AHIP CERTIFICATION FULLCOURSE 2022/2023 Q&A
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? (correct answers)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. (correct
answers)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? (correct answers)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? (correct answers)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? (correct answers)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? (correct answers)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? (correct answers)
Choose one answer. (correct answers)
(correct answers)a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is
available in her area.
(correct answers)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.
(correct answers)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.
(correct answers)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 (correct answers)
Marks: 1 (correct answers)
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 (Part D plan) that his neighbor
told him about. What should his agent do? (correct answers)
Choose one answer. (correct answers)
, (correct answers)a. Since Mr. Peters requested a description of the Part D plan, his agent must leave the
Part D plan brochure, but not an enrollment form, and would have to schedule another appointment
after at least 48 hours have passed to discuss the Part D plan with Mr. Peters.
(correct answers)b. Since Mr. Peters requested a description of the Part D plan, his agent must have Mr.
Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the
Part D plan so Mr. Peters can compare plans and make an informed enrollment choice during the
appointment.
(correct answers)c. Since Mr. Peters requested a description of the Part D plan, his agent must inform
Mr. Peters that he can only sign up for the MA-PD plan and cannot receive a brochure or any other
information about the Part D plan now because he did not agree in advance to discuss that plan
(correct answers)d. Since Mr. Peters requested a description of the Part D plan, his agent must discuss
both the Part D and the MA-PD plans and return after at least 48 hours to complete the Part D plan
enrollment form with Mr. Peters.
Question9 (correct answers)
Marks: 1 (correct answers)
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an
automatic monthly withdrawal from his savings account until it is exhausted, and then have his
premiums withheld from his Social Security check. What should you tell him? (correct answers)
Choose one answer. (correct answers)
(correct answers)a. In general, he must select a single Part D premium payment mechanism that will be
used throughout the year.
(correct answers)b. As long as he fills out the paperwork to begin withholding from his Social Security
check at least 63 days before such withholding should begin, he can change his method of Part D
premium payment and withholding will begin the month after his savings account is exhausted.
(correct answers)c. During 2017, many people experienced significant problems with deductions from
their Social Security check for their Part D premium. As a result, this method of payment is no longer an
option for Part D premium payments
(correct answers)d. In general, to pay his Part D premium, he only can have automatic withdrawals
made from a checking account, so he will need to transfer the funds prior to beginning such
withdrawals.
Question10 (correct answers)
Marks: 1 (correct answers)
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? (correct answers)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. (correct
answers)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? (correct answers)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? (correct answers)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? (correct answers)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? (correct answers)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? (correct answers)
Choose one answer. (correct answers)
(correct answers)a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is
available in her area.
(correct answers)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.
(correct answers)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.
(correct answers)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 (correct answers)
Marks: 1 (correct answers)
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 (Part D plan) that his neighbor
told him about. What should his agent do? (correct answers)
Choose one answer. (correct answers)
, (correct answers)a. Since Mr. Peters requested a description of the Part D plan, his agent must leave the
Part D plan brochure, but not an enrollment form, and would have to schedule another appointment
after at least 48 hours have passed to discuss the Part D plan with Mr. Peters.
(correct answers)b. Since Mr. Peters requested a description of the Part D plan, his agent must have Mr.
Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the
Part D plan so Mr. Peters can compare plans and make an informed enrollment choice during the
appointment.
(correct answers)c. Since Mr. Peters requested a description of the Part D plan, his agent must inform
Mr. Peters that he can only sign up for the MA-PD plan and cannot receive a brochure or any other
information about the Part D plan now because he did not agree in advance to discuss that plan
(correct answers)d. Since Mr. Peters requested a description of the Part D plan, his agent must discuss
both the Part D and the MA-PD plans and return after at least 48 hours to complete the Part D plan
enrollment form with Mr. Peters.
Question9 (correct answers)
Marks: 1 (correct answers)
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an
automatic monthly withdrawal from his savings account until it is exhausted, and then have his
premiums withheld from his Social Security check. What should you tell him? (correct answers)
Choose one answer. (correct answers)
(correct answers)a. In general, he must select a single Part D premium payment mechanism that will be
used throughout the year.
(correct answers)b. As long as he fills out the paperwork to begin withholding from his Social Security
check at least 63 days before such withholding should begin, he can change his method of Part D
premium payment and withholding will begin the month after his savings account is exhausted.
(correct answers)c. During 2017, many people experienced significant problems with deductions from
their Social Security check for their Part D premium. As a result, this method of payment is no longer an
option for Part D premium payments
(correct answers)d. In general, to pay his Part D premium, he only can have automatic withdrawals
made from a checking account, so he will need to transfer the funds prior to beginning such
withdrawals.
Question10 (correct answers)
Marks: 1 (correct answers)
