AHIP Extras 2027 with Complete Solutions
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?
a. Regular CMS and renewal compensation rules apply to the PDP enrollment, but
compensation is limited to $100 for the MSA health plan enrollment to recompense
CMS for contributions made to the enrollee's MSA account.
b. MSA Medicare health plans are subject to special rules limiting initial year
compensation to 50 percent of the fair market value (FMV) published annually by
CMS. Regular initial year enrollment rules apply to the PDP.
c. When an MSA Medicare health plan is combined with a PDP, initial and renewal
year(s) compensation is paid only for the MSA enrollment to recompense CMS for
contributions made to th - ANS-This situation is considered a "dual enrollment," and
CMS compensation rules are applied to the two plans at once and independently of
each other.
Ms. Chase is interested in discussing various Medicare Advantage (MA) Plans
available in her area with you. She has heard that MA plans have something called
a "maximum out-of-pocket" limit. She asks you to explain what this means. What
do you say?
a. Each year, CMS specifies an optional MOOP, which health plans can exceed or
lower.
b. Original Medicare, not MA plans, have a maximum out-of-pocket limit, for Part A
and Part B benefits.
c. MA plans have a maximum out-of-pocket limit, known as the "MOOP" for Part A
and Part B benefits. Once a plan member pays a specified amount of cost-sharing,
the health plan covers 80 percent of covered medical services.
d. MA plans have a maximum out-of-pocket limit, known as the "MOOP", for Part A
and Part B benefits. Once a plan member pays a specified amount of cost-sharing,
the health plan covers 100 percent of covered medical services. - ANS-MA plans
have a maximum out-of-pocket limit, known as the "MOOP", for Part A and Part B
benefits. Once a plan member pays a specified amount of cost-sharing, the health
plan covers 100 percent of covered medical services.
Agent Marvin Millner wants to reach out to his current clients for referrals. What
, advice would you give to Marvin?
a. CMS guidelines limit the value of gifts provided in exchange for referrals to a
value of $50 or less.
b. Marvin should understand that under CMS guidelines he can no longer provide
gifts, even of minimal value, in exchange for referrals.
c. Marvin should consult with the health plans he represents to determine whether
those plans impose requirements around beneficiary referrals.
d. CMS guidelines limit the value of gifts provided in exchange for referrals to a
value of $100 or less. - ANS-Marvin should consult with the health plans he
represents to determine whether those plans impose requirements around
beneficiary referrals
Mr. Perry is entitled to Medicare Part A but has not yet enrolled in Part B, even
though he is 69 years old. He would like to enroll in a Medicare Part D prescription
drug plan but is concerned that he will have to sign up for Part B as well in order to
qualify for enrollment in a Part D plan. What should you tell him?
a. He need not be entitled to Part A or enrolled in Part B to be eligible for the Part D
prescription drug benefit. He must only be aged 65 or older to qualify for
enrollment in Part D, so he can go ahead and enroll in a Part D prescription drug
plan.
b. He is eligible for the Part D prescription drug benefit because he is entitled to
Part A and he does not have to be enrolled in Part B.
c. He does not have to enroll in Part B but, must pay a penalty for his failure to do
so when he first turned 65. After that, he can enroll in a Part D prescription drug
plan.
d. He will have to enroll in Part B - ANS-He is eligible for the Part D prescription
drug benefit because he is entitled to Part A and he does not have to be enrolled in
Part B
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage
(MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the
neighbors have for senior citizens. What should Agent Tom Smith tell Mr. Moreno
about the kinds of food that can be provided to potential enrollees who attend the
sales presentation?
a. A meal cannot be provided, but light snacks would be permitted.
b. Any type of meal or food is allowed, as long as it is available to the general
public and not just those who are eligible to enroll in the plans.
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?
a. Regular CMS and renewal compensation rules apply to the PDP enrollment, but
compensation is limited to $100 for the MSA health plan enrollment to recompense
CMS for contributions made to the enrollee's MSA account.
b. MSA Medicare health plans are subject to special rules limiting initial year
compensation to 50 percent of the fair market value (FMV) published annually by
CMS. Regular initial year enrollment rules apply to the PDP.
c. When an MSA Medicare health plan is combined with a PDP, initial and renewal
year(s) compensation is paid only for the MSA enrollment to recompense CMS for
contributions made to th - ANS-This situation is considered a "dual enrollment," and
CMS compensation rules are applied to the two plans at once and independently of
each other.
Ms. Chase is interested in discussing various Medicare Advantage (MA) Plans
available in her area with you. She has heard that MA plans have something called
a "maximum out-of-pocket" limit. She asks you to explain what this means. What
do you say?
a. Each year, CMS specifies an optional MOOP, which health plans can exceed or
lower.
b. Original Medicare, not MA plans, have a maximum out-of-pocket limit, for Part A
and Part B benefits.
c. MA plans have a maximum out-of-pocket limit, known as the "MOOP" for Part A
and Part B benefits. Once a plan member pays a specified amount of cost-sharing,
the health plan covers 80 percent of covered medical services.
d. MA plans have a maximum out-of-pocket limit, known as the "MOOP", for Part A
and Part B benefits. Once a plan member pays a specified amount of cost-sharing,
the health plan covers 100 percent of covered medical services. - ANS-MA plans
have a maximum out-of-pocket limit, known as the "MOOP", for Part A and Part B
benefits. Once a plan member pays a specified amount of cost-sharing, the health
plan covers 100 percent of covered medical services.
Agent Marvin Millner wants to reach out to his current clients for referrals. What
, advice would you give to Marvin?
a. CMS guidelines limit the value of gifts provided in exchange for referrals to a
value of $50 or less.
b. Marvin should understand that under CMS guidelines he can no longer provide
gifts, even of minimal value, in exchange for referrals.
c. Marvin should consult with the health plans he represents to determine whether
those plans impose requirements around beneficiary referrals.
d. CMS guidelines limit the value of gifts provided in exchange for referrals to a
value of $100 or less. - ANS-Marvin should consult with the health plans he
represents to determine whether those plans impose requirements around
beneficiary referrals
Mr. Perry is entitled to Medicare Part A but has not yet enrolled in Part B, even
though he is 69 years old. He would like to enroll in a Medicare Part D prescription
drug plan but is concerned that he will have to sign up for Part B as well in order to
qualify for enrollment in a Part D plan. What should you tell him?
a. He need not be entitled to Part A or enrolled in Part B to be eligible for the Part D
prescription drug benefit. He must only be aged 65 or older to qualify for
enrollment in Part D, so he can go ahead and enroll in a Part D prescription drug
plan.
b. He is eligible for the Part D prescription drug benefit because he is entitled to
Part A and he does not have to be enrolled in Part B.
c. He does not have to enroll in Part B but, must pay a penalty for his failure to do
so when he first turned 65. After that, he can enroll in a Part D prescription drug
plan.
d. He will have to enroll in Part B - ANS-He is eligible for the Part D prescription
drug benefit because he is entitled to Part A and he does not have to be enrolled in
Part B
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage
(MA) and Part D plans that Agent Smith sells at the regular Tuesday brunch the
neighbors have for senior citizens. What should Agent Tom Smith tell Mr. Moreno
about the kinds of food that can be provided to potential enrollees who attend the
sales presentation?
a. A meal cannot be provided, but light snacks would be permitted.
b. Any type of meal or food is allowed, as long as it is available to the general
public and not just those who are eligible to enroll in the plans.
