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,AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025_2026 ACTUAL
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Terms in this set (360)
Mr. Davies is turning 65 next month. He would like to a. Cost plan enrollees can choose to receive Medicare covered services under
enroll in a Medicare health plan, but does not want to be the plan's benefits by going to plan network providers and paying plan cost
limited in terms of where he obtains his care. What sharing, or may receive services from non-network providers and pay cost-
should you tell him about how a Medicare Cost Plan sharing due under Original Medicare.
might fit his needs?
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025_2026 ACTUAL
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EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025_2026 ACTUAL
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b. Ms. Lopez is considered a marketing representative of Ms. Lopez is an independent agent under contract with MarketCo, a third-party
BestCare and thus is obligated to comply with CMS marketing organization. MarketCo has a contract with BestCare health plan, a
marketing requirements, including those regarding using Medicare Advantage (MA) organization, to offer marketing services through its
only approved call scripts. contracted agents and agencies. Ms. Lopez returns calls to individuals who
contact MarketCo in response to its mailers promoting BestCare health plan.
Which of the following best describes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative of BestCare but is exempt
from the marketing rules regarding approved call scripts because she works
directly for MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those
regarding using only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about state licensure since she is
marketing an MA product subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a
third-party marketing organization she is exempt from CMS training requirements
that apply to BestCare captive agents.
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025_2026 ACTUAL
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Mr. Edwards, a marketing representative of the ACME a. He can do this because the estimated number of attendees is based on the
Insurance Company, scheduled a marketing event and venue size and response rate and the value of the gift does not exceed $15.
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?
Mrs. Ramos is considering a Medicare Advantage PPO b. Mrs. Ramos can obtain care from any provider who participates in Original
and has questions about which providers she can go to Medicare, but generally will have a higher cost-sharing amount if she sees a
for her health care. What should you tell her? provider who/that is not a part of the PPO network.
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025_2026 ACTUAL
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EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025_2026 ACTUAL
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