AHIP FINAL EXAM VERSION B LATEST VERSION
2024-2025 COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+||BRAND NEW.
Save
Terms in this set (360)
Mr. Davies is turning 65 a. Cost plan enrollees can choose to receive
next month. He would like Medicare covered services under the plan's benefits
to enroll in a Medicare by going to plan network providers and paying plan
health plan, but does not cost sharing, or may receive services from non-
want to be limited in terms network providers and pay cost-sharing due under
of where he obtains his Original Medicare.
care. What should you tell
him about how a Medicare
Cost Plan might fit his
needs?
, 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?
b. Ms. Lopez is considered
a. Ms. Lopez is considered a marketing representative
a marketing representative
of BestCare but is exempt from the marketing rules
of BestCare and thus is
regarding approved call scripts because she works
obligated to comply with
directly for MarketCo.
CMS marketing
requirements, including
b. Ms. Lopez is considered a marketing representative
those regarding using only
of BestCare and thus is obligated to comply with CMS
approved call scripts.
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 a. He can do this because the estimated number of
representative of the attendees is based on the venue size and response
ACME Insurance rate and the value of the gift does not exceed $15.
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?
Mrs. Ramos is considering b. Mrs. Ramos can obtain care from any provider who
a Medicare Advantage participates in Original Medicare, but generally will
PPO and has questions have a higher cost-sharing amount if she sees a
about which providers she provider who/that is not a part of the PPO network.
can go to for her health
care. What should you tell
her?
Julia Harris is turning 66 in c. Tell Julia that you will meet with her to explain
July, at which time she will Medicare and should she be interested you can
retire. She has contacted accept and submit an enrollment request, since this is
your office and requested an initial enrollment qualifying her for a special
a meeting so that she can enrollment period.
learn about Medicare and
the products you
represent. How should
you respond?
, Mr. Rivera has Qualified The doctor may only collect from Mr. Rivera the cost
Medicare Beneficiary sharing allowable under the state's Medicaid program.
(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?
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?
Choose one 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.
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.
2024-2025 COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+||BRAND NEW.
Save
Terms in this set (360)
Mr. Davies is turning 65 a. Cost plan enrollees can choose to receive
next month. He would like Medicare covered services under the plan's benefits
to enroll in a Medicare by going to plan network providers and paying plan
health plan, but does not cost sharing, or may receive services from non-
want to be limited in terms network providers and pay cost-sharing due under
of where he obtains his Original Medicare.
care. What should you tell
him about how a Medicare
Cost Plan might fit his
needs?
, 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?
b. Ms. Lopez is considered
a. Ms. Lopez is considered a marketing representative
a marketing representative
of BestCare but is exempt from the marketing rules
of BestCare and thus is
regarding approved call scripts because she works
obligated to comply with
directly for MarketCo.
CMS marketing
requirements, including
b. Ms. Lopez is considered a marketing representative
those regarding using only
of BestCare and thus is obligated to comply with CMS
approved call scripts.
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 a. He can do this because the estimated number of
representative of the attendees is based on the venue size and response
ACME Insurance rate and the value of the gift does not exceed $15.
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?
Mrs. Ramos is considering b. Mrs. Ramos can obtain care from any provider who
a Medicare Advantage participates in Original Medicare, but generally will
PPO and has questions have a higher cost-sharing amount if she sees a
about which providers she provider who/that is not a part of the PPO network.
can go to for her health
care. What should you tell
her?
Julia Harris is turning 66 in c. Tell Julia that you will meet with her to explain
July, at which time she will Medicare and should she be interested you can
retire. She has contacted accept and submit an enrollment request, since this is
your office and requested an initial enrollment qualifying her for a special
a meeting so that she can enrollment period.
learn about Medicare and
the products you
represent. How should
you respond?
, Mr. Rivera has Qualified The doctor may only collect from Mr. Rivera the cost
Medicare Beneficiary sharing allowable under the state's Medicaid program.
(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?
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?
Choose one 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.
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.
