AHIP MODULE 5 2026 CERTIFICATION
TEST QUESTIONS AND COMPLETE
SOLUTIONS FULL STUDY GUIDE GRADED
A+
⩥ 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:
TEST QUESTIONS AND COMPLETE
SOLUTIONS FULL STUDY GUIDE GRADED
A+
⩥ 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:
