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AHIP ALL MODULES Verified Questions and Correct Answers A+ Graded. Stanford Uniersity

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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?



a. Regular CMS and renewal compensation rules apply to the PDP enrollment, but compensation is
limited to $100 for the MSA health plan enrollment to recompense CMS for contributions made to the
enrollee's MSA account.



b. MSA Medicare health plans are subject to special rules limiting initial year compensation to 50
percent of the fair market value (FMV) published annually by CMS. Regular initial year enrollment rules
apply to the PDP.



c. When an MSA Medicare health plan is combined with a PDP, initial and renewal year(s) compensation
is paid only for the MSA enrollment to recompense CMS for contributions made to th - Answer: This
situation is considered a "dual enrollment," and CMS compensation rules are applied to the two plans at
once and independently of each other.



Ms. Chase is interested in discussing various Medicare Advantage (MA) Plans available in her area with
you. She has heard that MA plans have something called a "maximum out-of-pocket" limit. She asks you
to explain what this means. What do you say?



a. Each year, CMS specifies an optional MOOP, which health plans can exceed or lower.



b. Original Medicare, not MA plans, have a maximum out-of-pocket limit, for Part A and Part B benefits.

, c. MA plans have a maximum out-of-pocket limit, known as the "MOOP" for Part A and Part B benefits.
Once a plan member pays a specified amount of cost-sharing, the health plan covers 80 percent of
covered medical services.



d. MA plans have a maximum out-of-pocket limit, known as the "MOOP", for Part A and Part B benefits.
Once a plan member pays a specified amount of cost-sharing, the health plan covers 100 percent of
covered medical services. - Answer: MA plans have a maximum out-of-pocket limit, known as the
"MOOP", for Part A and Part B benefits. Once a plan member pays a specified amount of cost-sharing,
the health plan covers 100 percent of covered medical services.



Agent Marvin Millner wants to reach out to his current clients for referrals. What advice would you give
to Marvin?



a. CMS guidelines limit the value of gifts provided in exchange for referrals to a value of $50 or less.



b. Marvin should understand that under CMS guidelines he can no longer provide gifts, even of minimal
value, in exchange for referrals.



c. Marvin should consult with the health plans he represents to determine whether those plans impose
requirements around beneficiary referrals.



d. CMS guidelines limit the value of gifts provided in exchange for referrals to a value of $100 or less. -
Answer: Marvin should consult with the health plans he represents to determine whether those plans
impose requirements around beneficiary referrals



Mr. Perry is entitled to Medicare Part A but has not yet enrolled in Part B, even though he is 69 years
old. He would like to enroll in a Medicare Part D prescription drug plan but is concerned that he will
have to sign up for Part B as well in order to qualify for enrollment in a Part D plan. What should you tell
him?

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