AHIP Combined Set Final EXAM comprehensive
questions and verified accurate solution (detailed &
elaborated) 2025 TEST!!
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? -
(ANSWER)a. 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 from non-network providers and pay cost-sharing
due under Original Medicare.
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. - (ANSWER)Ms. Lopez is an independent agent
under contract with MarketCo, a third-party marketing organization. MarketCo
has a contract with BestCare health plan, a Medicare Advantage (MA)
organization, to offer marketing services through its 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.
Mr. Edwards, a marketing representative of the ACME Insurance Company,
scheduled a marketing event and 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? - (ANSWER)a. He can do this
because the estimated number of attendees is based on the venue size and
response rate and the value of the gift does not exceed $15.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she can go to for her health care. What should you tell her? -
(ANSWER)b. Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will have a higher cost-sharing amount if she sees
a provider who/that is not a part of the PPO network.
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? - (ANSWER)c. Tell Julia
that you will meet with her to explain Medicare and should she be interested you
can accept and submit an enrollment request, since this is an initial enrollment
qualifying her for a special enrollment period.
,Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus
covered by both Medicare and Medicaid. He decides to enroll in a Medicare
Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a
Medicare covered service. How much The doctor may only collect from Mr. Rivera
the cost sharing allowable under the state's Medicaid program.may the doctor
collect from Mr. Rivera? - (ANSWER)The doctor may only collect from Mr. Rivera
the cost sharing allowable under the state's Medicaid program.
During a sales presentation in Ms. Sullivan's home, she tells you that she has
heard about a type of Medicare health plan known as Private Fee-for-Service
(PFFS). She wants to know if this would be available to her. What should you tell
her about PFFS plans? - (ANSWER)
Choose one answer. - (ANSWER)
- (ANSWER)a. A PFFS plan is a type of Medicare Supplement plan and she may
enroll in one if it is available in her area.
- (ANSWER)b. A PFFS plan is exactly the same as Original Medicare, only offered
by a private entity and she may enroll in one if it is available in her area.
- (ANSWER)c. PFFS plans are designed to cover only prescription drugs and if that
is the type of coverage she wants, she may enroll in one if it is available in her
area.
, - (ANSWER)d. A PFFS plan is one of the various types of Medicare Advantage
plans offered by private entities and she may enroll in one if it is available in her
area.
Question8 - (ANSWER)
Marks: 1 - (ANSWER)
During an appointment scheduled to discuss a Medicare Advantage Prescription
Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone
prescription drug plan (Part D plan) that his neighbor told him about. What should
his agent do? - (ANSWER)
Choose one answer. - (ANSWER)
- (ANSWER)a. Since Mr. Peters requested a description of the Part D plan, his
agent must leave the Part D plan brochure, but not an enrollment form, and
would have to schedule another appointment after at least 48 hours have passed
to discuss the Part D plan with Mr. Peters.
- (ANSWER)b. Since Mr. Peters requested a description of the Part D plan, his
agent must have Mr. Peters sign a new scope of appointment form that includes
Part D, and then the agent may discuss the Part D plan so Mr. Peters can compare
plans and make an informed enrollment choice during the appointment.
questions and verified accurate solution (detailed &
elaborated) 2025 TEST!!
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? -
(ANSWER)a. 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 from non-network providers and pay cost-sharing
due under Original Medicare.
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. - (ANSWER)Ms. Lopez is an independent agent
under contract with MarketCo, a third-party marketing organization. MarketCo
has a contract with BestCare health plan, a Medicare Advantage (MA)
organization, to offer marketing services through its 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.
Mr. Edwards, a marketing representative of the ACME Insurance Company,
scheduled a marketing event and 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? - (ANSWER)a. He can do this
because the estimated number of attendees is based on the venue size and
response rate and the value of the gift does not exceed $15.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she can go to for her health care. What should you tell her? -
(ANSWER)b. Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will have a higher cost-sharing amount if she sees
a provider who/that is not a part of the PPO network.
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? - (ANSWER)c. Tell Julia
that you will meet with her to explain Medicare and should she be interested you
can accept and submit an enrollment request, since this is an initial enrollment
qualifying her for a special enrollment period.
,Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus
covered by both Medicare and Medicaid. He decides to enroll in a Medicare
Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a
Medicare covered service. How much The doctor may only collect from Mr. Rivera
the cost sharing allowable under the state's Medicaid program.may the doctor
collect from Mr. Rivera? - (ANSWER)The doctor may only collect from Mr. Rivera
the cost sharing allowable under the state's Medicaid program.
During a sales presentation in Ms. Sullivan's home, she tells you that she has
heard about a type of Medicare health plan known as Private Fee-for-Service
(PFFS). She wants to know if this would be available to her. What should you tell
her about PFFS plans? - (ANSWER)
Choose one answer. - (ANSWER)
- (ANSWER)a. A PFFS plan is a type of Medicare Supplement plan and she may
enroll in one if it is available in her area.
- (ANSWER)b. A PFFS plan is exactly the same as Original Medicare, only offered
by a private entity and she may enroll in one if it is available in her area.
- (ANSWER)c. PFFS plans are designed to cover only prescription drugs and if that
is the type of coverage she wants, she may enroll in one if it is available in her
area.
, - (ANSWER)d. A PFFS plan is one of the various types of Medicare Advantage
plans offered by private entities and she may enroll in one if it is available in her
area.
Question8 - (ANSWER)
Marks: 1 - (ANSWER)
During an appointment scheduled to discuss a Medicare Advantage Prescription
Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone
prescription drug plan (Part D plan) that his neighbor told him about. What should
his agent do? - (ANSWER)
Choose one answer. - (ANSWER)
- (ANSWER)a. Since Mr. Peters requested a description of the Part D plan, his
agent must leave the Part D plan brochure, but not an enrollment form, and
would have to schedule another appointment after at least 48 hours have passed
to discuss the Part D plan with Mr. Peters.
- (ANSWER)b. Since Mr. Peters requested a description of the Part D plan, his
agent must have Mr. Peters sign a new scope of appointment form that includes
Part D, and then the agent may discuss the Part D plan so Mr. Peters can compare
plans and make an informed enrollment choice during the appointment.
