AHIP 2025/2026
A client wants to provide you with an enrollment utility on October 1 earlier than the beginning of
the Annual Election Period because he's leaving on excursion for 2 weeks and does no longer
need to neglect about turning it in. What ought to you inform him? - ANS-You need to inform him
you are not accredited to take the form. If he sends the shape at once to the plan, the plan will
procedure the enrollment on the day the Annual Election Period starts.
A Medicare beneficiary has walked into your office and asked that you take a seat down
together with her and talk her options underneath the Medicare Advantage program. Before
engaging in such a discussion, what should you do? - ANS-You should have her sign a scope of
appointment shape, indicating which products she needs to discuss. You might also then
proceed with the dialogue.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information
to marketplace non-health related products which includes life insurance and annuities. Which
announcement fine describes ABC's responsibility to its enrollees concerning advertising such
merchandise? - ANS-XXXIt need to gain a HIPAA grievance authorization from an enrollee that
indicates the plan or plan sponsor may additionally use their records for marketing functions.
Agent Armstrong is hired with the aid of XYZ Agency, which is below contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a internet site advertising and marketing the MA plans with which it has contracts.
Agent Armstrong follows up with folks who request greater statistics approximately ABC MA
plans through the internet site and attempts to persuade them to sign up for ABC plans. What
assertion best describes the advertising and compliance rules that observe to Agent Armstrong?
- ANS-Agent Armstrong needs to be certified and appointed in every state in which beneficiaries
to whom he markets ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an academic occasion. Agent
Jennings distributes substances which can be entirely educational. However, she offers a short
presentation that mentions plan-particular rates. Is this a prohibited pastime at an occasion that
has been advertised as educational? - ANS-Yes. When an event has been marketed as
"educational," discussing plan-particular rates is impermissible.
Agent John Miller is assembly with Jerry Smith, a new prospect. Jerry is presently enrolled in
Medicare Parts A and B. Jerry has also bought a Medicare Supplement (Medigap) plan which
he has had for numerous years. However, the plan does no longer offer drug blessings. How
would you advocate Agent John Miller to proceed? - ANS-Tell prospect Jerry Smith that he
ought to recollect adding a standalone Part D prescription drug coverage coverage to his
present coverage.
Agent Martinez desires to solicit Medicare Advantage prospects thru electronic mail and asks
you for advice as to whether that is feasible. What must you inform her? - ANS-Marketing
representatives might also provoke digital touch via e-mail but an choose-out process need to
be supplied.
, All plans ought to cover at least the usual Part D insurance or its actuarial equivalent. Which of
the following statements first-class describes a number of the expenses a beneficiary would
incur for prescription drugs beneath the same old insurance? - ANS-Standard Part D insurance
would require price of an annual deductible, and as soon as past the catastrophic coverage
threshold, the beneficiary pays whichever is greater of both the co-can pay for familiar and
emblem name drugs or coinsurance of 5%.
Another agent working in your business enterprise claims that due to the fact you aren't hired
via the Medicare Advantage plans that you constitute, you aren't concern to the equal
advertising requirements as the plans themselves. How should you reply to such a
announcement? - ANS-Your coworker is not accurate. Marketing on behalf of a plan is
considered advertising by the plan and requires that every one gotten smaller and employed
sellers observe all Medicare marketing rules.
Another agent you already know has engaged in misconduct that has been verified by way of
the plan she represented. What form of penalty might the plan impose in this character? -
ANS-The plan might also withhold commission, require retraining, record the misconduct to a
nation department of insurance or terminate the contract.
Daniel is a middle-income Medicare beneficiary. He has continual bronchitis, putting him at
excessive chance for pneumonia. Otherwise, he has no troubles functioning. Which sort of SNP
is possibly to be maximum appropriate for him? - ANS-C-SNP
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan however accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for remedy. How tons may
also Dr. Brennan price? - ANS-Dr. Brennan can rate Mary Rogers no extra than the cost sharing
particular in the PFFS plan's terms and condition of payment which may also include stability
billing up to 15% of the Medicare charge.
During a income presentation in Ms. Sullivan's home, she tells you that she has heard about a
sort of Medicare fitness plan called Private Fee-for-Service (PFFS). She wants to understand if
this will be to be had to her. What ought to you tell her approximately PFFS plans? - ANS-A
PFFS plan is one of the diverse sorts of Medicare Advantage plans supplied by using private
entities and she or he can also join in a single if it's miles available in her region.
During a income presentation, your patron asks you whether the Medicare employer
recommends that she join up on your plan or live in Original Medicare. What ought to you inform
her? - ANS-Tell her that the Medicare business enterprise does now not advocate or advocate
any plan.
Juan Perez, who's turning age 65 next month, intends to work for several extra years at
Smallcap, Incorporated. Smallcap has a group of workers of 15 personnel and offers
organisation-sponsored healthcare insurance. Juan is a naturalized citizen and has contributed
to the Medicare device for over twenty years. Juan asks you if he might be entitled to Medicare
and if he enrolls how so as to impact his agency-sponsored healthcare insurance. How would
you respond? - ANS-Juan is possibly to be eligible for Medicare once he turns age sixty five and
if he enrolls Medicare would emerge as the primary payor of his healthcare claims and Smallcap
does now not need to retain to provide him coverage akin to the ones underneath age 65 under
its corporation-backed institution health plan.
Melissa Meadows is a advertising representative for Best Care which has lately brought a
Medicare Advantage plan offering complete dental advantages for $15 consistent with month.
