AHIP 2025 Final Exam 50 with
Complete Solutions
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? - correct Answer-You must have her sign a
scope of appointment form, indicating which products she wishes to discuss. You may
then proceed with the discussion.
Able, Baker, and Charles are engaged in the marketing to and enrollment of
beneficiaries into Medicare health plans. Mr. Able is an independent agent paid directly
by a health plan. Ms. Baker is an independent agent paid through a field marketing
organization (FMO). Mr. Charles is an independent agent paid for his work by a third-
party marketing organization (TMO). How do the CMS compensation rules apply to
these three agents? - correct Answer-Baker and Charles are subject to CMS
compensation rules because they are paid by third parties. Able is not because he is
paid directly by a health plan.
Agent Jennings makes a presentation on Medicare advertised as an educational event.
Agent Jennings distributes materials that are solely educational. However, she gives a
brief presentation that mentions plan-specific premiums. Is this a prohibited activity at
an event that has been advertised as educational? - correct Answer-Yes. When an
event has been advertised as "educational," discussing plan-specific premiums is
impermissible.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap)
plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which he is
enrolled. It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Anita comes to you for advice. What should you tell her? -
correct Answer-You are sorry to disappoint Anita, but a Medigap F plan is no longer
available to those who turn age 65 after January 1, 2020. Anita might instead consider
other Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
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 benefits package. What should you do to make
sure your clients know about these pieces of information? - correct Answer-You may
make comparisons between plans if you can support them with studies or statistical
data and such comparisons are factually based and referenced.
, Dr. Elizabeth Brennan does not contract with the ABC 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? - correct Answer-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%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 best statement to say
to her? - correct Answer-The Medicare Advantage plan received a 5-star rating in
customer service and care coordination with an overall performance rating of 4 stars.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription to help to regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them? -
correct Answer-Medicare prescription drug plans are not permitted to cover the
prescription medications the Vaughns are interested in under Part D coverage,
however, plans may cover them as supplemental benefits and the Vaughns could look
into that possibility.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - correct Answer-You can offer to review the plans appeal process to help him ask
the plan to review the coverage decision.
Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that offers
better coverage than that available through his MA-PD plan and in addition, has a low
premium. It won't cost him much more and, because he has the means to do so, he
wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan.
What should you tell him? - correct Answer-If Mr. Block enrolls in the stand-alone
Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage
plan.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is
eligible for Medicare. What should you tell him? - correct Answer-Mr. Chen can disenroll
from his employer-sponsored coverage to elect a Medicare Advantage or Part D plan
within 2 months of his disenrollment.
Complete Solutions
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? - correct Answer-You must have her sign a
scope of appointment form, indicating which products she wishes to discuss. You may
then proceed with the discussion.
Able, Baker, and Charles are engaged in the marketing to and enrollment of
beneficiaries into Medicare health plans. Mr. Able is an independent agent paid directly
by a health plan. Ms. Baker is an independent agent paid through a field marketing
organization (FMO). Mr. Charles is an independent agent paid for his work by a third-
party marketing organization (TMO). How do the CMS compensation rules apply to
these three agents? - correct Answer-Baker and Charles are subject to CMS
compensation rules because they are paid by third parties. Able is not because he is
paid directly by a health plan.
Agent Jennings makes a presentation on Medicare advertised as an educational event.
Agent Jennings distributes materials that are solely educational. However, she gives a
brief presentation that mentions plan-specific premiums. Is this a prohibited activity at
an event that has been advertised as educational? - correct Answer-Yes. When an
event has been advertised as "educational," discussing plan-specific premiums is
impermissible.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap)
plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which he is
enrolled. It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Anita comes to you for advice. What should you tell her? -
correct Answer-You are sorry to disappoint Anita, but a Medigap F plan is no longer
available to those who turn age 65 after January 1, 2020. Anita might instead consider
other Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
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 benefits package. What should you do to make
sure your clients know about these pieces of information? - correct Answer-You may
make comparisons between plans if you can support them with studies or statistical
data and such comparisons are factually based and referenced.
, Dr. Elizabeth Brennan does not contract with the ABC 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? - correct Answer-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%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 best statement to say
to her? - correct Answer-The Medicare Advantage plan received a 5-star rating in
customer service and care coordination with an overall performance rating of 4 stars.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription to help to regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them? -
correct Answer-Medicare prescription drug plans are not permitted to cover the
prescription medications the Vaughns are interested in under Part D coverage,
however, plans may cover them as supplemental benefits and the Vaughns could look
into that possibility.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - correct Answer-You can offer to review the plans appeal process to help him ask
the plan to review the coverage decision.
Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that offers
better coverage than that available through his MA-PD plan and in addition, has a low
premium. It won't cost him much more and, because he has the means to do so, he
wishes to enroll in the stand-alone prescription drug plan in addition to his MA-PD plan.
What should you tell him? - correct Answer-If Mr. Block enrolls in the stand-alone
Medicare prescription drug plan, he will be disenrolled from the Medicare Advantage
plan.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is
eligible for Medicare. What should you tell him? - correct Answer-Mr. Chen can disenroll
from his employer-sponsored coverage to elect a Medicare Advantage or Part D plan
within 2 months of his disenrollment.
