AHIP 2025 Final Exam 50 questions AND
ANSWERS
1. A Medicare beneficiary has walked into your office and asked that you take a seat down
together with her and talk her options beneath the Medicare Advantage program. Before
conducting this sort of dialogue, what must you do? - ANSWER-You have to have her
signal a scope of appointment form, indicating which products she wishes to
discuss. You may additionally then proceed with the dialogue.
2. Able, Baker, and Charles are engaged in the marketing to and enrollment of
beneficiaries into Medicare fitness plans. Mr. Able is an impartial agent paid immediately
by using a health plan. Ms. Baker is an impartial agent paid through a discipline
advertising company (FMO). Mr. Charles is an unbiased agent paid for his work by a
3rd-birthday party advertising and marketing enterprise (TMO). How do the CMS
compensation policies practice to those 3 marketers? - ANSWER-Baker and Charles
are concern to CMS reimbursement guidelines due to the fact they may be paid by
means of third events. Able is not due to the fact he is paid directly by way of a
health plan.
3. Agent Jennings makes a presentation on Medicare advertised as an academic event.
Agent Jennings distributes substances which might be solely instructional. However, she
offers a brief presentation that mentions plan-specific premiums. Is this a prohibited
interest at an event that has been marketed as instructional? - ANSWER-Yes. When an
occasion has been advertised as "academic," discussing plan-precise charges is
impermissible.
4. Anita Magri will flip age 65 in August 2023. Anita intends to join Original Medicare Part A
and Part B. She would additionally like to join a Medicare Supplement (Medigap) plan.
Anita's older neighbor Mel has instructed her about the Medigap Plan F wherein he's
enrolled. It not simplest provides foreign journey emergency blessings however also
covers his Medicare Part B deductible. Anita comes to you for advice. What need to you
inform her? - ANSWER-You are sorry to disappoint Anita, however a Medigap F
plan is not to be had to those who turn age 65 after January 1, 2020. Anita would
possibly alternatively remember different Medigap plans that offer foreign tour
benefits but do no longer cowl the Part B deductible.
5. By contacting plans available for your location, you have found out that the plan you
represent has a appreciably lower month-to-month top class than the others.
Furthermore, you spot that the plan you constitute has a completely unique advantages
bundle. What ought to you do to make sure your customers know approximately these
portions of facts? - ANSWER-You may additionally make comparisons among plans
if you may assist them with studies or statistical records and such comparisons
are factually based and referenced.
6. Dr. Elizabeth Brennan does not agreement with the ABC PFFS plan however accepts
the plan's terms and situations for price. Mary Rodgers sees Dr. Brennan for remedy.
, How an awful lot might also Dr. Brennan price? - ANSWER-Dr. Brennan can price
Mary Rogers no extra than the value sharing particular in the PFFS plan's phrases
and situation of charge which may also consist of balance billing as much as
15p.Cof the Medicare fee.
7. During a income presentation to Ms. Daley for a Medicare Advantage plan that has a
5-big name rating in customer support and care coordination, and acquired an normal
plan overall performance score of a four-superstar, which of the subsequent would be
the exceptional announcement to mention to her? - ANSWER-The Medicare
Advantage plan acquired a five-celebrity score in customer support and care
coordination with an average performance score of four stars.
8. Mr. And Mrs. Vaughn both take a specialised multivitamin prescription each day. Mr.
Vaughn takes a prescription to assist to regrow his hair. They are tense to have their
Medicare prescription drug plan cover those drug wishes. What should you inform them?
- ANSWER-Medicare prescription drug plans aren't accredited to cowl the
prescription medicines the Vaughns are interested by underneath Part D
coverage, but, plans can also cover them as supplemental advantages and the
Vaughns may want to check out that possibility.
9. Mr. Barker enjoys a cozy retirement income. He recently had surgical treatment and
expected that he would have sure services and gadgets blanketed by way of the plan
with minimum out-of-pocket costs because his MA-PD coverage has been superb.
However, when he received the invoice, he changed into amazed to peer massive
expenses in excess of his most out-of-pocket restriction that protected a few services
and gadgets he thought would be absolutely included. He known as you to ask what he
should do? What should you inform him? - ANSWER-You can provide to check the plans
enchantment procedure to help him ask the plan to review the coverage selection.
10.Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
insurance. He found a stand-on my own Medicare prescription drug plan in his place that
offers higher coverage than that available through his MA-PD plan and similarly, has a
low top rate. It may not cost him lots extra and, due to the fact he has the way to achieve
this, he needs to enroll in the stand-by myself prescription drug plan in addition to his
MA-PD plan. What should you inform him? - ANSWER-If Mr. Block enrolls inside the
stand-by myself Medicare prescription drug plan, he will be disenrolled from the
Medicare Advantage plan.
11.Mr. Chen is enrolled in his agency's organization health plan and might be retiring soon.
He would like to recognise his options due to the fact that he has decided to drop his
retiree coverage and is eligible for Medicare. What need to you inform him? -
ANSWER-Mr. Chen can disenroll from his organization-sponsored insurance to go
with a Medicare Advantage or Part D plan within 2 months of his disenrollment.
12.Mr. Ford enrolled in an MA-simplest plan in mid-November throughout the Annual
Election Period (AEP). On December 1, he calls you up and says that he has modified
his mind and would like to enroll in a MA-PD plan. What enrollment regulations would
practice in this example? - ANSWER-He could make as many enrollment changes as
he likes at some point of the Annual Election Period and the remaining choice
made earlier than the quit of the period could be the effective one as of January 1.
