AHIP TEST
- ANS -
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.
Able, Baker, and Charles are engaged in the marketing to 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 - Able is subject to CMS compensation rules because he is
paid directly by a health plan. Agents Baker and Charles are not because they are paid
by third parties.
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.
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.
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that
has suffered from major flooding that has been declared a major disaster by both the
Federal government and her state. As a result of dealing with the flooding issues and
being evacuated from her home, Edna missed her chance to enroll in MA during her
Initial Coverage Election Period. Felix lives in an area with a Medicare Advantage plan
with a 4-star rating that he would like to join. George dropped his Medigap policy six
months ago when he first enrolled in a Medicare Advantage plan. He now wants to
return to Original Medicare. Harriet has recently developed diabetes and would like to
enroll in a Medicare Advantage plan that focuses on care for those with that disease.
Which, if any, of these individuals would qualify for a special election period (SEP)? -
ANS - Edna would qualify for a SEP because government officials have declared a
major disaster for her area and she did not enroll in MA during her ICEP due to the
emergency. George would qualify for an SEP because he enrolled in Medicare
Advantage (MA) plan for the first time and would now like to return to Original Medicare
within the first 12 months of his enrollment. Harriet would also qualify for a SEP to enroll
in a C-SNP because she has developed a chronic condition. Felix would not qualify for
a SEP since he seeks to enroll in a 4-star not a 5-star MA plan.
Hector Hernandez is an independent agent. Hector sells plans on behalf of three
Medicare Advantage organizations that offer a total of 10 plans but does not represent
all Medicare Advantage organizations offering plans that are available in his area.
Which of the following statements best describes any steps Hector is required to take? -
ANS - During the first minute of a sales call, Hector must use a disclaimer that says "I
do not represent every plan available in your area. I represent 3 organizations that offer
- ANS -
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.
Able, Baker, and Charles are engaged in the marketing to 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 - Able is subject to CMS compensation rules because he is
paid directly by a health plan. Agents Baker and Charles are not because they are paid
by third parties.
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.
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.
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that
has suffered from major flooding that has been declared a major disaster by both the
Federal government and her state. As a result of dealing with the flooding issues and
being evacuated from her home, Edna missed her chance to enroll in MA during her
Initial Coverage Election Period. Felix lives in an area with a Medicare Advantage plan
with a 4-star rating that he would like to join. George dropped his Medigap policy six
months ago when he first enrolled in a Medicare Advantage plan. He now wants to
return to Original Medicare. Harriet has recently developed diabetes and would like to
enroll in a Medicare Advantage plan that focuses on care for those with that disease.
Which, if any, of these individuals would qualify for a special election period (SEP)? -
ANS - Edna would qualify for a SEP because government officials have declared a
major disaster for her area and she did not enroll in MA during her ICEP due to the
emergency. George would qualify for an SEP because he enrolled in Medicare
Advantage (MA) plan for the first time and would now like to return to Original Medicare
within the first 12 months of his enrollment. Harriet would also qualify for a SEP to enroll
in a C-SNP because she has developed a chronic condition. Felix would not qualify for
a SEP since he seeks to enroll in a 4-star not a 5-star MA plan.
Hector Hernandez is an independent agent. Hector sells plans on behalf of three
Medicare Advantage organizations that offer a total of 10 plans but does not represent
all Medicare Advantage organizations offering plans that are available in his area.
Which of the following statements best describes any steps Hector is required to take? -
ANS - During the first minute of a sales call, Hector must use a disclaimer that says "I
do not represent every plan available in your area. I represent 3 organizations that offer
