AHIP Final Exam Test Questions and Answers
(2022/2023) (Verified 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? - ANSWER:
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. - 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 - ANSWER:
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? -
ANSWER:
Choose one answer. - ANSWER:
- ANSWER: 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.
- ANSWER: 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.
- ANSWER: 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
- ANSWER: 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 - ANSWER:
Marks: 1 - ANSWER:
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? - ANSWER:
Choose one answer. - ANSWER:
- ANSWER: a. In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
- ANSWER: 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.
- ANSWER: 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
(2022/2023) (Verified 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? - ANSWER:
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. - 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 - ANSWER:
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? -
ANSWER:
Choose one answer. - ANSWER:
- ANSWER: 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.
- ANSWER: 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.
- ANSWER: 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
- ANSWER: 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 - ANSWER:
Marks: 1 - ANSWER:
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? - ANSWER:
Choose one answer. - ANSWER:
- ANSWER: a. In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
- ANSWER: 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.
- ANSWER: 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
