AHIP Practice Test
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
protected health information to market non-health related products such as life
insurance and annuities. To do so it must obtain authorization from the enrollees. Which
statement best descri...
AHIP Practice Test
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
protected health information to market non-health related products such as life
insurance and annuities. To do so it must obtain authorization from the enrollees. Which
statement best describes the authorization process? - ✔✔Authorization may be
obtained by directing a beneficiary to a website to provide consent.
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 correct statement to
say to her? - ✔✔The Medicare Advantage plan received a 5-star rating in customer
service and care coordination with an overall performance rating of 4-stars.
agent lopez helps Ralph to enroll in Top Choice Medicare Advantage plan during the
open enrollment period. Ralph's effective enrollment is January 1st. Ralph disenrolls on
February 12th because he did not understand that the plan did not cover services
furnished by several of his longtime providers. Which of the following statements best
describes the impact of Ralph's action upon Agent lopez's compensation? - ✔✔Agent
Lopez's entire compensation must be recouped because Ralph disenrolled within the 3
month period.
Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage plan during the
Annual open enrollment period. Mrs. O'Malley effective enrollment date is January 1st.
Subsequently, Mrs. O'Malley disenrolls on February 12th following a move outside the
plan's service area. What impact will this have on Agent Higgins compensation? -
✔✔AB MA PLAN does not have to recoup Agent Higgins compensation because she
has moved away from the service area.
You plan to participate in an educational event sponsored by a large regional health
care system. One of your colleagues suggests that you do a presentation on one of the
Medicare Health plans you market, and modify it to include information about preventive
screening tests showcased at the event. How should you respond to your colleague's
suggestion? - ✔✔You should tell your colleague no because participation in an
educational event may not include a sales presentation.
Agent Mary Jennings makes a presentation on Medicare advertised as an educational
event. Agent Jennings distributes materials that are solely educational in nature.
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? - ✔✔Yes. When
an event has been advertised as "educational," discussing plan-specific premiums is
impermissible.
, What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? - ✔✔Part D plans do not have to cover all
medications. As a result, their formularies, or lists of covered drugs, will vary from plan
to plan. In addition, they can use cost containment techniques such as tiered co-
payments and prior authorization.
Mrs. Allen has a rare condition for which two different brand name drugs are the only
available treatment. She is concerned that since no generic prescription drug is
available and these drugs are very high cost, she will not be able to find a Medicare Part
D prescription drug plan that covers either one of them. What should you tell her? -
✔✔Medicare prescription drug plans are required to cover drugs in each therapeutic
category. She should be able to enroll in a Medicare prescription drug plan that covers
the medications she needs.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription for helping to regrow his hair. They are anxious to have
their Medicare prescription drug plan cover these drug needs. What should you tell
them? - ✔✔Medicare prescription drug plans are not permitted to cover the prescription
medications the Vaughns are interested in under Part D coverage, however, plans may
cover them as supplemental benefits and the Vaughn's could look into that possibility
All plans must cover at least the standard Part D coverage or its actuarial equivalent.
What costs would a beneficiary incur for prescription drugs in 2018 under the standard
coverage? - ✔✔Standard Part D coverage would require payment of an annual
deductible, 25% cost-sharing up to the coverage gap, a portion of costs for both
generics and brand-name drugs in the coverage gap, and co-pays or co-insurance after
the coverage gap.
Mrs. Andrews was preparing a budget for next year because she takes quite a few
prescription drugs, she will reach the coverage gap, and wants to be sure she has
enough money set aside for those months. She received assistance calculating her
projected expenses from her daughter who is a pharmacist, but she doesn't think the
calculations are correct because her out-of-pocket expenses would be lower than last
year. She calls to ask if you can help. What might you tell her? - ✔✔It would not be
unusual for her costs to be a bit less because the Bipartisan Act of 2018 moved up the
date for closing the so-called "donut hole" for brand name drugs to 2019.
You are mailing invitations to new Medicare beneficiaries for a marketing event. You
want an idea of how many people to expect, so you would like to request RSVPs. What
should you keep in mind? - ✔✔You may request RSVPs, but you are not permitted to
require contact information.
Agent Antonio is preparing for a presentation on Medicare and Medicare Advantage
before a local senior citizen civic group where he hopes to enroll some attendees.
Which of the following steps should he take in order to be in compliance with Medicare
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