AHIP FINAL EXAM TEST QUESTIONS AND
ANSWERS VERIFIED 100% CORRECT
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
thirdparty marketing organization (TMO). How do the CMS compensation
rules apply to these three agents? -ANSWER-- All three are treated as
independent agents under CMS compensation rules.
You have set up an appointment for an in-home sales presentation with Mrs.
Fernandez, who expressed
interest in the Medicare plans you represent. In preparation for the sales
presentation, what must you do? -ANSWER-- Prior to conducting the
presentation, obtain, and document having obtained her permission to visit, along
with her interest in the specific products you will present.
If you are to be in compliance with Medicare's guidance regarding educational
events, which of the following
would be acceptable activities? -ANSWER-- You may distribute
business cards to individuals who request information on how to contact
you for further details on the plan(s) you represent.
Mr. Chen has heard about a Medical Savings Account (MSA), but wants to know
if it is just about saving money, or if he will get insurance coverage for his health
care expenditures as well. What should you tell him? -ANSWER-- Under the
Medicare Advantage program, a MSA plan involves the combination of a
high deductible health plan and a savings account for health expenses. Medicare
will make contributions to this savings account to help him pay his health care
expenses while in the deductible.
,Under what conditions can a Medicare prescription drug plan reduce its coverage
for a given drug during the first 60 days of the year? -ANSWER-- When a
formulary change is in response to a drug's removal from the market.
Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare
Supplemental Insurance provides since his health care needs are different from his
wife's needs. What could
you tell Mr.Meoni? -ANSWER-- Medicare Supplemental Insurance
would help cover his Part A and Part B cost
sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services
that Medicare does not cover
Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached
age 68. He has heard that there is a premium penalty for those who did not sign up
for Part B when first eligible and wants to know how much he will have to pay.
What should you tell him? ANSWER-- Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
Mr. Roberts is enrolled in an MA plan. He recently suffered complications
following hip replacement surgery. As a result, he has spent the last three months
in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged.
What advice would you give him regarding his health coverage options? -
ANSWER-- His open enrollment period as an
institutionalized individual will continue for two months
after the month he moves out of the facility.
What impact, if any, will the Medicare Access and CHIP Reauthorization Act of
2015 (MACRA) have upon
Medigap plans? -ANSWER-- The Part B deductible will no longer be covered
for individuals newly eligible for Medicare starting January 1, 2020.
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should
you tell her? -ANSWER-- . Mrs. Radford must be entitled to Part A and enrolled
in Part B to enroll in Medicare
,Advantage
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for
that condition. However, she and her physicians feel that after her lengthy hospital
stay she will need a month
or two of nursing and rehabilitative care. What should you tell them about Original
Medicare's coverage of care
in a skilled nursing facility? -ANSWER-- Medicare will cover Mrs.
Shields' skilled nursing services provided during the first 20
days of her stay, after which she would have a coinsurance until she has been in the
facility for 100 days.
Mr. Polanski likes the cost of an HMO plan available in his area, but would like to
be able to visit one or two
doctors who aren't participating providers. He wants to know if the Point of
Service (POS) option available with some HMOs will be of any help in this
situation. What should you tell him? ANSWER-- The POS option might be a good
solution for him as it will allow him to visit out-ofnetwork providers, generally
without prior approval. However, he should be aware that it is likely he will have
to pay higher cost-sharing for services from out-of-network providers.
Mr. Lopez takes several high cost prescription drugs. He would like to enroll in a
standalone Part D prescription drug plan that is available in his area. In what type
of Medicare Health Plan can he enroll? -ANSWER-- Private Fee-for-Service
(PFFS) plan that does not include drug coverage.
Monica is an agent focused on serving seniors eligible for Medicare. As she
reviews her records, she is trying to determine which of the following items are
considered compensation. What do you tell her? I. Commissions
II. Bonuses
III. Mileage reimbursement
IV. Referral fees -ANSWER-- I, II, and IV only
Mrs. Chou likes a PFFS plan available in her area that does not include drug
coverage. She wants to enroll in the plan and enroll in a stand-alone prescription
drug plan. What should you tell her? -ANSWER-- She could enroll in a PFFS
plan and a stand-alone Medicare prescription drug plan.
, Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D
during the Annual Enrollment
Period (AEP). At the beginning of January, her neighbor told her about the
Medicare Advantage (MA) plan he
selected. He also told her there was an open enrollment period that she might be
able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly
after speaking to her neighbor.
What should you tell her? -ANSWER-- There is a MA Open
Enrollment Period (OEP) that takes place between January 1 and March 31, but
Ms. Gonzales cannot use it because eligibility to use the OEP is available only to
MA enrollees.
Mrs. Grant uses several very expensive drugs and anticipates that she will enter
catastrophic coverage at some
point during the year. To help her determine when she is likely to qualify for
catastrophic coverage, she asked
which expenses count toward the out-of-pocket limit that qualifies her for
catastrophic coverage. Which one of
the following would count? -ANSWER-- Prescription drugs she
purchases when in the Part D coverage gap.
Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in
her area. Ms. Levi often travels to visit relatives and is concerned that she may
need emergency care outside of her plan's service area.
What should you tell her about coverage of emergency care? -ANSWER-- Plans
are required to cover out-of-network emergency care.
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-- 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. Roswell is a new Medicare beneficiary and is interested in selecting a
Medicare Part D prescription drug
ANSWERS VERIFIED 100% CORRECT
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
thirdparty marketing organization (TMO). How do the CMS compensation
rules apply to these three agents? -ANSWER-- All three are treated as
independent agents under CMS compensation rules.
