AHIP 2026 Certification Exam | Latest
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A client wants to give you an enrollment application on October 1 before the beginning of the
Annual Election Period because he is leaving on vacation for two weeks and does not want to
forget about turning it in. What should you tell him? - You must tell him you are not permitted
to take the form. If he sends the form directly to the plan, the plan will process the enrollment
on the day the Annual Election Period begins.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to
market non-health related products such as life insurance and annuities. Which statement best
describes ABC's obligation to its enrollees regarding marketing such products? - It must obtain a
HIPAA compliant authorization from an enrollee that indicates the plan or plan sponsor may use
their information for marketing purposes.
Agent Chandler is conducting a sales presentation on senior issues where he hopes to enroll
some attendees in the Medicare Advantage (MA) plans he represents. What action(s) may
Agent Chandler take during the event? - Discuss plan specific information such as premiums and
benefits.
Agent Higgins helps Mrs. O'Malley enroll in AB Medicare Advantage (MA) plan during the
Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st.
Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's
service area. What impact will this have on Agent Higgins' compensation? - AB MA plan does
not have to recoup Agent Higgins' compensation because she has moved away from its service
area.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
,he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - Tell prospect Jerry Smith that he should consider adding
a standalone Part D prescription drug coverage policy to his present coverage.
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual
Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph disenrolls on
February 12th because he discovers that the plan does not cover services furnished by several
of his longtime providers. Which of the following statements best describes the impact of
Ralph's action upon Agent Lopez's compensation? - Agent Lopez's entire compensation must be
recouped because Ralph disenrolled within 3 months of enrollment.
Agent Mendez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her? - Marketing representatives may
initiate electronic contact through e-mail but an opt-out process must be provided.
Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA) Medicare
health plan. The MSA plan does not offer prescription drug coverage, so Agent Roderick also
enrolls Mrs. Martinez in a standalone prescription drug plan (PDP). What CMS compensation
rules apply to this situation? - This situation is considered a "dual enrollment," and CMS
compensation rules are applied to the two plans at once and independently of each other.
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a
health plan who markets for multiple plans and sponsors. Carl is a captive agent who markets
for only one plan/sponsor. Denise is an independent agent who markets to different types of
groups. Edward is an independent agent who markets only to employer and union groups. CMS
marketing representative compensation rules generally apply to: - Betty and Denise, but not
Alice (the employee) or Carl or Edward (to whom exceptions apply).
Angel is new to the Medicare marketplace having previously been focused on life insurance and
disability income protection products. He intends to conduct an educational seminar during the
AEP at a local hotel and then invite those who attend to a subsequent marketing meeting to
discuss the benefits of next year's plans. How would you advise Angel? - Angel should conduct
, the education seminar as an early morning meeting and the marketing meeting on the following
day in the late afternoon so that there are at least 12 hours between the two meetings.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual? - The plan may
withhold commission, require retraining, report the misconduct to a state department of
insurance or terminate the contract.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - Anthony is eligible for a special enrollment period (SEP)
because he missed an enrollment period due to the impact of the Federally declared disaster.
This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency
declaration. Anthony may enroll in premium-free Part A at any time and his Part A coverage will
be retroactive for up to 6 months.
Archer works as a representative focused on the senior marketplace. What would be considered
prohibited activity by Archer? - Implying that only seniors can enroll in a Medicare Advantage
plan when meeting with Mr. Lynn, who is 58 but qualifies for Medicare because he is disabled.
Best Care Health Plan has received a request from a state insurance department in connection
with the investigation of several marketing representatives licensed by the state who sell
Medicare Advantage plans. What action(s) should Best Care take in response? - Cooperate with
the state and supply requested information.
Dr. Elizabeth Morgan does not contract with the ABC PFFS plan but accepts the plan's terms and
conditions for payment. Mary Rodgers sees Dr. Morgan for treatment. How much may Dr.
