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AHIP 2025 – 2026| MODULES 1-5 QUESTIONS & ANSWERS
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? - CORRECT ANSWER - 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? -
CORRECT ANSWER - 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 Chandler is conducting a sales presentation on senior issues
where he hopes to enroll some attendees in the Medicare Advantage
(MA) plans he represents. What action(s) may Agent Chandler take
during the event? - CORRECT ANSWER - Discuss plan specific
information such as premiums and benefits.
Agent Higgins helps Mrs. O'Malley enroll in AB Medicare Advantage
(MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's
effective enrollment date is January 1st. Subsequently, Mrs. O'Malley
disenrolls on February 12th following a move outside the plan's service
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area. What impact will this have on Agent Higgins' compensation? -
CORRECT ANSWER - AB MA plan does not have to recoup Agent
Higgins' compensation because she has moved away from its service
area.
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? - CORRECT ANSWER - Tell
prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage
plan during the Annual Open Enrollment Period. Ralph's effective
enrollment date is January 1st. Ralph disenrolls on February 12th
because he discovers that the plan does not cover services furnished by
several of his longtime providers. Which of the following statements
best describes the impact of Ralph's action upon Agent Lopez's
compensation? - CORRECT ANSWER - Agent Lopez's entire
compensation must be recouped because Ralph disenrolled within 3
months of enrollment.
Agent Mendez 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? - CORRECT ANSWER - Marketing representatives
may initiate electronic contact through e-mail but an opt-out process
must be provided.
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Agent Roderick enrolls retiree Mrs. Martinez in a medical savings
account (MSA) Medicare health plan. The MSA plan does not offer
prescription drug coverage, so Agent Roderick also enrolls Mrs. Martinez
in a standalone prescription drug plan (PDP). What CMS compensation
rules apply to this situation? - CORRECT ANSWER - This situation is
considered a "dual enrollment," and CMS compensation rules are
applied to the two plans at once and independently of each other.
Alice is a marketing representative employed by a health plan. Betty is a
captive agent of a health plan who markets for multiple plans and
sponsors. Carl is a captive agent who markets for only one plan/sponsor.
Denise is an independent agent who markets to different types of
groups. Edward is an independent agent who markets only to employer
and union groups. CMS marketing representative compensation rules
generally apply to: - CORRECT ANSWER - Betty and Denise, but not
Alice (the employee) or Carl or Edward (to whom exceptions apply).
Angel is new to the Medicare marketplace having previously been
focused on life insurance and disability income protection products. He
intends to conduct an educational seminar during the AEP at a local
hotel and then invite those who attend to a subsequent marketing
meeting to discuss the benefits of next year's plans. How would you
advise Angel? - CORRECT ANSWER - Angel should conduct the
education seminar as an early morning meeting and the marketing
meeting on the following day in the late afternoon so that there are at
least 12 hours between the two meetings.
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Another agent you know has engaged in misconduct that has been
verified by the plan she represented. What sort of penalty might the
plan impose on this individual? - CORRECT ANSWER - The plan may
withhold commission, require retraining, report the misconduct to a
state department of insurance or terminate the contract.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security
or Railroad Retirement Benefits on his 65th birthday. He was interested
in obtaining Medicare coverage and is eligible for premium-free Part A.
Before he could enroll in Medicare, his entire area was impacted by a
hurricane causing massive flooding and severe wind damage. The
Federal government declared this to be a natural disaster which has
recently ended. During this period Anthony's initial enrollment period
expired. Anthony asks you how he can now obtain Medicare coverage.
What should you say? - CORRECT ANSWER - Anthony is eligible for a
special enrollment period (SEP) because he missed an enrollment period
due to the impact of the Federally declared disaster. This SEP will allow
Anthony to enroll in Part B up to six months after the end of the
emergency declaration. Anthony may enroll in premium-free Part A at
any time and his Part A coverage will be retroactive for up to 6 months.
Archer works as a representative focused on the senior marketplace.
What would be considered prohibited activity by Archer? - CORRECT
ANSWER - Implying that only seniors can enroll in a Medicare
Advantage plan when meeting with Mr. Lynn, who is 58 but qualifies for
Medicare because he is disabled.
