AHIP 2024 final exam
A client wants to give you an enrollment application on October 1 before the
beginning of the Annual Election Period because he is leaving on vacation for two
weeks and does not want to forget about turning it in. What should you tell him? -
ANS-You must tell him you are not permitted to take the form. If he sends the form
directly to the plan, the plan will process the enrollment on the day the Annual
Election Period begins.
\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. Which statement best describes ABC's obligation to its enrollees regarding
marketing such products? - ANS-b.
It must obtain a HIPAA compliant authorization from an enrollee that indicates the
plan or plan sponsor may use their information for marketing purposes.
\Agent Daniel Webber has properly set up a sales appointment to meet with client
Edward Young at Agent Webber's office. At the agreed upon appointment time, Mr.
Young arrives with his elderly neighbor - Clara Burton, who wants to learn about her
Medicare Advantage options. What should Agent Daniel Webber do? - ANS-
\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?
- ANS-Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
\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? -
ANS-Marketing representatives may initiate electronic contact through e-mail but an
opt-out process must be provided.
\Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area
that has suffered from major flooding that has been declared a major disaster by
both the Federal government and her state. As a result of dealing with the flooding
issues and being evacuated from her home, Edna missed her chance to enroll in MA
during her Initial Coverage Election Period. Felix lives in an area with a Medicare
Advantage plan with a 4-star rating that he would like to join. George dropped his
Medigap policy six months ago when he first enrolled in a Medicare Advantage plan.
He now wants to return to Original Medicare. Harriet has recently developed
diabetes and would like to enroll in a Medicare Advantage plan that focuses on care
for those with that disease. Which, if any, of these individuals would qualify for a
special election period (SEP)? - ANS-Edna would qualify for a SEP because
government officials have declared a major disaster for her area and she did not
enroll in MA during her ICEP due to the emergency. George would qualify for an
SEP because he enrolled in Medicare Advantage (MA) plan for the first time and
, would now like to return to Original Medicare within the first 12 months of his
enrollment. Harriet would also qualify for a SEP to enroll in a C-SNP because she
has developed a chronic condition. Felix would not qualify for a SEP since he seeks
to enroll in a 4-star not a 5-star MA plan.
\Hector Hernandez is an independent agent. Hector sells plans on behalf of three
Medicare Advantage organizations that offer a total of 10 plans but does not
represent all Medicare Advantage organizations offering plans that are available in
his area. Which of the following statements best describes any steps Hector is
required to take? - ANS-During the first minute of a sales call, Hector must send an
email to the prospect stating that "I represent 3 plans but not every plan available in
your area. Please contact Medicare.gov to get information on all your options.
\If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep
that plan, what type of Medicare health plan could the individual also enroll in,
without being automatically disenrolled from the stand-alone prescription drug plan?
- ANS-The beneficiary could enroll in a private fee-for-service (PFFS) plan that does
not include prescription drug coverage; a cost plan; or a Medicare Medical Savings
Account (MSA) plan.
\Juan Hernandez is turning 65 next month, Juan legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Juan has
worked at Smallcap Incorporated and contributed to the Medicare system. Juan
suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare
Advantage plan that you represent. How would you respond? - ANS-Juan is eligible
to enroll in a Medicare Advantage as long as he is entitled to Part A and enrolled in
Part B. Juan should go to the Social Security website to enroll in Medicare Part A
and B if he has not done so already. Once he is enrolled, he can choose a Medicare
Advantage plan.
\Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate
which provides Madeline with an annual income of approximately $130,000.
Madeline, who has only worked part-time for the last three years, will soon turn age
65 and hopes to enroll in Original Medicare. She comes to you for advice. What
should you tell her? - ANS-You should tell Madeline that she will be able to enroll in
Medicare Part A without paying monthly premiums due to her husband's long work
record and participation in the Medicare system. You should also tell Madeline that
she will pay Part B premiums at more than the standard lowest rate but less than the
highest rate due her substantial income.
\Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a
few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the Allcare
Medicare Advantage plan. What should you say? - ANS-Mildred may remain
enrolled in Allcare and make a hospice election. Hospice benefits will be paid for by
Original Medicare under Part A and Allcare will continue to pay for any non-hospice
services.