You have set up an appointment for an in-home sales presentation with Mrs.
Fernandez, who expressed
interest in the Medicare plans you represent. In preparation for the sales
presentation, what must you do? -ANSWER-- Prior to conducting the
presentation, obtain, and document having obtained her permission to visit, along
with her interest in the specific products you will present.
If you are to be in compliance with Medicare's guidance regarding educational
events, which of the following
would be acceptable activities? -ANSWER-- You may distribute
business cards to individuals who request information on how to contact
you for further details on the plan(s) you represent.
Mr. Chen has heard about a Medical Savings Account (MSA), but wants to know
if it is just about saving money, or if he will get insurance coverage for his health
care expenditures as well. What should you tell him? -ANSWER-- Under the
Medicare Advantage program, a MSA plan involves the combination of a
high deductible health plan and a savings account for health expenses. Medicare
will make contributions to this savings account to help him pay his health care
expenses while in the deductible.
,Under what conditions can a Medicare prescription drug plan reduce its coverage
for a given drug during the first 60 days of the year? -ANSWER-- When a
formulary change is in response to a drug's removal from the market.
Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare
Supplemental Insurance provides since his health care needs are different from his
wife's needs. What could
you tell Mr.Meoni? -ANSWER-- Medicare Supplemental Insurance
would help cover his Part A and Part B cost
sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services
that Medicare does not cover
Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached
age 68. He has heard that there is a premium penalty for those who did not sign up
for Part B when first eligible and wants to know how much he will have to pay.
What should you tell him? ANSWER-- Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
Mr. Roberts is enrolled in an MA plan. He recently suffered complications
following hip replacement surgery. As a result, he has spent the last three months
in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged.
What advice would you give him regarding his health coverage options? -
ANSWER-- His open enrollment period as an
institutionalized individual will continue for two months
after the month he moves out of the facility.
What impact, if any, will the Medicare Access and CHIP Reauthorization Act of
2015 (MACRA) have upon
Medigap plans? -ANSWER-- The Part B deductible will no longer be covered
for individuals newly eligible for Medicare starting January 1, 2020.
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should
you tell her? -ANSWER-- . Mrs. Radford must be entitled to Part A and enrolled
in Part B to enroll in Medicare
,Advantage
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for
that condition. However, she and her physicians feel that after her lengthy hospital
stay she will need a month
or two of nursing and rehabilitative care. What should you tell them about Original
Medicare's coverage of care
in a skilled nursing facility? -ANSWER-- Medicare will cover Mrs.
Shields' skilled nursing services provided during the first 20
days of her stay, after which she would have a coinsurance until she has been in the
facility for 100 days.
Mr. Polanski likes the cost of an HMO plan available in his area, but would like to
be able to visit one or two
doctors who aren't participating providers. He wants to know if the Point of
Service (POS) option available with some HMOs will be of any help in this
situation. What should you tell him? ANSWER-- The POS option might be a good
solution for him as it will allow him to visit out-ofnetwork providers, generally
without prior approval. However, he should be aware that it is likely he will have
to pay higher cost-sharing for services from out-of-network providers.
Mr. Lopez takes several high cost prescription drugs. He would like to enroll in a
standalone Part D prescription drug plan that is available in his area. In what type
of Medicare Health Plan can he enroll? -ANSWER-- Private Fee-for-Service
(PFFS) plan that does not include drug coverage.
Monica is an agent focused on serving seniors eligible for Medicare. As she
reviews her records, she is trying to determine which of the following items are
considered compensation. What do you tell her? I. Commissions
II. Bonuses
III. Mileage reimbursement
IV. Referral fees -ANSWER-- I, II, and IV only
Mrs. Chou likes a PFFS plan available in her area that does not include drug
coverage. She wants to enroll in the plan and enroll in a stand-alone prescription
drug plan. What should you tell her? -ANSWER-- She could enroll in a PFFS
plan and a stand-alone Medicare prescription drug plan.
, Ms. Gonzales decided to remain in Original Medicare (Parts A and B) and Part D
during the Annual Enrollment
Period (AEP). At the beginning of January, her neighbor told her about the
Medicare Advantage (MA) plan he
selected. He also told her there was an open enrollment period that she might be
able to use to enroll in a MA plan. Ms. Gonzales comes to you for advice shortly
after speaking to her neighbor.
What should you tell her? -ANSWER-- There is a MA Open
Enrollment Period (OEP) that takes place between January 1 and March 31, but
Ms. Gonzales cannot use it because eligibility to use the OEP is available only to
MA enrollees.
Mrs. Grant uses several very expensive drugs and anticipates that she will enter
catastrophic coverage at some
point during the year. To help her determine when she is likely to qualify for
catastrophic coverage, she asked
which expenses count toward the out-of-pocket limit that qualifies her for
catastrophic coverage. Which one of
the following would count? -ANSWER-- Prescription drugs she
purchases when in the Part D coverage gap.
Ms. Levi is considering enrollment in a Medicare Advantage HMO plan offered in
her area. Ms. Levi often travels to visit relatives and is concerned that she may
need emergency care outside of her plan's service area.
What should you tell her about coverage of emergency care? -ANSWER-- Plans
are required to cover out-of-network emergency care.
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-- 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. Roswell is a new Medicare beneficiary and is interested in selecting a
Medicare Part D prescription drug
