AHIP MEDICARE EXAMS WITH
CORRECT ANSWERS /GRADED A+
1. 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? - ANSWER-You must have her sign a scope of
appointment form, indicating which products she wishes to discuss,
and note on the form that she is a "walk in. " You may then proceed
with the discussion.
2. ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its
enrollees' information to market non-health related products such as
life insurance and annuities. To do so it must obtain authorization from
the enrollees. Which statement best describes the authorization
process? - ANSWER-Authorization may be obtained by directing a
beneficiary to a website to provide consent as long as the website
includes a mechanism for an electronic signature that is valid under
applicable law.
3. Agent Armstrong is employed by XYZ Agency, which is under contract
with ABC Health Plan, a Medicare Advantage (MA) plan that offers
plans in multiple states. XYZ Agency maintains a website marketing
the MA plans with which it has contracts. Agent Armstrong follows up
with individuals who request more information about ABC MA plans via
the website and tries to persuade them to enroll in ABC plans. What
statement best describes the marketing and compliance rules that
apply to Agent Armstrong? - ANSWER-Agent Armstrong needs to be
licensed and appointed in every state in which beneficiaries to whom
he markets ABC MA plans are located.
4. Agent Jennings makes a presentation on Medicare advertised as an
educational event. Agent Jennings distributes materials that are solely
educational in nature. 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? - ANSWER-Yes. When
an event has been advertised as "educational," discussing plan-
specific premiums is impermissible.
5. 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? - ANSWER--Tell prospect Jerry
Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
6. Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage
plan during the Annual Open Enrollment Period. Ralph's effective
enrollment date is January 1st. Ralph disenrolls on February 12th
because he discovers that the plan does not cover services furnished
by several of his longtime providers. Which of the following
statements best describes the impact of Ralph's action upon Agent
Lopez's compensation? - ANSWER-Agent Lopez's entire compensation
must be recouped because Ralph disenrolled within 3 months of
enrollment.
7. 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? - ANSWER-Marketing representatives may
initiate electronic contact through e-mail but an opt-out process must
be provided
8. All plans must cover at least the standard Part D coverage or its
actuarial equivalent. Which of the following statements best describes
some of the costs a beneficiary would incur for prescription drugs
under the standard coverage? - ANSWER--Standard Part D coverage
would require payment of an annual deductible, and once past the
catastrophic coverage threshold, the beneficiary pays whichever is
, greater of either the co-pays for generic and brand name drugs or
coinsurance of 5%.
9. Anita Magri will turn age 65 in August 2020. 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 Part F plan 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? - ANSWER--You are sorry to disappoint Anita but a
Medigap Part 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.
10. 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? - ANSWER--C-SNP
11. 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? - 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.
12. During a sales presentation, your client asks you whether the
Medicare agency recommends that she sign up for your plan or stay in
Original Medicare. What should you tell her? - ANSWER-Tell her that
the Medicare agency does not endorse or recommend any plan.
13. Juan Perez, who is turning age 65 next month, intends to work
for several more years at Smallcap, Incorporated. Smallcap has a
CORRECT ANSWERS /GRADED A+
1. 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? - ANSWER-You must have her sign a scope of
appointment form, indicating which products she wishes to discuss,
and note on the form that she is a "walk in. " You may then proceed
with the discussion.
2. ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its
enrollees' information to market non-health related products such as
life insurance and annuities. To do so it must obtain authorization from
the enrollees. Which statement best describes the authorization
process? - ANSWER-Authorization may be obtained by directing a
beneficiary to a website to provide consent as long as the website
includes a mechanism for an electronic signature that is valid under
applicable law.
3. Agent Armstrong is employed by XYZ Agency, which is under contract
with ABC Health Plan, a Medicare Advantage (MA) plan that offers
plans in multiple states. XYZ Agency maintains a website marketing
the MA plans with which it has contracts. Agent Armstrong follows up
with individuals who request more information about ABC MA plans via
the website and tries to persuade them to enroll in ABC plans. What
statement best describes the marketing and compliance rules that
apply to Agent Armstrong? - ANSWER-Agent Armstrong needs to be
licensed and appointed in every state in which beneficiaries to whom
he markets ABC MA plans are located.
4. Agent Jennings makes a presentation on Medicare advertised as an
educational event. Agent Jennings distributes materials that are solely
educational in nature. 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? - ANSWER-Yes. When
an event has been advertised as "educational," discussing plan-
specific premiums is impermissible.
5. 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? - ANSWER--Tell prospect Jerry
Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
6. Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage
plan during the Annual Open Enrollment Period. Ralph's effective
enrollment date is January 1st. Ralph disenrolls on February 12th
because he discovers that the plan does not cover services furnished
by several of his longtime providers. Which of the following
statements best describes the impact of Ralph's action upon Agent
Lopez's compensation? - ANSWER-Agent Lopez's entire compensation
must be recouped because Ralph disenrolled within 3 months of
enrollment.
7. 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? - ANSWER-Marketing representatives may
initiate electronic contact through e-mail but an opt-out process must
be provided
8. All plans must cover at least the standard Part D coverage or its
actuarial equivalent. Which of the following statements best describes
some of the costs a beneficiary would incur for prescription drugs
under the standard coverage? - ANSWER--Standard Part D coverage
would require payment of an annual deductible, and once past the
catastrophic coverage threshold, the beneficiary pays whichever is
, greater of either the co-pays for generic and brand name drugs or
coinsurance of 5%.
9. Anita Magri will turn age 65 in August 2020. 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 Part F plan 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? - ANSWER--You are sorry to disappoint Anita but a
Medigap Part 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.
10. 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? - ANSWER--C-SNP
11. 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? - 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.
12. During a sales presentation, your client asks you whether the
Medicare agency recommends that she sign up for your plan or stay in
Original Medicare. What should you tell her? - ANSWER-Tell her that
the Medicare agency does not endorse or recommend any plan.
13. Juan Perez, who is turning age 65 next month, intends to work
for several more years at Smallcap, Incorporated. Smallcap has a
