AHIP 2025 FINAL EXAM 50 QUESTIONS
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.
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.
