AHIP Practice Exam ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health 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? - ✔️✔️Authorization may be obtained by directing a beneficiary to a website to provide consent Agent Harriet Walker has recently begun marketing Medicare Advantage and related products aimed at meeting the needs of senior citizens. Client Mildred Jones has expressed interest in a Medicare Advantage plan. It is now the beginning of September. If you were in Agent Walker's position, what would you do? - ✔️✔️Inquire whether the client qualifies for a special enrollment period, and if not, solicit an enrollment application once the annual open enrollment election period begins on October 15th. Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an independent agent who markets only to employer and union groups. CMS marketing representative compensation rules generally apply to: - ✔️✔️Betty and Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply). Another agent working for your agency claims that because you are not employed by the Medicare Advantage plans that you represent, you are not subject to the same requirements as the plans themselves. How should you respond to such a statement? - ✔️✔️Your coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and required that all contracted and employed agents comply with all Medicare marketing rules. During a sales presentation to Ms Daley for a Medicare Advantage plan that has a 5 -
star rating in customer service and care coordination, and received an overall plan performance of a 4 -star, which of the following would be the correct statement to say to her? - ✔️✔️The Medicare Advantage plan received a 5 -star rating in customer service and care coordination with an overall performance rating of 4 -stars Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare Advantage (MA) health plans. This year she has decided to focus on non -MA products. What advice would you Melanie if she wishes to continue to receive renewal fees? - ✔️✔️Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her? I. Commissions II. Bonuses III. Mileage reimbursement IV. Referral fees - ✔️✔️I, II, and IV only Mr. Bickford did not quite qualify for the extra help low -income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him? - ✔️✔️He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. Mr. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him? - ✔️✔️Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but h e also wants prescription drug coverage. What should you tell him? - ✔️✔️Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. Mr. Chen has heard about a Medical Savings Account (MSA), but wants to know if it is just about saving money, or if he will get insurance coverage for his health care expenditures as well. What should you tell him? - ✔️✔️Under the Medicare Advantage program, a MSA plan involves the combination of a high deductible health plan and a savings account for health expenses. Medicare will make contributions to this savings account to help him pay his health care expenses while in the deductible. Mr. Cole has been a Medicaid beneficiary for sometime, and recently qualified for Medicare as well. He is concerned about changes in his cost -sharing. What should you tell him? - ✔️✔️He should know that Medicaid will pay cost0sharing only for services provided by Medicaid participating providers. Mr. Davis is 52 years old and has recently been diagnosed with end -stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? - ✔️✔️He may sign -up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatment starts. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should you tell him? - ✔️✔️Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. Mr. Fitzgerald is selling his home to permanently move into a retirement facility near his daughter in a neighboring state. He has a stand -alone prescription drug plan, and has learned it is not available where he is moving. He doesn't know what he should do. What can you tell him? - ✔️✔️Because he is moving outside of the service area, the plan must automatically disenroll him. He will have a special election period to select a new plan. Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Private Fee -for-Service (PFFS) plan, what will he have to do? - ✔️✔️He will have to enroll in Part B prior to enrolling in the PFFS plan. Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not been changed, he is keeping the same Part D plan and the benefits, cost -sharing, and coverage of his drugs are all the same as last year. He asked what to expect for this year about his out -of-pocket costs. What could you tell him? - ✔️✔️Because he reached the coverage gap last year, he will probably reah it again this year close to the same time. Mr. McTaggert notes that a Private Fee -for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? - ✔️✔️Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and conditions and agrees to accept them. Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What advice would you give him regarding his health coverage options? - ✔️✔️His open enrollment period as an institutionalized individual will continue for two months after the month he moves out of the facility. Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice that his employer is cutting back on prescription drug benefits, and as of June his coverage will no longer be creditable. He has come to you for advice. What
star rating in customer service and care coordination, and received an overall plan performance of a 4 -star, which of the following would be the correct statement to say to her? - ✔️✔️The Medicare Advantage plan received a 5 -star rating in customer service and care coordination with an overall performance rating of 4 -stars Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare Advantage (MA) health plans. This year she has decided to focus on non -MA products. What advice would you Melanie if she wishes to continue to receive renewal fees? - ✔️✔️Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. Monica is an agent focused on serving seniors eligible for Medicare. As she reviews her records, she is trying to determine which of the following items are considered compensation. What do you tell her? I. Commissions II. Bonuses III. Mileage reimbursement IV. Referral fees - ✔️✔️I, II, and IV only Mr. Bickford did not quite qualify for the extra help low -income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug costs. What should you tell him? - ✔️✔️He could check with the manufacturers of his medications to see if they offer an assistance program to help people with limited means obtain the medications they need. Alternatively, he could check to see whether his state has a pharmacy assistance program to help him with his expenses. Mr. Buck has several family members who died from different cancers. He wants to know if Medicare covers cancer screening. What should you tell him? - ✔️✔️Medicare covers periodic performance of a range of screening tests that are meant to provide early detection of disease. Mr. Buck will need to check specific tests before obtaining them to see if they will be covered. Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies under a program known as Medicare Advantage (MA), not by the government. He likes Original Medicare and does not want to sign up for an MA product, but h e also wants prescription drug coverage. What should you tell him? - ✔️✔️Mr. Carlini can stay with Original Medicare and also enroll in a Medicare prescription drug plan through a private company that has contracted with the government to provide only such drug coverage to eligible Medicare beneficiaries. Mr. Chen has heard about a Medical Savings Account (MSA), but wants to know if it is just about saving money, or if he will get insurance coverage for his health care expenditures as well. What should you tell him? - ✔️✔️Under the Medicare Advantage program, a MSA plan involves the combination of a high deductible health plan and a savings account for health expenses. Medicare will make contributions to this savings account to help him pay his health care expenses while in the deductible. Mr. Cole has been a Medicaid beneficiary for sometime, and recently qualified for Medicare as well. He is concerned about changes in his cost -sharing. What should you tell him? - ✔️✔️He should know that Medicaid will pay cost0sharing only for services provided by Medicaid participating providers. Mr. Davis is 52 years old and has recently been diagnosed with end -stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? - ✔️✔️He may sign -up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatment starts. Mr. Diaz continued working with his company and was insured under his employer's group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should you tell him? - ✔️✔️Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan. Mr. Fitzgerald is selling his home to permanently move into a retirement facility near his daughter in a neighboring state. He has a stand -alone prescription drug plan, and has learned it is not available where he is moving. He doesn't know what he should do. What can you tell him? - ✔️✔️Because he is moving outside of the service area, the plan must automatically disenroll him. He will have a special election period to select a new plan. Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he wants to enroll in a Private Fee -for-Service (PFFS) plan, what will he have to do? - ✔️✔️He will have to enroll in Part B prior to enrolling in the PFFS plan. Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not been changed, he is keeping the same Part D plan and the benefits, cost -sharing, and coverage of his drugs are all the same as last year. He asked what to expect for this year about his out -of-pocket costs. What could you tell him? - ✔️✔️Because he reached the coverage gap last year, he will probably reah it again this year close to the same time. Mr. McTaggert notes that a Private Fee -for-Service (PFFS) plan available in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? - ✔️✔️Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and conditions and agrees to accept them. Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What advice would you give him regarding his health coverage options? - ✔️✔️His open enrollment period as an institutionalized individual will continue for two months after the month he moves out of the facility. Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice that his employer is cutting back on prescription drug benefits, and as of June his coverage will no longer be creditable. He has come to you for advice. What