ANSWERS
1. A Medicare beneficiary has walked into your office and asked that you take a seat down
together with her and talk her options beneath the Medicare Advantage program. Before
conducting this sort of dialogue, what must you do? - ANSWER-You have to have her
signal a scope of appointment form, indicating which products she wishes to
discuss. You may additionally then proceed with the dialogue.
2. Able, Baker, and Charles are engaged in the marketing to and enrollment of
beneficiaries into Medicare fitness plans. Mr. Able is an impartial agent paid immediately
by using a health plan. Ms. Baker is an impartial agent paid through a discipline
advertising company (FMO). Mr. Charles is an unbiased agent paid for his work by a
3rd-birthday party advertising and marketing enterprise (TMO). How do the CMS
compensation policies practice to those 3 marketers? - ANSWER-Baker and Charles
are concern to CMS reimbursement guidelines due to the fact they may be paid by
means of third events. Able is not due to the fact he is paid directly by way of a
health plan.
3. Agent Jennings makes a presentation on Medicare advertised as an academic event.
Agent Jennings distributes substances which might be solely instructional. However, she
offers a brief presentation that mentions plan-specific premiums. Is this a prohibited
interest at an event that has been marketed as instructional? - ANSWER-Yes. When an
occasion has been advertised as "academic," discussing plan-precise charges is
impermissible.
4. Anita Magri will flip age 65 in August 2023. Anita intends to join Original Medicare Part A
and Part B. She would additionally like to join a Medicare Supplement (Medigap) plan.
Anita's older neighbor Mel has instructed her about the Medigap Plan F wherein he's
enrolled. It not simplest provides foreign journey emergency blessings however also
covers his Medicare Part B deductible. Anita comes to you for advice. What need to you
inform her? - ANSWER-You are sorry to disappoint Anita, however a Medigap F
plan is not to be had to those who turn age 65 after January 1, 2020. Anita would
possibly alternatively remember different Medigap plans that offer foreign tour
benefits but do no longer cowl the Part B deductible.
5. By contacting plans available for your location, you have found out that the plan you
represent has a appreciably lower month-to-month top class than the others.
Furthermore, you spot that the plan you constitute has a completely unique advantages
bundle. What ought to you do to make sure your customers know approximately these
portions of facts? - ANSWER-You may additionally make comparisons among plans
if you may assist them with studies or statistical records and such comparisons
are factually based and referenced.
6. Dr. Elizabeth Brennan does not agreement with the ABC PFFS plan however accepts
the plan's terms and situations for price. Mary Rodgers sees Dr. Brennan for remedy.
, How an awful lot might also Dr. Brennan price? - ANSWER-Dr. Brennan can price
Mary Rogers no extra than the value sharing particular in the PFFS plan's phrases
and situation of charge which may also consist of balance billing as much as
15p.Cof the Medicare fee.
7. During a income presentation to Ms. Daley for a Medicare Advantage plan that has a
5-big name rating in customer support and care coordination, and acquired an normal
plan overall performance score of a four-superstar, which of the subsequent would be
the exceptional announcement to mention to her? - ANSWER-The Medicare
Advantage plan acquired a five-celebrity score in customer support and care
coordination with an average performance score of four stars.
8. Mr. And Mrs. Vaughn both take a specialised multivitamin prescription each day. Mr.
Vaughn takes a prescription to assist to regrow his hair. They are tense to have their
Medicare prescription drug plan cover those drug wishes. What should you inform them?
- ANSWER-Medicare prescription drug plans aren't accredited to cowl the
prescription medicines the Vaughns are interested by underneath Part D
coverage, but, plans can also cover them as supplemental advantages and the
Vaughns may want to check out that possibility.
9. Mr. Barker enjoys a cozy retirement income. He recently had surgical treatment and
expected that he would have sure services and gadgets blanketed by way of the plan
with minimum out-of-pocket costs because his MA-PD coverage has been superb.
However, when he received the invoice, he changed into amazed to peer massive
expenses in excess of his most out-of-pocket restriction that protected a few services
and gadgets he thought would be absolutely included. He known as you to ask what he
should do? What should you inform him? - ANSWER-You can provide to check the plans
enchantment procedure to help him ask the plan to review the coverage selection.
10.Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
insurance. He found a stand-on my own Medicare prescription drug plan in his place that
offers higher coverage than that available through his MA-PD plan and similarly, has a
low top rate. It may not cost him lots extra and, due to the fact he has the way to achieve
this, he needs to enroll in the stand-by myself prescription drug plan in addition to his
MA-PD plan. What should you inform him? - ANSWER-If Mr. Block enrolls inside the
stand-by myself Medicare prescription drug plan, he will be disenrolled from the
Medicare Advantage plan.
11.Mr. Chen is enrolled in his agency's organization health plan and might be retiring soon.
He would like to recognise his options due to the fact that he has decided to drop his
retiree coverage and is eligible for Medicare. What need to you inform him? -
ANSWER-Mr. Chen can disenroll from his organization-sponsored insurance to go
with a Medicare Advantage or Part D plan within 2 months of his disenrollment.
12.Mr. Ford enrolled in an MA-simplest plan in mid-November throughout the Annual
Election Period (AEP). On December 1, he calls you up and says that he has modified
his mind and would like to enroll in a MA-PD plan. What enrollment regulations would
practice in this example? - ANSWER-He could make as many enrollment changes as
he likes at some point of the Annual Election Period and the remaining choice
made earlier than the quit of the period could be the effective one as of January 1.
