AHIP FINAL EXAM TEST LATEST UPDATE 2023 / 2024 GRADED A+

AHIP FINAL EXAM TEST LATEST
UPDATE 2023 / 2024 GRADED 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 ANSWERSa. 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 thirdparty 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 ANSWERSChoose 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 ANSWERSMarks: 1 - CORRECT ANSWERSDuring 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 ANSWERSChoose 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 ANSWERSMarks: 1 - CORRECT ANSWERSMr. 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 ANSWERSChoose 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,