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2024 AHIP CERTIFICATION PART 4 EXAM WITH CORRECT ANSWERS
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2024 AHIP CERTIFICATION PART 4 EXAM WITH CORRECT ANSWERS
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2024 AHIP CERTIFICATION PART 4EXAM WITH CORRECT ANSWERS
Mr. Prentice has many clients who are Medicare beneficiaries. He should
review the Centers for Medicare & Medicaid Services' Marketing Guidelines
to ensure he is compliant for which type of products?
a. Medigap plans
b. Medicare Advantage (MA) and Prescription Drug (PDP) plans
c. Section 1332 waiver plans.
d. Long-Term Care policies for Medicare beneficiaries - CORRECT-ANSWERSb
Medicare health plans establish provisions in marketing representative
contracts to ensure compliance with applicable laws and policies. If non-
compliance occurs, CMS can penalize a plan in which of the following ways?
a. CMS requires plan sponsors to publish in local newspapers the names and
misdeeds of the marketing representatives who have not complied with the
terms of their contracts, so that potential clients can know whom to avoid.
b. CMS requires the dismissal of senior plan management.
c. CMS cannot penalize the plan sponsor for marketing representative non-
compliance. That is the role of the state.
d. CMS requires plan sponsors to create and complete a corrective action
plan and may terminate a sponsor's contract. - CORRECT-ANSWERSd
Mr. Lynn, an agent for Acme Insurance, Inc. thinks that, since state laws are
preempted with regard to the marketing of Medicare health plans, he doesn't
have much to worry about. What might you, as his colleague, advise him
concerning the type of scrutiny he will be under?
a. Organizations sponsoring Medicare health plans are not responsible for
enforcing compliance with applicable law and guidance. This job belongs
solely to the Medicare agency.
b. Organizations sponsoring Medicare health plans are responsible for the
behavior of their contracted representatives and will be conducting
monitoring activities to ensure compliance with all applicable Federal law
and guidance and plan policies. Furthermore, state agent licensure laws are
not preempted and he must abide by their requirements.
c. The Medicare agency conducts only complaint-based oversight and he
can market the products he represents as he sees fit, - CORRECT-ANSWERS
,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
a. I, II and III only
b. I, II, and IV only
c. I and II only
d. I, II, III, and IV - CORRECT-ANSWERSb
Alice is a marketing representative employed by a health plan. Betty is a
captive agent of a health plan who markets to multiple plans and sponsors.
Carl is a captive agent who markets to only one plan/sponsor. Denise is an
independent agent who markets to different types of groups. Edward is an
independent agent who markets only to employer and union groups. CMS
marketing representative compensation rules generally apply to:
a. All of these people.
b. Betty and Denise, but not Alice (the employee) or Carl or Edward (to
whom exceptions apply).
c. Denise and Edward (the independent agents), but not Alice (the
employee) or Betty or Carl (the captive agents).
d. All of these people except Alice, the employee. - CORRECT-ANSWERSb
Wendy Park becomes eligible for Medicare for the first time in July. With the
help of Agent James Chan, she enrolls in FeelBetter Medicare Advantage plan
with an effective date of July 1st. Which statement best describes how Agent
Chan may be compensated under CMS rules?
a. FeelBetter will pay Agent Chan initial year compensation for the period
July 1 through October 15th -(the date open enrollment begins). If Ms. Park
remains enrolled in the plan, renewal amounts will be paid.
b. FeelBetter will pay Agent Chan initial year compensation for the months
July through December. Renewal amounts will be paid starting in January if
Ms. Park remains enrolled the following year.
c. FeelBetter will pay Agent Chan a bonus equal to three months initial year
compensation since he has successfully enrolled Ms. Park in a MA plan when
she is both first eligible and a younger, and likely healthier, enrollee.
d. FeelBetter wil - CORRECT-ANSWERSb
Agent Lopez helps Ralph to enroll in Top Choice Medicare Advantage plan
during the Annual Open Enrollment Period. Ralph's effective enrollment date
, 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?
a. Agent Lopez's entire compensation must be recouped because Ralph
disenrolled within 3 months of enrollment.
b. Agent Lopez's compensation is not impacted because Ralph's
disenrollment occurred more than 30 days after the effective date of
coverage.
c. Agent Lopez is entitled to a pro rata amount of the compensation earned
including the full amount for the month of February.
d. Agent Lopez's compensation is not impacted because Ralph's
disenrollment occurred after the Annual Open Enrollment - CORRECT-
ANSWERSa
Agent Higgins helps Mrs. O'Malley to enroll in AB Medicare Advantage (MA)
plan during the Annual Open Enrollment Period. Mrs. O'Malley's 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?
a. AB MA plan must recoup a pro rata amount of Agent Higgins'
compensation and pay him only for the month of January.
b. AB MA plan must recoup a pro rata amount of Agent Higgins'
compensation if Mrs. O'Malley subsequently enrolls in Original Medicare and
Part D
c. Agent Higgins entire compensation must be recouped because Mrs.
O'Malley has disenrolled within 3 months of enrollment.
d. AB MA plan does not have to recoup Agent Higgins' compensation
because she has moved away from its service area. - CORRECT-ANSWERSd
Another agent working for your agency claims that because you are not
employed by the Medicare Advantage plans that you represent, you are not
subject to the same requirements as the plans themselves. How should you
respond to such a statement?
a. Your coworker is correct. You may use any marketing techniques that do
not involve providing misinformation to potential enrollees.
b. Your coworker is correct because employed agents have to follow a
stricter set of rules than do independent agents, such as yourself.
c. Your coworker is not correct. Marketing on behalf of a plan is considered
marketing by the plan and requires that all contracted and employed agents
comply with all Medicare marketing rules.
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