Morgan charge? - Dr. Morgan can charge Mary Rogers no more than the cost sharing specified
Updates, Costs, Module Changes, Study
Guide, Practice Questions, Solutions,
Answers, Compliance Tips & How to Pass
Fast
A client wants to give you an enrollment application on October 1 before the beginning of the
Annual Election Period because he is leaving on vacation for two weeks and does not want to
forget about turning it in. What should you tell him? - You must tell him you are not permitted
to take the form. If he sends the form directly to the plan, the plan will process the enrollment
on the day the Annual Election Period begins.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information to
market non-health related products such as life insurance and annuities. Which statement best
describes ABC's obligation to its enrollees regarding marketing such products? - It must obtain a
HIPAA compliant authorization from an enrollee that indicates the plan or plan sponsor may use
their information for marketing purposes.
Agent Chandler is conducting a sales presentation on senior issues where he hopes to enroll
some attendees in the Medicare Advantage (MA) plans he represents. What action(s) may
Agent Chandler take during the event? - Discuss plan specific information such as premiums and
benefits.
Agent Higgins helps Mrs. O'Malley enroll in AB Medicare Advantage (MA) plan during the
Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st.
Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's
service area. What impact will this have on Agent Higgins' compensation? - AB MA plan does
not have to recoup Agent Higgins' compensation because she has moved away from its service
area.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
,he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - Tell prospect Jerry Smith that he should consider adding
a standalone Part D prescription drug coverage policy to his present coverage.
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the Annual
Open Enrollment Period. Ralph's effective enrollment date is January 1st. Ralph disenrolls on
February 12th because he discovers that the plan does not cover services furnished by several
of his longtime providers. Which of the following statements best describes the impact of
Ralph's action upon Agent Lopez's compensation? - Agent Lopez's entire compensation must be
recouped because Ralph disenrolled within 3 months of enrollment.
Agent Mendez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her? - Marketing representatives may
initiate electronic contact through e-mail but an opt-out process must be provided.
Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA) Medicare
health plan. The MSA plan does not offer prescription drug coverage, so Agent Roderick also
enrolls Mrs. Martinez in a standalone prescription drug plan (PDP). What CMS compensation
rules apply to this situation? - This situation is considered a "dual enrollment," and CMS
compensation rules are applied to the two plans at once and independently of each other.
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a
health plan who markets for multiple plans and sponsors. Carl is a captive agent who markets
for only one plan/sponsor. Denise is an independent agent who markets to different types of
groups. Edward is an independent agent who markets only to employer and union groups. CMS
marketing representative compensation rules generally apply to: - Betty and Denise, but not
Alice (the employee) or Carl or Edward (to whom exceptions apply).
Angel is new to the Medicare marketplace having previously been focused on life insurance and
disability income protection products. He intends to conduct an educational seminar during the
AEP at a local hotel and then invite those who attend to a subsequent marketing meeting to
discuss the benefits of next year's plans. How would you advise Angel? - Angel should conduct
, the education seminar as an early morning meeting and the marketing meeting on the following
day in the late afternoon so that there are at least 12 hours between the two meetings.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual? - The plan may
withhold commission, require retraining, report the misconduct to a state department of
insurance or terminate the contract.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - Anthony is eligible for a special enrollment period (SEP)
because he missed an enrollment period due to the impact of the Federally declared disaster.
This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency
declaration. Anthony may enroll in premium-free Part A at any time and his Part A coverage will
be retroactive for up to 6 months.
Archer works as a representative focused on the senior marketplace. What would be considered
prohibited activity by Archer? - Implying that only seniors can enroll in a Medicare Advantage
plan when meeting with Mr. Lynn, who is 58 but qualifies for Medicare because he is disabled.
Best Care Health Plan has received a request from a state insurance department in connection
with the investigation of several marketing representatives licensed by the state who sell
Medicare Advantage plans. What action(s) should Best Care take in response? - Cooperate with
the state and supply requested information.
Dr. Elizabeth Morgan does not contract with the ABC PFFS plan but accepts the plan's terms and
conditions for payment. Mary Rodgers sees Dr. Morgan for treatment. How much may Dr.
Morgan charge? - Dr. Morgan can charge Mary Rogers no more than the cost sharing specified
