AHIP 2026 FINAL EXAM 50
QUESTIONS WITH DETAILED VERIFIED
ANSWERS
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? -
correct answer- You must have her sign a scope
of appointment form, indicating which products she
wishes to discuss. You may then proceed with the
discussion.
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? -
correct answer- Baker and Charles are subject to
CMS compensation rules because they are paid by third
,parties. Able is not because he is paid directly by a health
plan.
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? - correct answer-
Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
Anita Magri will turn age 65 in August 2023. Anita intends
to enroll in Original Medicare Part A and Part B. She
would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her
about the Medigap Plan F in which he is enrolled. It not
only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you
for advice. What should you tell her? - correct
answer- You are sorry to disappoint Anita, but a
Medigap F plan is no longer available to those who turn
age 65 after January 1, 2020. Anita might instead consider
, other Medigap plans that offer foreign travel benefits but
do not cover the Part B deductible.
By contacting plans available in your area, you have
learned that the plan you represent has a significantly
lower monthly premium than the others. Furthermore,
you see that the plan you represent has a unique benefits
package. What should you do to make sure your clients
know about these pieces of information? - correct
answer- You may make comparisons between plans
if you can support them with studies or statistical data
and such comparisons are factually based and referenced.
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? - correct
answer- 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.
QUESTIONS WITH DETAILED VERIFIED
ANSWERS
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? -
correct answer- You must have her sign a scope
of appointment form, indicating which products she
wishes to discuss. You may then proceed with the
discussion.
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? -
correct answer- Baker and Charles are subject to
CMS compensation rules because they are paid by third
,parties. Able is not because he is paid directly by a health
plan.
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? - correct answer-
Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
Anita Magri will turn age 65 in August 2023. Anita intends
to enroll in Original Medicare Part A and Part B. She
would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her
about the Medigap Plan F in which he is enrolled. It not
only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you
for advice. What should you tell her? - correct
answer- You are sorry to disappoint Anita, but a
Medigap F plan is no longer available to those who turn
age 65 after January 1, 2020. Anita might instead consider
, other Medigap plans that offer foreign travel benefits but
do not cover the Part B deductible.
By contacting plans available in your area, you have
learned that the plan you represent has a significantly
lower monthly premium than the others. Furthermore,
you see that the plan you represent has a unique benefits
package. What should you do to make sure your clients
know about these pieces of information? - correct
answer- You may make comparisons between plans
if you can support them with studies or statistical data
and such comparisons are factually based and referenced.
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? - correct
answer- 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.
