AHIP Final Exam, Health Insurance and Medicare Compliance, Complete Exam Preparation Material

AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE


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?




Choose one 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


Marks: 1




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? -




Choose one 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.