AHIP - Final examination QUESTIONS
AND ANSWERS
1. Able, Baker, and Charles are engaged inside the advertising and marketing to and
enrollment of beneficiaries into Medicare health plans. Mr. Able is an impartial agent paid
at once by using a health plan. Ms. Baker is an independent agent paid via a field
advertising employer (FMO). Mr. Charles is an unbiased agent paid for his paintings
through a 3rd-party marketing corporation (TMO). How do the CMS reimbursement
guidelines follow to those three retailers? - ANSWER-Baker and Charles are difficulty
to CMS
reimbursement rules because they're paid by means of third events. Able isn't
always because
she is paid immediately by a fitness plan.
2. Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA)
Medicare fitness plan. The MSA plan does now not offer prescription drug coverage, so
Agent Roderick additionally enrolls Mrs. Martinez in a standalone prescription drug plan
(PDP). What CMS repayment rules follow to this case? - ANSWER-This scenario is
taken into consideration a "dual
enrollment" and CMS compensation policies are implemented to the 2 plans
straight away and independently of every different.
3. Agent Willis had several customers who disenrolled from the plans he represents at
some stage in the AEP to strive new Medicare Advantage plans. Agent Willis believes
that the alternatives they made aren't perfect for them and would love to get their
commercial enterprise lower back throughout the Medicare Advantage Open Enrollment
Period (MA-OEP). What can agent Willis do? - ANSWER-He can wait till October and
send them records approximately the plans he represents.
4. Alice is enrolled in a MA-PD plan. She makes a everlasting pass throughout the united
states and wonders what her options are for continuing MA-PD coverage. What might
you assert to her in regard to a special enrollment duration (SEP)? - ANSWER-
5. Another agent working on your company claims that due to the fact you aren't employed
by the Medicare Advantage plans that you represent, you are not subject to the same
requirements because the plans themselves. How need to you respond to one of these
statement? - ANSWER-Your coworker isn't always correct. Marketing on behalf of a
plan is considered advertising and marketing by using the plan and requires that
every one shriveled and employed dealers observe all Medicare advertising and
marketing policies.
6. Eleanor takes several excessive-fee prescription drugs. She would love to enroll in a
standalone Part D prescription drug plan that is available in her vicinity. In what sort of
Medicare Health Plan can she enroll if she additionally wishes to enroll in the standalone
Part D plan? - ANSWER-
, 7. Julia Harris is popping sixty six in July, at which era she can retire. She has contacted
your workplace and requested a assembly in order that she will study Medicare and the
products you constitute. How must you reply? - ANSWER-
8. Last 12 months Agent Melanie Meyers marketed and enrolled numerous clients in
Medicare Advantage (MA) fitness plans. This yr she has determined to focus on non-MA
merchandise. What recommendation could you provide Melanie if she desires to keep to
get hold of renewal charges? - ANSWER-
9. Mr. Albert has heard about something called the Star Rating gadget for Medicare
Advantage plans. He asks you to give an explanation for it to him since he's interested
by enrolling in a plan this is newly to be had in his place. After you explain that it's far the
way for customers to decide plan overall performance, what else might you say? -
ANSWER-??????
10.Beneficiaries who live inside the provider region of a 5-celebrity plan and are enrolled in
an MA or PDP plan, or beginning in 2013, a Cost plan
Beneficiaries who live inside the provider vicinity of a five-big name plan, are enrolled in
Original Medicare, and meet the eligibility necessities for Medicare Advantage or Part D
plans
The SEP is available each yr starting on December 8 and may be used once through
November 30 of the subsequent 12 months. For instance, the SEP for calendar year
2018 may be
used from December eight, 2017 through November 30, 2018.
Disenroll from an MA plan, PDP or Cost plan or
leave Original Medicare
Enroll in a five-big name MA plan, PDP or Cost plan
Eligible individuals may also enroll in a five-big name plan
via 1-800-MEDICARE, Medicare.Gov, or
immediately through the five-famous person plan.
Mr. Barker had surgical operation currently and expected that he would have positive
services and gadgets covered with the aid of the plan with minimal out-of-pocket prices
due to the fact his MA-PD insurance has been excellent. However, when he received the
invoice, he changed into surprised to see big fees in excess of his maximum
out-of-pocket restrict that covered a number of services and objects he concept might be
absolutely included. He known as you to invite what he could do? What ought to you tell
him? - ANSWER-You can provide to check the plans appeal procedure to assist
him ask the plan to check the coverage choice.
11.Mr. Capadona would love to purchase a Medicare Advantage (MA) plan and a Medigap
plan to choose up expenses no longer blanketed with the aid of that plan. What have to
you tell him? - ANSWER-It is unlawful in order to promote Mr. Capadona a Medigap
plan if he is enrolled in an MA plan, and except, Medigap most effective works with
Original Medicare.
12.Mr. Cole has been a Medicaid beneficiary for a while, and currently certified for Medicare
as nicely. He is concerned about changes in his price-sharing. What need to you tell
him? - ANSWER-He ought to understand that Medicaid pays cost sharing most
effective for services provided by Medicaid collaborating carriers.
