan's benefits by going to plan network providers and paying plan
cost sharing, or may receive services from non-network providers and pay cost-sharing
due under Original Medicare.
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?
, Deeagles - Stuvia US
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.
, Deeagles - Stuvia US
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
, Deeagles - Stuvia US
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.
AHIP FINAL EXAM | 360 QUESTIONS &
100% CORRECT ANSWERS (VERIFIED) |
LATEST UPDATE | GRADED A+ |
ALREADY GRADED
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan,
but does not want to be limited in terms of where he obtains his care. What should you
tell him about how a Medicare Cost Plan might fit his needs?
ANSWER: a. Cost plan enrollees can choose to receive Medicare covered
services under the plan's benefits by going to plan network providers and paying plan
cost sharing, or may receive services from non-network providers and pay cost-sharing
due under Original Medicare.
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?
, Deeagles - Stuvia US
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.
, Deeagles - Stuvia US
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
, Deeagles - Stuvia US
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.
