AHIP Final Exam Test Questions
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a website marketing the MA plans with which it has contracts. Agent
Armstrong follows up with individuals who request more information about ABC MA
plans via the website and tries to persuade them to enroll in ABC plans. What statement
best describes the marketing and compliance rules that apply to Agent Armstrong? -
Agent Armstrong needs to be licensed 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 educational event.
Agent Jennings distributes materials that are solely educational in nature. However, she
gives a brief presentation that mentions plan-specific premiums. Is this a prohibited
activity at an event that has been advertised as educational? - Yes. When an event has
been advertised as "educational," discussing plan-specific premiums is impermissible.
Agent Martinez 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? - Marketing
representatives may initiate electronic contact through e-mail but the subject line must
say "marketing" and an opt-out process must be provided.
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)? - She is likely to qualify for a SEP.
She can choose an effective date of up to three months after the month in which the
enrollment form is received by the new plan, but the effective date may not be earlier
than the date of her permanent move.
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? -
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.
During a sales presentation, your client asks you whether the Medicare agency
recommends that she sign up for your plan or stay in Original Medicare. What should
you tell her? - Tell her that the Medicare agency does not endorse or recommend any
plan.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to
come to their home to clear up a few questions. During the presentation, Mrs. Nunez
feels tired and tells you that her husband can finish things up. She goes to bed. At the
, end of your discussion, Mr. Nunez says that he wants to enroll both himself and his
wife. What should you do? - As long as she is able to do so, only Mrs. Nunez can sign
her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at
another time.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery 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? - You can offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any other
option he has for obtaining help with his considerable drug costs. What should you tell
him? - He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him? - He is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is
just about saving money, or if he will get insurance coverage for his health care
expenditures as well. What should you tell him? - Under the Medicare Advantage
program. an MSA plan involves the combination of high deductible health plan and
savings account for health expenses. Medicare will make contributions to this savings
account to help him pay his health care expenses while in the deductible.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is
eligible for Medicare. What should you tell him? - Mr. Chen can disenroll from his
employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2
months of his disenrollment, but he should revaluate if he really wants to drop his
employer coverage.
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? - He should know that Medicaid will pay cost sharing only for services provided
by Medicaid participating providers.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a website marketing the MA plans with which it has contracts. Agent
Armstrong follows up with individuals who request more information about ABC MA
plans via the website and tries to persuade them to enroll in ABC plans. What statement
best describes the marketing and compliance rules that apply to Agent Armstrong? -
Agent Armstrong needs to be licensed 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 educational event.
Agent Jennings distributes materials that are solely educational in nature. However, she
gives a brief presentation that mentions plan-specific premiums. Is this a prohibited
activity at an event that has been advertised as educational? - Yes. When an event has
been advertised as "educational," discussing plan-specific premiums is impermissible.
Agent Martinez 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? - Marketing
representatives may initiate electronic contact through e-mail but the subject line must
say "marketing" and an opt-out process must be provided.
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)? - She is likely to qualify for a SEP.
She can choose an effective date of up to three months after the month in which the
enrollment form is received by the new plan, but the effective date may not be earlier
than the date of her permanent move.
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? -
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.
During a sales presentation, your client asks you whether the Medicare agency
recommends that she sign up for your plan or stay in Original Medicare. What should
you tell her? - Tell her that the Medicare agency does not endorse or recommend any
plan.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to
come to their home to clear up a few questions. During the presentation, Mrs. Nunez
feels tired and tells you that her husband can finish things up. She goes to bed. At the
, end of your discussion, Mr. Nunez says that he wants to enroll both himself and his
wife. What should you do? - As long as she is able to do so, only Mrs. Nunez can sign
her enrollment form. Mrs. Nunez will have to wake up to sign her form or do so at
another time.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery 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? - You can offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any other
option he has for obtaining help with his considerable drug costs. What should you tell
him? - He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him? - He is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is
just about saving money, or if he will get insurance coverage for his health care
expenditures as well. What should you tell him? - Under the Medicare Advantage
program. an MSA plan involves the combination of high deductible health plan and
savings account for health expenses. Medicare will make contributions to this savings
account to help him pay his health care expenses while in the deductible.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is
eligible for Medicare. What should you tell him? - Mr. Chen can disenroll from his
employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2
months of his disenrollment, but he should revaluate if he really wants to drop his
employer coverage.
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? - He should know that Medicaid will pay cost sharing only for services provided
by Medicaid participating providers.
