AHIP FINAL EXAM 200 CONCEPT REVIEW
GUIDE 2026 BENEFITS COVERAGE AND
CLIENT COMMUNICATION
◉ 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
GUIDE 2026 BENEFITS COVERAGE AND
CLIENT COMMUNICATION
◉ 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