A client wants to provide you with an enrollment utility on October 1 earlier than the beginning of
the Annual Election Period because he's leaving on excursion for 2 weeks and does no longer
need to neglect about turning it in. What ought to you inform him? - ANS-You need to inform him
you are not accredited to take the form. If he sends the shape at once to the plan, the plan will
procedure the enrollment on the day the Annual Election Period starts.
A Medicare beneficiary has walked into your office and asked that you take a seat down
together with her and talk her options underneath the Medicare Advantage program. Before
engaging in such a discussion, what should you do? - ANS-You should have her sign a scope of
appointment shape, indicating which products she needs to discuss. You might also then
proceed with the dialogue.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information
to marketplace non-health related products which includes life insurance and annuities. Which
announcement fine describes ABC's responsibility to its enrollees concerning advertising such
merchandise? - ANS-XXXIt need to gain a HIPAA grievance authorization from an enrollee that
indicates the plan or plan sponsor may additionally use their records for marketing functions.
Agent Armstrong is hired with the aid of XYZ Agency, which is below contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a internet site advertising and marketing the MA plans with which it has contracts.
Agent Armstrong follows up with folks who request greater statistics approximately ABC MA
plans through the internet site and attempts to persuade them to sign up for ABC plans. What
assertion best describes the advertising and compliance rules that observe to Agent Armstrong?
- ANS-Agent Armstrong needs to be certified and appointed in every state in which beneficiaries
to whom he markets ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an academic occasion. Agent
Jennings distributes substances which can be entirely educational. However, she offers a short
presentation that mentions plan-particular rates. Is this a prohibited pastime at an occasion that
has been advertised as educational? - ANS-Yes. When an event has been marketed as
"educational," discussing plan-particular rates is impermissible.
Agent John Miller is assembly with Jerry Smith, a new prospect. Jerry is presently enrolled in
Medicare Parts A and B. Jerry has also bought a Medicare Supplement (Medigap) plan which
he has had for numerous years. However, the plan does no longer offer drug blessings. How
would you advocate Agent John Miller to proceed? - ANS-Tell prospect Jerry Smith that he
ought to recollect adding a standalone Part D prescription drug coverage coverage to his
present coverage.
Agent Martinez desires to solicit Medicare Advantage prospects thru electronic mail and asks
you for advice as to whether that is feasible. What must you inform her? - ANS-Marketing
representatives might also provoke digital touch via e-mail but an choose-out process need to
be supplied.
, All plans ought to cover at least the usual Part D insurance or its actuarial equivalent. Which of
the following statements first-class describes a number of the expenses a beneficiary would
incur for prescription drugs beneath the same old insurance? - ANS-Standard Part D insurance
would require price of an annual deductible, and as soon as past the catastrophic coverage
threshold, the beneficiary pays whichever is greater of both the co-can pay for familiar and
emblem name drugs or coinsurance of 5%.
Another agent working in your business enterprise claims that due to the fact you aren't hired
via the Medicare Advantage plans that you constitute, you aren't concern to the equal
advertising requirements as the plans themselves. How should you reply to such a
announcement? - ANS-Your coworker is not accurate. Marketing on behalf of a plan is
considered advertising by the plan and requires that every one gotten smaller and employed
sellers observe all Medicare marketing rules.
Another agent you already know has engaged in misconduct that has been verified by way of
the plan she represented. What form of penalty might the plan impose in this character? -
ANS-The plan might also withhold commission, require retraining, record the misconduct to a
nation department of insurance or terminate the contract.
Daniel is a middle-income Medicare beneficiary. He has continual bronchitis, putting him at
excessive chance for pneumonia. Otherwise, he has no troubles functioning. Which sort of SNP
is possibly to be maximum appropriate for him? - ANS-C-SNP
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan however accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for remedy. How tons may
also Dr. Brennan price? - ANS-Dr. Brennan can rate Mary Rogers no extra than the cost sharing
particular in the PFFS plan's terms and condition of payment which may also include stability
billing up to 15% of the Medicare charge.
During a income presentation in Ms. Sullivan's home, she tells you that she has heard about a
sort of Medicare fitness plan called Private Fee-for-Service (PFFS). She wants to understand if
this will be to be had to her. What ought to you tell her approximately PFFS plans? - ANS-A
PFFS plan is one of the diverse sorts of Medicare Advantage plans supplied by using private
entities and she or he can also join in a single if it's miles available in her region.
During a income presentation, your patron asks you whether the Medicare employer
recommends that she join up on your plan or live in Original Medicare. What ought to you inform
her? - ANS-Tell her that the Medicare business enterprise does now not advocate or advocate
any plan.
Juan Perez, who's turning age 65 next month, intends to work for several extra years at
Smallcap, Incorporated. Smallcap has a group of workers of 15 personnel and offers
organisation-sponsored healthcare insurance. Juan is a naturalized citizen and has contributed
to the Medicare device for over twenty years. Juan asks you if he might be entitled to Medicare
and if he enrolls how so as to impact his agency-sponsored healthcare insurance. How would
you respond? - ANS-Juan is possibly to be eligible for Medicare once he turns age sixty five and
if he enrolls Medicare would emerge as the primary payor of his healthcare claims and Smallcap
does now not need to retain to provide him coverage akin to the ones underneath age 65 under
its corporation-backed institution health plan.
Melissa Meadows is a advertising representative for Best Care which has lately brought a
Medicare Advantage plan offering complete dental advantages for $15 consistent with month.
