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? - ANS-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? - ANS-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? -
ANS-Marketing representatives may initiate electronic contact through email 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)? - ANS-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? - 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.
\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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-He should know that Medicaid will pay cost sharing only for
services provided by Medicaid participating providers.
\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 Medicare. What should you tell him? - ANS-He may sign-up for
Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
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? - ANS-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? - ANS-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? -
ANS-Marketing representatives may initiate electronic contact through email 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)? - ANS-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? - 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.
\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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-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? - ANS-He should know that Medicaid will pay cost sharing only for
services provided by Medicaid participating providers.
\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 Medicare. What should you tell him? - ANS-He may sign-up for
Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
