AHIP
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? - questions and answers-You must have her sign a scope of
appointment form, indicating which products she wishes to discuss. You may then proceed with
the discussion
Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the
Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st.
Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's
service area. What impact will this have on Agent Higgins compensation? - questions and
answers-AB MA plan does not have to recoup Agent Higgins' compensation because she has
moved away from its service area.
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 did not understand that the plan did 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? - questions and answers-Agent Lopez's
entire compensation must be recouped because Ralph disenrolled within 3 months of
enrollment.
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? - questions and
answers-Marketing representatives may initiate electronic contact through e-mail but an opt-out
process must be provided. Correct
All plans must cover at least the standard Part D coverage or its actuarial equivalent. What
costs would a beneficiary incur for prescription drugs in 2019 under the standard coverage? -
questions and answers-Standard Part D coverage would require payment of an annual
deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both generics and
brand-name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap.
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 benefit package. What should you do to make sure your clients know
about these pieces of information? - questions and answers-you may make comparisons
between plans if you can support them by studies or statistical data and such comparisons are
factually based
, 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? - questions and answers-C-SNP
Dr. Elizabeth Brennan does not contract with the 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? - questions and answers-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 percent of the Medicare rate.
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 rating of a
4-star, which of the following would be the correct statement to say to her? - questions and
answers-The Medicare Advantage plan received a 5-star rating in customer service and care
coordination with an overall performance rating of 4-stars.
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? - questions
and answers-Tell her that the Medicare agency does not endorse or recommend any plan.
For which of the following individuals would a Cost Plan be most appropriate? - questions and
answers-Ms. Baker who is enrolled in Medicare Part B and is willing to continue paying Part B
premiums plus any plan premiums.
If Mr. Johannsen gains the Part D low-income subsidy, how does that affect his ability to enroll
or disenroll in a Part D plan? - questions and answers-He qualifies for a special enrollment
period and can enroll in or disenroll from a Part D plan and the subsidy will apply to the plan he
chooses.
Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP), but he lost the paper that
explains what he could do during the SEP. What can you tell him? - questions and answers-If
the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage.
Mr. Rice has coverage for medical services and medications through his employer's retiree plan.
He is considering switching to a Medicare prescription drug plan because his retiree plan does
not cover two important medications. What should he consider before making a change? -
questions and answers-If Mr. Rice drops his drug coverage through the retiree plan, he may not
be able to get it back and he also may lose his medical health coverage.
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 may the doctor
collect from Mr. Rivera? - questions and answers-The doctor may only collect from Mr. Rivera
the cost sharing allowable under the state's Medicaid program.
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? - questions and answers-You must have her sign a scope of
appointment form, indicating which products she wishes to discuss. You may then proceed with
the discussion
Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA) plan during the
Annual Open Enrollment Period. Mrs. O'Malley's effective enrollment date is January 1st.
Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the plan's
service area. What impact will this have on Agent Higgins compensation? - questions and
answers-AB MA plan does not have to recoup Agent Higgins' compensation because she has
moved away from its service area.
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 did not understand that the plan did 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? - questions and answers-Agent Lopez's
entire compensation must be recouped because Ralph disenrolled within 3 months of
enrollment.
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? - questions and
answers-Marketing representatives may initiate electronic contact through e-mail but an opt-out
process must be provided. Correct
All plans must cover at least the standard Part D coverage or its actuarial equivalent. What
costs would a beneficiary incur for prescription drugs in 2019 under the standard coverage? -
questions and answers-Standard Part D coverage would require payment of an annual
deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both generics and
brand-name drugs in the coverage gap, and co-pays or co-insurance after the coverage gap.
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 benefit package. What should you do to make sure your clients know
about these pieces of information? - questions and answers-you may make comparisons
between plans if you can support them by studies or statistical data and such comparisons are
factually based
, 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? - questions and answers-C-SNP
Dr. Elizabeth Brennan does not contract with the 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? - questions and answers-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 percent of the Medicare rate.
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 rating of a
4-star, which of the following would be the correct statement to say to her? - questions and
answers-The Medicare Advantage plan received a 5-star rating in customer service and care
coordination with an overall performance rating of 4-stars.
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? - questions
and answers-Tell her that the Medicare agency does not endorse or recommend any plan.
For which of the following individuals would a Cost Plan be most appropriate? - questions and
answers-Ms. Baker who is enrolled in Medicare Part B and is willing to continue paying Part B
premiums plus any plan premiums.
If Mr. Johannsen gains the Part D low-income subsidy, how does that affect his ability to enroll
or disenroll in a Part D plan? - questions and answers-He qualifies for a special enrollment
period and can enroll in or disenroll from a Part D plan and the subsidy will apply to the plan he
chooses.
Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP), but he lost the paper that
explains what he could do during the SEP. What can you tell him? - questions and answers-If
the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage.
Mr. Rice has coverage for medical services and medications through his employer's retiree plan.
He is considering switching to a Medicare prescription drug plan because his retiree plan does
not cover two important medications. What should he consider before making a change? -
questions and answers-If Mr. Rice drops his drug coverage through the retiree plan, he may not
be able to get it back and he also may lose his medical health coverage.
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 may the doctor
collect from Mr. Rivera? - questions and answers-The doctor may only collect from Mr. Rivera
the cost sharing allowable under the state's Medicaid program.