AND ANSWERS
1. Able, Baker, and Charles are engaged inside the advertising and marketing to and
enrollment of beneficiaries into Medicare health plans. Mr. Able is an impartial agent paid
at once by using a health plan. Ms. Baker is an independent agent paid via a field
advertising employer (FMO). Mr. Charles is an unbiased agent paid for his paintings
through a 3rd-party marketing corporation (TMO). How do the CMS reimbursement
guidelines follow to those three retailers? - ANSWER-Baker and Charles are difficulty
to CMS
reimbursement rules because they're paid by means of third events. Able isn't
always because
she is paid immediately by a fitness plan.
2. Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA)
Medicare fitness plan. The MSA plan does now not offer prescription drug coverage, so
Agent Roderick additionally enrolls Mrs. Martinez in a standalone prescription drug plan
(PDP). What CMS repayment rules follow to this case? - ANSWER-This scenario is
taken into consideration a "dual
enrollment" and CMS compensation policies are implemented to the 2 plans
straight away and independently of every different.
3. Agent Willis had several customers who disenrolled from the plans he represents at
some stage in the AEP to strive new Medicare Advantage plans. Agent Willis believes
that the alternatives they made aren't perfect for them and would love to get their
commercial enterprise lower back throughout the Medicare Advantage Open Enrollment
Period (MA-OEP). What can agent Willis do? - ANSWER-He can wait till October and
send them records approximately the plans he represents.
4. Alice is enrolled in a MA-PD plan. She makes a everlasting pass throughout the united
states and wonders what her options are for continuing MA-PD coverage. What might
you assert to her in regard to a special enrollment duration (SEP)? - ANSWER-
5. Another agent working on your company claims that due to the fact you aren't employed
by the Medicare Advantage plans that you represent, you are not subject to the same
requirements because the plans themselves. How need to you respond to one of these
statement? - ANSWER-Your coworker isn't always correct. Marketing on behalf of a
plan is considered advertising and marketing by using the plan and requires that
every one shriveled and employed dealers observe all Medicare advertising and
marketing policies.
6. Eleanor takes several excessive-fee prescription drugs. She would love to enroll in a
standalone Part D prescription drug plan that is available in her vicinity. In what sort of
Medicare Health Plan can she enroll if she additionally wishes to enroll in the standalone
Part D plan? - ANSWER-
, 7. Julia Harris is popping sixty six in July, at which era she can retire. She has contacted
your workplace and requested a assembly in order that she will study Medicare and the
products you constitute. How must you reply? - ANSWER-
8. Last 12 months Agent Melanie Meyers marketed and enrolled numerous clients in
Medicare Advantage (MA) fitness plans. This yr she has determined to focus on non-MA
merchandise. What recommendation could you provide Melanie if she desires to keep to
get hold of renewal charges? - ANSWER-
9. Mr. Albert has heard about something called the Star Rating gadget for Medicare
Advantage plans. He asks you to give an explanation for it to him since he's interested
by enrolling in a plan this is newly to be had in his place. After you explain that it's far the
way for customers to decide plan overall performance, what else might you say? -
ANSWER-??????
10.Beneficiaries who live inside the provider region of a 5-celebrity plan and are enrolled in
an MA or PDP plan, or beginning in 2013, a Cost plan
Beneficiaries who live inside the provider vicinity of a five-big name plan, are enrolled in
Original Medicare, and meet the eligibility necessities for Medicare Advantage or Part D
plans
The SEP is available each yr starting on December 8 and may be used once through
November 30 of the subsequent 12 months. For instance, the SEP for calendar year
2018 may be
used from December eight, 2017 through November 30, 2018.
Disenroll from an MA plan, PDP or Cost plan or
leave Original Medicare
Enroll in a five-big name MA plan, PDP or Cost plan
Eligible individuals may also enroll in a five-big name plan
via 1-800-MEDICARE, Medicare.Gov, or
immediately through the five-famous person plan.
Mr. Barker had surgical operation currently and expected that he would have positive
services and gadgets covered with the aid of the plan with minimal out-of-pocket prices
due to the fact his MA-PD insurance has been excellent. However, when he received the
invoice, he changed into surprised to see big fees in excess of his maximum
out-of-pocket restrict that covered a number of services and objects he concept might be
absolutely included. He known as you to invite what he could do? What ought to you tell
him? - ANSWER-You can provide to check the plans appeal procedure to assist
him ask the plan to check the coverage choice.
11.Mr. Capadona would love to purchase a Medicare Advantage (MA) plan and a Medigap
plan to choose up expenses no longer blanketed with the aid of that plan. What have to
you tell him? - ANSWER-It is unlawful in order to promote Mr. Capadona a Medigap
plan if he is enrolled in an MA plan, and except, Medigap most effective works with
Original Medicare.
12.Mr. Cole has been a Medicaid beneficiary for a while, and currently certified for Medicare
as nicely. He is concerned about changes in his price-sharing. What need to you tell
him? - ANSWER-He ought to understand that Medicaid pays cost sharing most
effective for services provided by Medicaid collaborating carriers.
