AHIP 2020 Final Exam ACCURATE TESTED VERSIONS OF THE EXAM FROM 2025 TO 2026 | ACCURATE AND VERIFIED ANSWERS | NEXT GEN FORMAT | GUARANTEED PASS

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? 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. b. Yes, as long as the cost of entertainment is divided among attendees and does not exceed $15 per person. c. No, providing entertainment is prohibited at Medicare marketing events regardless of cost. d. Yes, if the attendees pay a small fee to cover the entertainment cost. Correct Answer: c. No, providing entertainment is prohibited at Medicare marketing events regardless of cost. Rationale: CMS prohibits entertainment or recreational activities (such as hiring magicians or providing entertainment) at Medicare marketing events, regardless of the cost or value per person. 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? a. She can only use in-network providers for all services. 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 is not part of the PPO network. c. She can visit any provider, and her costs will be the same in-network or out-of-network. d. She can only use out-of-network providers in an emergency. Correct 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 is not part of the PPO network. Rationale: Medicare Advantage PPO plans allow members to see any Medicare-approved provider, but costs are lower when using network providers. 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? a. Decline the meeting until after her birthday. b. Provide only printed materials and avoid discussing plan details. c. Tell Julia that you will meet with her to explain Medicare and, if she is interested, you can accept and submit an enrollment request since this is an initial enrollment qualifying her for a special enrollment period. d. Tell her to wait for the Annual Enrollment Period in October. Correct Answer: c. Tell Julia that you will meet with her to explain Medicare and, if she is interested, you can accept and submit an enrollment request since this is an initial enrollment qualifying her for a special enrollment period. Rationale: Julia qualifies for her Initial Enrollment Period (IEP) when she turns 65 and retires, so you can meet with her and assist with enrollment. 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? a. The full out-of-network cost-sharing amount. b. The standard Medicare Part B coinsurance. c. Nothing at all, since QMB enrollees have zero cost-sharing. d. The cost-sharing allowable under the state's Medicaid program. Correct Answer: d. The cost-sharing allowable under the state's Medicaid program. Rationale: Under the QMB program, providers cannot bill the beneficiary beyond Medicaidallowed amounts for Medicare-covered services. 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? a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available in her area. b. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity. c. PFFS plans are designed to cover only prescription drugs. 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. Correct 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. Rationale: PFFS is a type of Medicare Advantage plan that sets its own payment terms and conditions. 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? a. Leave the Part D brochure but schedule another appointment after 48 hours. b. Have Mr. Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan. c. Tell Mr. Peters he cannot receive any information about the Part D plan now. d. Discuss both plans now and return in 48 hours to complete enrollment. Correct Answer: b. Have Mr. Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan. Rationale: CMS requires agents to have a signed Scope of Appointment (SOA) for any plans discussed during a meeting. Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his savings account until it is exhausted, and then have his premiums withheld from his Social Security check. What should you tell him? a. He must select a single payment method for the entire year. b. As long as he fills out the paperwork 63 days before, he can switch to Social Security withholding. c. Social Security withholding is no longer an option. d. He can only use a checking account for automatic withdrawals. Correct Answer: a. He must select a single payment method for the entire year. Rationale: CMS rules generally require one consistent payment method throughout the plan year. Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage. She has recently received a letter from her Medigap carrier informing her that her drug coverage is not "creditable." She wants to know what this means. What should you tell her? a. Her Medigap coverage must be supplemented immediately. b. The coverage does not meet the minimum standard of Part D, and if she delays enrollment in Part D, she may pay a late enrollment penalty. c. Her plan must discontinue drug coverage. d. There is no need to change; her coverage is as good as Part D. Correct Answer: b. The coverage does not meet the minimum standard of Part D, and if she delays enrollment in Part D, she may pay a late enrollment penalty. Rationale: "Creditable coverage" means drug coverage at least as good as Part D. If not creditable, a penalty applies for late enrollment. Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism? a. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan Health Plan. b. Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election period (ICEP). c. Alice and Bob because each of them has had coverage through Spartan Health Plan. d. Alice, Bob, and Charlotte because electronic health record interoperability will allow Richard to access any needed information for their applications. Correct Answer: a. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan Health Plan. Rationale: The simplified enrollment mechanism is available when there is continuous coverage with the same organization transitioning from non-Medicare to Medicare coverage. Alice qualifies because she is staying with Spartan Health Plan without a gap. Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60 days of the year? a. When a formulary change is in response to a drug's removal from the market. b. When the Part D plan can demonstrate to CMS that no enrollee has accessed the medication in the past six months, the plan can remove the drug from its formulary within the first 60 days of the year. c. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any point during the year. d. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for the Part D plan and the Medicare program. Correct Answer: a. When a formulary change is in response to a drug's removal from the market. Rationale: Part D plans generally must maintain coverage for formulary drugs during the plan year, but an exception applies if the FDA removes a drug from the market or a manufacturer discontinues it.