AHIP ALL MODULES
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? -
ANS-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
\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.
\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? - ANS-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 Armstrong is employed by XYZ Agency, which is under contract with ABC
Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states.
XYZ Agency maintains a website marketing the MA plans with which it has contracts.
Agent Armstrong follows up with individuals who request more information about
ABC MA plans via the website and tries to persuade them to enroll in ABC plans.
What statement best describes the marketing and compliance rules that apply to
Agent Armstrong? - ANS-Agent Armstrong needs to be licensed and appointed in
every state in which beneficiaries to whom he markets ABC MA plans are located.
\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.
\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?
- ANS-Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
\Agent Martinez 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? -
, ANS-Marketing representatives may initiate electronic contact through e-mail but an
opt-out process must be provided.
\All plans must cover at least the standard Part D coverage or its actuarial
equivalent. Which of the following statements best describes some of the costs a
beneficiary would incur for prescription drugs under the standard coverage? -
ANS-Standard Part D coverage would require payment of an annual deductible, and
once past the catastrophic coverage threshold, the beneficiary pays whichever is
greater of either the co-pays for generic and brand name drugs or coinsurance of
5%.
\Another agent working for your agency claims that because you are not employed
by the Medicare Advantage plans that you represent, you are not subject to the
same marketing requirements as the plans themselves. How should you respond to
such a statement? - ANS-Your coworker is not correct. Marketing on behalf of a plan
is considered marketing by the plan and requires that all contracted and employed
agents comply with all Medicare marketing rules.
\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?
- ANS-The plan may withhold commission, require retraining, report the misconduct
to a state department of insurance or terminate the contract.
\Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting
him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which
type of SNP is likely to be most appropriate for him? - ANS-C-SNP
\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, your client asks you whether the Medicare agency
recommends that she sign up for your plan or stay in Original Medicare. What should
you tell her? - ANS-Tell her that the Medicare agency does not endorse or
recommend any plan.
\Juan Perez, who is turning age 65 next month, intends to work for several more
years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and
offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and
has contributed to the Medicare system for over 20 years. Juan asks you if he will be
entitled to Medicare and if he enrolls how that will impact his employer-sponsored
healthcare coverage. How would you respond? - ANS-Juan is likely to be eligible for
Medicare once he turns age 65 and if he enrolls Medicare would become the primary
payor of his healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under its employer-sponsored group
health plan.
\Melissa Meadows is a marketing representative for Best Care which has recently
introduced a Medicare Advantage plan offering comprehensive dental benefits for
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? -
ANS-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
\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.
\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? - ANS-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 Armstrong is employed by XYZ Agency, which is under contract with ABC
Health Plan, a Medicare Advantage (MA) plan that offers plans in multiple states.
XYZ Agency maintains a website marketing the MA plans with which it has contracts.
Agent Armstrong follows up with individuals who request more information about
ABC MA plans via the website and tries to persuade them to enroll in ABC plans.
What statement best describes the marketing and compliance rules that apply to
Agent Armstrong? - ANS-Agent Armstrong needs to be licensed and appointed in
every state in which beneficiaries to whom he markets ABC MA plans are located.
\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.
\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?
- ANS-Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
\Agent Martinez 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? -
, ANS-Marketing representatives may initiate electronic contact through e-mail but an
opt-out process must be provided.
\All plans must cover at least the standard Part D coverage or its actuarial
equivalent. Which of the following statements best describes some of the costs a
beneficiary would incur for prescription drugs under the standard coverage? -
ANS-Standard Part D coverage would require payment of an annual deductible, and
once past the catastrophic coverage threshold, the beneficiary pays whichever is
greater of either the co-pays for generic and brand name drugs or coinsurance of
5%.
\Another agent working for your agency claims that because you are not employed
by the Medicare Advantage plans that you represent, you are not subject to the
same marketing requirements as the plans themselves. How should you respond to
such a statement? - ANS-Your coworker is not correct. Marketing on behalf of a plan
is considered marketing by the plan and requires that all contracted and employed
agents comply with all Medicare marketing rules.
\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?
- ANS-The plan may withhold commission, require retraining, report the misconduct
to a state department of insurance or terminate the contract.
\Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting
him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which
type of SNP is likely to be most appropriate for him? - ANS-C-SNP
\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, your client asks you whether the Medicare agency
recommends that she sign up for your plan or stay in Original Medicare. What should
you tell her? - ANS-Tell her that the Medicare agency does not endorse or
recommend any plan.
\Juan Perez, who is turning age 65 next month, intends to work for several more
years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and
offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and
has contributed to the Medicare system for over 20 years. Juan asks you if he will be
entitled to Medicare and if he enrolls how that will impact his employer-sponsored
healthcare coverage. How would you respond? - ANS-Juan is likely to be eligible for
Medicare once he turns age 65 and if he enrolls Medicare would become the primary
payor of his healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under its employer-sponsored group
health plan.
\Melissa Meadows is a marketing representative for Best Care which has recently
introduced a Medicare Advantage plan offering comprehensive dental benefits for
