AHIP MODULE 4 2026 QUESTIONS
AND ANSWERS
Youxhavexapproachedxaxhospitalxadministratorxaboutxmarketingxinxherxfacility.xThexadm
inistratorxisxuncomfortablexwithxthexsuggestion.xHowxcouldxyouxaddressxherxconcerns?
x-xans-
✔✔TellxherxthatxMedicarexguidelinesxallowxyouxtoxconductxmarketingxactivitiesxinxcomm
onxareasxofxaxprovider'sxfacility.
Alicexisxaxmarketingxrepresentativexemployedxbyxaxhealthxplan.xBettyxisxaxcaptivexagent
xofxaxhealthxplanxwhoxmarketsxforxmultiplexplansxandxsponsors.xCarlxisxaxcaptivexagentx
whoxmarketsxforxonlyxonexplan/
sponsor.xDenisexisxanxindependentxagentxwhoxmarketsxtoxdifferentxtypesxofxgroups.xEd
wardxisxanxindependentxagentxwhoxmarketsxonlyxtoxemployerxandxunionxgroups.xCMSx
marketingxrepresentativexcompensationxrulesxgenerallyxapplyxto:x-xans-
✔✔BettyxandxDenise,xbutxnotxAlicex(thexemployee)xorxCarlxorxEdwardx(toxwhomxexcept
ionsxapply).
StephaniexKingxbecomesxeligiblexforxMedicarexforxthexfirstxtimexinxJuly.xWithxthexhelpxof
xAgentxJamesxChan,xshexenrollsxinxFeelBetterxMedicarexAdvantagexplanxwithxanxeffecti
vexdatexofxJulyx1st.xWhichxstatementxbestxdescribesxhowxAgentxChanxmayxbexcompen
satedxunderxCMSxrules?x-xans-
✔✔FeelBetterxwillxpayxAgentxChanxinitialxyearxcompensationxforxJulyxthroughxDecemb
er.xThexrenewalxamountsxwillxbexpaidxstartingxinxJanuaryxifxMs.xKingxremainsxenrolledxt
hexfollowingxyear.
ABCxisxaxMedicarexAdvantagex(MA)xplanxsponsor.xItxwouldxlikextoxusexitsxenrollees'xinf
ormationxtoxmarketxnon-
healthxrelatedxproductsxsuchxasxlifexinsurancexandxannuities.xWhichxstatementxbestxde
scribesxABC'sxobligationxtoxitsxenrolleesxregardingxmarketingxsuchxproducts?x-xans-
✔✔ItxmustxobtainxaxHIPAAxcompliantxauthorizationxfromxanxenrolleexthatxindicatesxthex
planxorxplanxsponsorxmayxusextheirxinformationxforxmarketingxpurposes.
Mrs.xLewisxisxturningx65xinxNovemberxandxcalledxtoxaskxforxyourxhelpxdecidingxonxaxMe
dicarexAdvantagexplan.xShexagreedxtoxsignxaxscopexofxappointmentxformxandxmeetxwit
hxyouxonxOctoberx15.xDuringxthexappointment,xwhatxarexyouxpermittedxtoxdo?x-xans-
✔✔Youxmayxprovidexherxwithxthexrequiredxenrollmentxmaterialsxandxtakexherxcomplete
dxenrollmentxapplication.
AND ANSWERS
Youxhavexapproachedxaxhospitalxadministratorxaboutxmarketingxinxherxfacility.xThexadm
inistratorxisxuncomfortablexwithxthexsuggestion.xHowxcouldxyouxaddressxherxconcerns?
x-xans-
✔✔TellxherxthatxMedicarexguidelinesxallowxyouxtoxconductxmarketingxactivitiesxinxcomm
onxareasxofxaxprovider'sxfacility.
Alicexisxaxmarketingxrepresentativexemployedxbyxaxhealthxplan.xBettyxisxaxcaptivexagent
xofxaxhealthxplanxwhoxmarketsxforxmultiplexplansxandxsponsors.xCarlxisxaxcaptivexagentx
whoxmarketsxforxonlyxonexplan/
sponsor.xDenisexisxanxindependentxagentxwhoxmarketsxtoxdifferentxtypesxofxgroups.xEd
wardxisxanxindependentxagentxwhoxmarketsxonlyxtoxemployerxandxunionxgroups.xCMSx
marketingxrepresentativexcompensationxrulesxgenerallyxapplyxto:x-xans-
✔✔BettyxandxDenise,xbutxnotxAlicex(thexemployee)xorxCarlxorxEdwardx(toxwhomxexcept
ionsxapply).
StephaniexKingxbecomesxeligiblexforxMedicarexforxthexfirstxtimexinxJuly.xWithxthexhelpxof
xAgentxJamesxChan,xshexenrollsxinxFeelBetterxMedicarexAdvantagexplanxwithxanxeffecti
vexdatexofxJulyx1st.xWhichxstatementxbestxdescribesxhowxAgentxChanxmayxbexcompen
satedxunderxCMSxrules?x-xans-
✔✔FeelBetterxwillxpayxAgentxChanxinitialxyearxcompensationxforxJulyxthroughxDecemb
er.xThexrenewalxamountsxwillxbexpaidxstartingxinxJanuaryxifxMs.xKingxremainsxenrolledxt
hexfollowingxyear.
ABCxisxaxMedicarexAdvantagex(MA)xplanxsponsor.xItxwouldxlikextoxusexitsxenrollees'xinf
ormationxtoxmarketxnon-
healthxrelatedxproductsxsuchxasxlifexinsurancexandxannuities.xWhichxstatementxbestxde
scribesxABC'sxobligationxtoxitsxenrolleesxregardingxmarketingxsuchxproducts?x-xans-
✔✔ItxmustxobtainxaxHIPAAxcompliantxauthorizationxfromxanxenrolleexthatxindicatesxthex
planxorxplanxsponsorxmayxusextheirxinformationxforxmarketingxpurposes.
Mrs.xLewisxisxturningx65xinxNovemberxandxcalledxtoxaskxforxyourxhelpxdecidingxonxaxMe
dicarexAdvantagexplan.xShexagreedxtoxsignxaxscopexofxappointmentxformxandxmeetxwit
hxyouxonxOctoberx15.xDuringxthexappointment,xwhatxarexyouxpermittedxtoxdo?x-xans-
✔✔Youxmayxprovidexherxwithxthexrequiredxenrollmentxmaterialsxandxtakexherxcomplete
dxenrollmentxapplication.
