AHIP - Final examination
1. 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? - ANS-Baker and Charles are subject to CMS
2. compensation rules because they are paid by third parties. Able is not because
3. she is paid directly by a health plan.
4. 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? - ANS-This situation is considered a
"dual
5. enrollment" and CMS compensation rules are applied to the two plans at once and
independently of each other.
6. Agent Willis had several clients who disenrolled from the plans he represents during the
AEP to try new Medicare Advantage plans. Agent Willis believes that the choices they
made are not ideal for them and would like to get their business back during the
Medicare Advantage Open Enrollment Period (MA-OEP). What can agent Willis do? -
ANS-He can wait until October and send them information about the plans he
represents.
7. Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and
wonders what her options are for continuing MA-PD coverage. What would you say to
her in regard to a special enrollment period (SEP)? - ANS-
8. Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same
requirements as the plans themselves. How should you respond to such a statement? -
ANS-Your coworker is not correct. Marketing on behalf of a plan is considered marketing
by the plan and requires that all contracted and employed agents comply with all
Medicare marketing rules.
9. Eleanor takes several high-cost prescription drugs. She would like to enroll in a
standalone Part D prescription drug plan that is available in her area. In what type of
Medicare Health Plan can she enroll if she also wishes to enroll in the standalone Part D
plan? - ANS-
10. Julia Harris is turning 66 in July, at which time she will retire. She has contacted your
office and requested a meeting so that she can learn about Medicare and the products
you represent. How should you respond? - ANS-
11. Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare
Advantage (MA) health plans. This year she has decided to focus on non-MA products.
, What advice would you give Melanie if she wishes to continue to receive renewal fees? -
ANS-
12. Mr. Albert has heard about something called the Star Rating system for Medicare
Advantage plans. He asks you to explain it to him since he is interested in enrolling in a
plan that is newly available in his area. After you explain that it is the way for consumers
to judge plan performance, what else would you say? - ANS-??????
13. Beneficiaries who live in the service area of a 5-star plan and are enrolled in an MA or
PDP plan, or beginning in 2013, a Cost plan
14. Beneficiaries who live in the service area of a 5-star plan, are enrolled in Original
Medicare, and meet the eligibility requirements for Medicare Advantage or Part D plans
15. The SEP is available each year beginning on December 8 and may be used once
through November 30 of the following year. For example, the SEP for calendar year
2018 can be
16. used from December 8, 2017 through November 30, 2018.
17. Disenroll from an MA plan, PDP or Cost plan or
18. leave Original Medicare
19. Enroll in a 5-star MA plan, PDP or Cost plan
20. Eligible individuals may enroll in a 5-star plan
21. through 1-800-MEDICARE, Medicare.gov, or
22. directly through the 5-star plan.
23. Mr. Barker had surgery recently 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 a number
of services and items he thought would be fully covered. He called you to ask what he
could do? What could you tell him? - ANS-You can offer to review the plans appeal
process to help him ask the plan to review the coverage decision.
24. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap
plan to pick up costs not covered by that plan. What should you tell him? - ANS-It is
illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
besides, Medigap only works with Original Medicare.
25. Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for
Medicare as well. He is concerned about changes in his cost-sharing. What should you
tell him? - ANS-He should know that Medicaid will pay cost sharing only for services
provided by Medicaid participating providers.
26. Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan,
but does not want to be limited in terms of where he obtains his care. What should you
tell him about how a Medicare Cost Plan might fit his needs? - ANS-Cost plan enrollees
can choose to receive Medicare covered services under the plan's benefits by going to
plan network providers and paying plan cost sharing, or may receive services
27. from non-network providers and pay cost sharing due under Original Medicare.
28. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
1. 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? - ANS-Baker and Charles are subject to CMS
2. compensation rules because they are paid by third parties. Able is not because
3. she is paid directly by a health plan.
4. 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? - ANS-This situation is considered a
"dual
5. enrollment" and CMS compensation rules are applied to the two plans at once and
independently of each other.
6. Agent Willis had several clients who disenrolled from the plans he represents during the
AEP to try new Medicare Advantage plans. Agent Willis believes that the choices they
made are not ideal for them and would like to get their business back during the
Medicare Advantage Open Enrollment Period (MA-OEP). What can agent Willis do? -
ANS-He can wait until October and send them information about the plans he
represents.
7. Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and
wonders what her options are for continuing MA-PD coverage. What would you say to
her in regard to a special enrollment period (SEP)? - ANS-
8. Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same
requirements as the plans themselves. How should you respond to such a statement? -
ANS-Your coworker is not correct. Marketing on behalf of a plan is considered marketing
by the plan and requires that all contracted and employed agents comply with all
Medicare marketing rules.
9. Eleanor takes several high-cost prescription drugs. She would like to enroll in a
standalone Part D prescription drug plan that is available in her area. In what type of
Medicare Health Plan can she enroll if she also wishes to enroll in the standalone Part D
plan? - ANS-
10. Julia Harris is turning 66 in July, at which time she will retire. She has contacted your
office and requested a meeting so that she can learn about Medicare and the products
you represent. How should you respond? - ANS-
11. Last year Agent Melanie Meyers marketed and enrolled several clients in Medicare
Advantage (MA) health plans. This year she has decided to focus on non-MA products.
, What advice would you give Melanie if she wishes to continue to receive renewal fees? -
ANS-
12. Mr. Albert has heard about something called the Star Rating system for Medicare
Advantage plans. He asks you to explain it to him since he is interested in enrolling in a
plan that is newly available in his area. After you explain that it is the way for consumers
to judge plan performance, what else would you say? - ANS-??????
13. Beneficiaries who live in the service area of a 5-star plan and are enrolled in an MA or
PDP plan, or beginning in 2013, a Cost plan
14. Beneficiaries who live in the service area of a 5-star plan, are enrolled in Original
Medicare, and meet the eligibility requirements for Medicare Advantage or Part D plans
15. The SEP is available each year beginning on December 8 and may be used once
through November 30 of the following year. For example, the SEP for calendar year
2018 can be
16. used from December 8, 2017 through November 30, 2018.
17. Disenroll from an MA plan, PDP or Cost plan or
18. leave Original Medicare
19. Enroll in a 5-star MA plan, PDP or Cost plan
20. Eligible individuals may enroll in a 5-star plan
21. through 1-800-MEDICARE, Medicare.gov, or
22. directly through the 5-star plan.
23. Mr. Barker had surgery recently 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 a number
of services and items he thought would be fully covered. He called you to ask what he
could do? What could you tell him? - ANS-You can offer to review the plans appeal
process to help him ask the plan to review the coverage decision.
24. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap
plan to pick up costs not covered by that plan. What should you tell him? - ANS-It is
illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
besides, Medigap only works with Original Medicare.
25. Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for
Medicare as well. He is concerned about changes in his cost-sharing. What should you
tell him? - ANS-He should know that Medicaid will pay cost sharing only for services
provided by Medicaid participating providers.
26. Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan,
but does not want to be limited in terms of where he obtains his care. What should you
tell him about how a Medicare Cost Plan might fit his needs? - ANS-Cost plan enrollees
can choose to receive Medicare covered services under the plan's benefits by going to
plan network providers and paying plan cost sharing, or may receive services
27. from non-network providers and pay cost sharing due under Original Medicare.
28. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
