AHIP Study Guide Exam Questions and
Correct Detailed Answers with Rationales
(Verified Answers) Already Graded A+
Newest Version
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?
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.
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?
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?
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?
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?
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?
Choose one 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.
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.
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.
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
Marks: 1
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
Correct Detailed Answers with Rationales
(Verified Answers) Already Graded A+
Newest Version
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?
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.
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?
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?
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?
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?
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?
Choose one 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.
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.
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.
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
Marks: 1
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