BestCare Health Plan has received a request from a state insurance
department in connection with the investigation of several marketing
AHIP 2025 – 2026| MODULES 1-5 QUESTIONS & ANSWERS
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? - CORRECT ANSWER - 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? -
CORRECT ANSWER - 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 Chandler is conducting a sales presentation on senior issues
where he hopes to enroll some attendees in the Medicare Advantage
(MA) plans he represents. What action(s) may Agent Chandler take
during the event? - CORRECT ANSWER - Discuss plan specific
information such as premiums and benefits.
Agent Higgins helps Mrs. O'Malley enroll in AB Medicare Advantage
(MA) plan during the Annual Open Enrollment Period. Mrs. O'Malley's
effective enrollment date is January 1st. Subsequently, Mrs. O'Malley
disenrolls on February 12th following a move outside the plan's service
,1
area. What impact will this have on Agent Higgins' compensation? -
CORRECT ANSWER - AB MA plan does not have to recoup Agent
Higgins' compensation because she has moved away from its service
area.
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? - CORRECT ANSWER - Tell
prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage
plan during the Annual Open Enrollment Period. Ralph's effective
enrollment date is January 1st. Ralph disenrolls on February 12th
because he discovers that the plan does not cover services furnished by
several of his longtime providers. Which of the following statements
best describes the impact of Ralph's action upon Agent Lopez's
compensation? - CORRECT ANSWER - Agent Lopez's entire
compensation must be recouped because Ralph disenrolled within 3
months of enrollment.
Agent Mendez 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? - CORRECT ANSWER - Marketing representatives
may initiate electronic contact through e-mail but an opt-out process
must be provided.
,1
Agent Roderick enrolls retiree Mrs. Martinez in a medical savings
account (MSA) Medicare health plan. The MSA plan does not offer
prescription drug coverage, so Agent Roderick also enrolls Mrs. Martinez
in a standalone prescription drug plan (PDP). What CMS compensation
rules apply to this situation? - CORRECT ANSWER - This situation is
considered a "dual enrollment," and CMS compensation rules are
applied to the two plans at once and independently of each other.
Alice is a marketing representative employed by a health plan. Betty is a
captive agent of a health plan who markets for multiple plans and
sponsors. Carl is a captive agent who markets for only one plan/sponsor.
Denise is an independent agent who markets to different types of
groups. Edward is an independent agent who markets only to employer
and union groups. CMS marketing representative compensation rules
generally apply to: - CORRECT ANSWER - Betty and Denise, but not
Alice (the employee) or Carl or Edward (to whom exceptions apply).
Angel is new to the Medicare marketplace having previously been
focused on life insurance and disability income protection products. He
intends to conduct an educational seminar during the AEP at a local
hotel and then invite those who attend to a subsequent marketing
meeting to discuss the benefits of next year's plans. How would you
advise Angel? - CORRECT ANSWER - Angel should conduct the
education seminar as an early morning meeting and the marketing
meeting on the following day in the late afternoon so that there are at
least 12 hours between the two meetings.
, 1
Another agent you know has engaged in misconduct that has been
verified by the plan she represented. What sort of penalty might the
plan impose on this individual? - CORRECT ANSWER - The plan may
withhold commission, require retraining, report the misconduct to a
state department of insurance or terminate the contract.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security
or Railroad Retirement Benefits on his 65th birthday. He was interested
in obtaining Medicare coverage and is eligible for premium-free Part A.
Before he could enroll in Medicare, his entire area was impacted by a
hurricane causing massive flooding and severe wind damage. The
Federal government declared this to be a natural disaster which has
recently ended. During this period Anthony's initial enrollment period
expired. Anthony asks you how he can now obtain Medicare coverage.
What should you say? - CORRECT ANSWER - Anthony is eligible for a
special enrollment period (SEP) because he missed an enrollment period
due to the impact of the Federally declared disaster. This SEP will allow
Anthony to enroll in Part B up to six months after the end of the
emergency declaration. Anthony may enroll in premium-free Part A at
any time and his Part A coverage will be retroactive for up to 6 months.
Archer works as a representative focused on the senior marketplace.
What would be considered prohibited activity by Archer? - CORRECT
ANSWER - Implying that only seniors can enroll in a Medicare
Advantage plan when meeting with Mr. Lynn, who is 58 but qualifies for
Medicare because he is disabled.
BestCare Health Plan has received a request from a state insurance
department in connection with the investigation of several marketing