A client wants to give you an enrollment application on October 1 before the
beginning of the Annual Election Period because he is leaving on vacation for two
weeks and does not want to forget about turning it in. What should you tell him? -
ANS-You must tell him you are not permitted to take the form. If he sends the form
directly to the plan, the plan will process the enrollment on the day the Annual
Election Period begins.
\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. Which statement best describes ABC's obligation to its enrollees regarding
marketing such products? - ANS-b.
It must obtain a HIPAA compliant authorization from an enrollee that indicates the
plan or plan sponsor may use their information for marketing purposes.
\Agent Daniel Webber has properly set up a sales appointment to meet with client
Edward Young at Agent Webber's office. At the agreed upon appointment time, Mr.
Young arrives with his elderly neighbor - Clara Burton, who wants to learn about her
Medicare Advantage options. What should Agent Daniel Webber do? - ANS-
\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?
- ANS-Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
\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? -
ANS-Marketing representatives may initiate electronic contact through e-mail but an
opt-out process must be provided.
\Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area
that has suffered from major flooding that has been declared a major disaster by
both the Federal government and her state. As a result of dealing with the flooding
issues and being evacuated from her home, Edna missed her chance to enroll in MA
during her Initial Coverage Election Period. Felix lives in an area with a Medicare
Advantage plan with a 4-star rating that he would like to join. George dropped his
Medigap policy six months ago when he first enrolled in a Medicare Advantage plan.
He now wants to return to Original Medicare. Harriet has recently developed
diabetes and would like to enroll in a Medicare Advantage plan that focuses on care
for those with that disease. Which, if any, of these individuals would qualify for a
special election period (SEP)? - ANS-Edna would qualify for a SEP because
government officials have declared a major disaster for her area and she did not
enroll in MA during her ICEP due to the emergency. George would qualify for an
SEP because he enrolled in Medicare Advantage (MA) plan for the first time and
, would now like to return to Original Medicare within the first 12 months of his
enrollment. Harriet would also qualify for a SEP to enroll in a C-SNP because she
has developed a chronic condition. Felix would not qualify for a SEP since he seeks
to enroll in a 4-star not a 5-star MA plan.
\Hector Hernandez is an independent agent. Hector sells plans on behalf of three
Medicare Advantage organizations that offer a total of 10 plans but does not
represent all Medicare Advantage organizations offering plans that are available in
his area. Which of the following statements best describes any steps Hector is
required to take? - ANS-During the first minute of a sales call, Hector must send an
email to the prospect stating that "I represent 3 plans but not every plan available in
your area. Please contact Medicare.gov to get information on all your options.
\If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep
that plan, what type of Medicare health plan could the individual also enroll in,
without being automatically disenrolled from the stand-alone prescription drug plan?
- ANS-The beneficiary could enroll in a private fee-for-service (PFFS) plan that does
not include prescription drug coverage; a cost plan; or a Medicare Medical Savings
Account (MSA) plan.
\Juan Hernandez is turning 65 next month, Juan legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Juan has
worked at Smallcap Incorporated and contributed to the Medicare system. Juan
suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare
Advantage plan that you represent. How would you respond? - ANS-Juan is eligible
to enroll in a Medicare Advantage as long as he is entitled to Part A and enrolled in
Part B. Juan should go to the Social Security website to enroll in Medicare Part A
and B if he has not done so already. Once he is enrolled, he can choose a Medicare
Advantage plan.
\Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate
which provides Madeline with an annual income of approximately $130,000.
Madeline, who has only worked part-time for the last three years, will soon turn age
65 and hopes to enroll in Original Medicare. She comes to you for advice. What
should you tell her? - ANS-You should tell Madeline that she will be able to enroll in
Medicare Part A without paying monthly premiums due to her husband's long work
record and participation in the Medicare system. You should also tell Madeline that
she will pay Part B premiums at more than the standard lowest rate but less than the
highest rate due her substantial income.
\Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a
few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the Allcare
Medicare Advantage plan. What should you say? - ANS-Mildred may remain
enrolled in Allcare and make a hospice election. Hospice benefits will be paid for by
Original Medicare under Part A and Allcare will continue to pay for any non-hospice
services.
