AHIP FINAL EXAM SCRIPT UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
◉ 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? Answer:
◉ Choose one answer. 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 Answer:
◉ Marks: 1 Answer:
◉ 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? Answer:
◉ Choose one answer. 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.
QUESTIONS AND CORRECT ANSWERS
◉ 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? Answer:
◉ Choose one answer. 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 Answer:
◉ Marks: 1 Answer:
◉ 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? Answer:
◉ Choose one answer. 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.
