AHIP 2025 FINAL EXAM 50
QUESTIONS WITH CORRECT
SOLUTIONS /GRADED A+
1. A Medicare beneficiary has walked into your office and requested that
you sit down with her and discuss her options under the Medicare
Advantage program. Before engaging in such a discussion, what
should you do? - ANSWER-You must have her sign a scope of
appointment form, indicating which products she wishes to discuss.
You may then proceed with the discussion.
2. Able, Baker, and Charles are engaged in the marketing to and
enrollment of beneficiaries into Medicare health plans. Mr. Able is an
independent agent paid directly by a health plan. Ms. Baker is an
independent agent paid through a field marketing organization (FMO).
Mr. Charles is an independent agent paid for his work by a third-party
marketing organization (TMO). How do the CMS compensation rules
apply to these three agents? - ANSWER-Baker and Charles are subject
to CMS compensation rules because they are paid by third parties.
Able is not because he is paid directly by a health plan.
3. Agent Jennings makes a presentation on Medicare advertised as an
educational event. Agent Jennings distributes materials that are solely
educational. 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? - ANSWER-Yes. When an event
has been advertised as "educational," discussing plan-specific
premiums is impermissible.
4. Anita Magri will turn age 65 in August 2023. Anita intends to enroll in
Original Medicare Part A and Part B. She would also like to enroll in a
Medicare Supplement (Medigap) plan. Anita's older neighbor Mel has
told her about the Medigap Plan F in which he is enrolled. It not only
provides foreign travel emergency benefits but also covers his
, Medicare Part B deductible. Anita comes to you for advice. What
should you tell her? - ANSWER-You are sorry to disappoint Anita, but a
Medigap F plan is no longer available to those who turn age 65 after
January 1, 2020. Anita might instead consider other Medigap plans
that offer foreign travel benefits but do not cover the Part B
deductible.
5. By contacting plans available in your area, you have learned that the
plan you represent has a significantly lower monthly premium than
the others. Furthermore, you see that the plan you represent has a
unique benefits package. What should you do to make sure your
clients know about these pieces of information? - ANSWER-You may
make comparisons between plans if you can support them with
studies or statistical data and such comparisons are factually based
and referenced.
6. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but
accepts the plan's terms and conditions for payment. Mary Rodgers
sees Dr. Brennan for treatment. How much may Dr. Brennan charge? -
ANSWER-Dr. Brennan can charge Mary Rogers no more than the cost
sharing specified in the PFFS plan's terms and condition of payment
which may include balance billing up to 15%of the Medicare rate.
7. During a sales presentation to Ms. Daley for a Medicare Advantage
plan that has a 5-star rating in customer service and care
coordination, and received an overall plan performance rating of a 4-
star, which of the following would be the best statement to say to her?
- ANSWER-The Medicare Advantage plan received a 5-star rating in
customer service and care coordination with an overall performance
rating of 4 stars.
8. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription
each day. Mr. Vaughn takes a prescription to help to regrow his hair.
They are anxious to have their Medicare prescription drug plan cover
these drug needs. What should you tell them? - ANSWER-Medicare
prescription drug plans are not permitted to cover the prescription
QUESTIONS WITH CORRECT
SOLUTIONS /GRADED A+
1. A Medicare beneficiary has walked into your office and requested that
you sit down with her and discuss her options under the Medicare
Advantage program. Before engaging in such a discussion, what
should you do? - ANSWER-You must have her sign a scope of
appointment form, indicating which products she wishes to discuss.
You may then proceed with the discussion.
2. Able, Baker, and Charles are engaged in the marketing to and
enrollment of beneficiaries into Medicare health plans. Mr. Able is an
independent agent paid directly by a health plan. Ms. Baker is an
independent agent paid through a field marketing organization (FMO).
Mr. Charles is an independent agent paid for his work by a third-party
marketing organization (TMO). How do the CMS compensation rules
apply to these three agents? - ANSWER-Baker and Charles are subject
to CMS compensation rules because they are paid by third parties.
Able is not because he is paid directly by a health plan.
3. Agent Jennings makes a presentation on Medicare advertised as an
educational event. Agent Jennings distributes materials that are solely
educational. 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? - ANSWER-Yes. When an event
has been advertised as "educational," discussing plan-specific
premiums is impermissible.
4. Anita Magri will turn age 65 in August 2023. Anita intends to enroll in
Original Medicare Part A and Part B. She would also like to enroll in a
Medicare Supplement (Medigap) plan. Anita's older neighbor Mel has
told her about the Medigap Plan F in which he is enrolled. It not only
provides foreign travel emergency benefits but also covers his
, Medicare Part B deductible. Anita comes to you for advice. What
should you tell her? - ANSWER-You are sorry to disappoint Anita, but a
Medigap F plan is no longer available to those who turn age 65 after
January 1, 2020. Anita might instead consider other Medigap plans
that offer foreign travel benefits but do not cover the Part B
deductible.
5. By contacting plans available in your area, you have learned that the
plan you represent has a significantly lower monthly premium than
the others. Furthermore, you see that the plan you represent has a
unique benefits package. What should you do to make sure your
clients know about these pieces of information? - ANSWER-You may
make comparisons between plans if you can support them with
studies or statistical data and such comparisons are factually based
and referenced.
6. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but
accepts the plan's terms and conditions for payment. Mary Rodgers
sees Dr. Brennan for treatment. How much may Dr. Brennan charge? -
ANSWER-Dr. Brennan can charge Mary Rogers no more than the cost
sharing specified in the PFFS plan's terms and condition of payment
which may include balance billing up to 15%of the Medicare rate.
7. During a sales presentation to Ms. Daley for a Medicare Advantage
plan that has a 5-star rating in customer service and care
coordination, and received an overall plan performance rating of a 4-
star, which of the following would be the best statement to say to her?
- ANSWER-The Medicare Advantage plan received a 5-star rating in
customer service and care coordination with an overall performance
rating of 4 stars.
8. Mr. and Mrs. Vaughn both take a specialized multivitamin prescription
each day. Mr. Vaughn takes a prescription to help to regrow his hair.
They are anxious to have their Medicare prescription drug plan cover
these drug needs. What should you tell them? - ANSWER-Medicare
prescription drug plans are not permitted to cover the prescription
