AHIP 2025 Final Exam 50 questions
A Medicare beneficiary has walked into your office and requested that you sit down
with her and discuss her options under the Medicare Advantage program. Before
engaging in such a discussion, what should you do? - ANS-You must have her sign a
scope of appointment form, indicating which products she wishes to discuss. You
may then proceed with the discussion.
\Able, Baker, and Charles are engaged in the marketing and enrollment of
beneficiaries into Medicare health plans. Mr. Able is an independent agent paid
directly by a health plan. Ms. Baker is an independent agent paid through a field
marketing organization (FMO). Mr. Charles is an independent agent paid for his work
by a third-party marketing organization (TMO). How do the CMS compensation rules
apply to these three agents? - ANS-Baker and Charles are subject to CMS
compensation rules because they are paid by third parties. Able is not because he is
paid directly by a health plan.
\Agent Jennings makes a presentation on Medicare advertised as an educational
event. Agent Jennings distributes materials that are solely educational. However, she
gives a brief presentation that mentions plan-specific premiums. Is this a prohibited
activity at an event that has been advertised as educational? - ANS-Yes. When an
event has been advertised as "educational," discussing plan-specific premiums is
impermissible.
\Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in
which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should
you tell her? - ANS-You are sorry to disappoint Anita, but a Medigap F plan is no
longer available to those who turn age 65 after January 1, 2020. Anita might instead
consider other Medigap plans that offer foreign travel benefits but do not cover the
Part B deductible.
\By contacting plans available in your area, you have learned that the plan you
represent has a significantly lower monthly premium than the others. Furthermore,
you see that the plan you represent has a unique benefits package. What should you
do to make sure your clients know about these pieces of information? - ANS-You
may make comparisons between plans if you can support them with studies or
statistical data and such comparisons are factually based and referenced.
\Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge? - ANS-Dr. Brennan can charge Mary
Rogers no more than the cost sharing specified in the PFFS plan's terms and
condition of payment which may include balance billing up to 15%of the Medicare
rate.
, \During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a
5-star rating in customer service and care coordination, and received an overall plan
performance rating of a 4-star, which of the following would be the best statement to
say to her? - ANS-The Medicare Advantage plan received a 5-star rating in customer
service and care coordination with an overall performance rating of 4 stars.
\Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription to help to regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them?
- ANS-Medicare prescription drug plans are not permitted to cover the prescription
medications the Vaughns are interested in under Part D coverage, however, plans
may cover them as supplemental benefits and the Vaughns could look into that
possibility.
\Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess
of his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - ANS-You can offer to review the plans appeal process to help him ask the
plan to review the coverage decision.
\Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that
offers better coverage than that available through his MA-PD plan and in addition,
has a low premium. It won't cost him much more and, because he has the means to
do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his
MA-PD plan. What should you tell him? - ANS-If Mr. Block enrolls in the stand-alone
Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage
plan.
\Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and
is eligible for Medicare. What should you tell him? - ANS-Mr. Chen can disenroll from
his employer-sponsored coverage to elect a Medicare Advantage or Part D plan
within 2 months of his disenrollment.
\Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election
Period (AEP). On December 1, he calls you up and says that he has changed his
mind and would like to enroll in a MA-PD plan. What enrollment rules would apply in
this case? - ANS-He can make as many enrollment changes as he likes during the
Annual Election Period and the last choice made before the end of the period will be
the effective one as of January 1.
\Mr. Garcia was told he qualifies for a special election period (SEP), but he lost the
paper that explains what he could do during the SEP. What can you tell him? -
ANS-If the SEP is for MA coverage, he will generally have one opportunity to change
his MA coverage.
A Medicare beneficiary has walked into your office and requested that you sit down
with her and discuss her options under the Medicare Advantage program. Before
engaging in such a discussion, what should you do? - ANS-You must have her sign a
scope of appointment form, indicating which products she wishes to discuss. You
may then proceed with the discussion.
\Able, Baker, and Charles are engaged in the marketing and enrollment of
beneficiaries into Medicare health plans. Mr. Able is an independent agent paid
directly by a health plan. Ms. Baker is an independent agent paid through a field
marketing organization (FMO). Mr. Charles is an independent agent paid for his work
by a third-party marketing organization (TMO). How do the CMS compensation rules
apply to these three agents? - ANS-Baker and Charles are subject to CMS
compensation rules because they are paid by third parties. Able is not because he is
paid directly by a health plan.
\Agent Jennings makes a presentation on Medicare advertised as an educational
event. Agent Jennings distributes materials that are solely educational. However, she
gives a brief presentation that mentions plan-specific premiums. Is this a prohibited
activity at an event that has been advertised as educational? - ANS-Yes. When an
event has been advertised as "educational," discussing plan-specific premiums is
impermissible.
\Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in
which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should
you tell her? - ANS-You are sorry to disappoint Anita, but a Medigap F plan is no
longer available to those who turn age 65 after January 1, 2020. Anita might instead
consider other Medigap plans that offer foreign travel benefits but do not cover the
Part B deductible.
\By contacting plans available in your area, you have learned that the plan you
represent has a significantly lower monthly premium than the others. Furthermore,
you see that the plan you represent has a unique benefits package. What should you
do to make sure your clients know about these pieces of information? - ANS-You
may make comparisons between plans if you can support them with studies or
statistical data and such comparisons are factually based and referenced.
\Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge? - ANS-Dr. Brennan can charge Mary
Rogers no more than the cost sharing specified in the PFFS plan's terms and
condition of payment which may include balance billing up to 15%of the Medicare
rate.
, \During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a
5-star rating in customer service and care coordination, and received an overall plan
performance rating of a 4-star, which of the following would be the best statement to
say to her? - ANS-The Medicare Advantage plan received a 5-star rating in customer
service and care coordination with an overall performance rating of 4 stars.
\Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription to help to regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them?
- ANS-Medicare prescription drug plans are not permitted to cover the prescription
medications the Vaughns are interested in under Part D coverage, however, plans
may cover them as supplemental benefits and the Vaughns could look into that
possibility.
\Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess
of his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - ANS-You can offer to review the plans appeal process to help him ask the
plan to review the coverage decision.
\Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that
offers better coverage than that available through his MA-PD plan and in addition,
has a low premium. It won't cost him much more and, because he has the means to
do so, he wishes to enroll in the stand-alone prescription drug plan in addition to his
MA-PD plan. What should you tell him? - ANS-If Mr. Block enrolls in the stand-alone
Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage
plan.
\Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and
is eligible for Medicare. What should you tell him? - ANS-Mr. Chen can disenroll from
his employer-sponsored coverage to elect a Medicare Advantage or Part D plan
within 2 months of his disenrollment.
\Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election
Period (AEP). On December 1, he calls you up and says that he has changed his
mind and would like to enroll in a MA-PD plan. What enrollment rules would apply in
this case? - ANS-He can make as many enrollment changes as he likes during the
Annual Election Period and the last choice made before the end of the period will be
the effective one as of January 1.
\Mr. Garcia was told he qualifies for a special election period (SEP), but he lost the
paper that explains what he could do during the SEP. What can you tell him? -
ANS-If the SEP is for MA coverage, he will generally have one opportunity to change
his MA coverage.
