to be limited in terms of where he obtains his care. What should you tell him about how a Medicare Cost Plan might fit his needs? - ANSWER a. Cost plan enrollees can choose to receive Medicare covered services under the plan's benefits by going to plan network providers and paying plan cost sharing...
AHIP 2024 Final Exam 100% CORRECT
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not want
to be limited in terms of where he obtains his care. What should you tell him about how a Medicare Cost
Plan might fit his needs? - ANSWER a. Cost plan enrollees can choose to receive Medicare covered
services under the plan's benefits by going to plan network providers and paying plan cost sharing, or
may receive services from non-network providers and pay cost-sharing due under Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with
CMS marketing requirements, including those regarding using only approved call scripts. - ANSWER 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?
a. Ms. Lopez is considered a marketing representative of BestCare but is exempt from the marketing
rules regarding approved call scripts because she works directly for MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with
CMS 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 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 a. 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. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
go to for her health care. What should you tell her? - ANSWER b. Mrs. Ramos can obtain care from any
provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if
she sees a provider who/that is not a part of the PPO network.
Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and
requested a meeting so that she can learn about Medicare and the products you represent. How should
you respond? - ANSWER c. Tell Julia that you will meet with her to explain Medicare and should she be
interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying
her for a special enrollment period.
Mr. Rivera has Qualified Medicare Beneficiary (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? -
ANSWER The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's
Medicaid program.
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? - ANSWER
Choose one answer. - ANSWER
- 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.
- ANSWER 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.
- ANSWER c. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage
she wants, she may enroll in one if it is available in her area.
- ANSWER d. A PFFS plan is one of the various types of Medicare Advantage plans offered by private
entities and she may enroll in one if it is available in her area.
, Question8 - ANSWER
Marks: 1 - ANSWER
During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr.
Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor
told him about. What should his agent do? - ANSWER
Choose one answer. - ANSWER
- ANSWER a. Since Mr. Peters requested a description of the Part D plan, his agent must leave the Part D
plan brochure, but not an enrollment form, and would have to schedule another appointment after at
least 48 hours have passed to discuss the Part D plan with Mr. Peters.
- ANSWER b. Since Mr. Peters requested a description of the Part D plan, his agent must have Mr. Peters
sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D
plan so Mr. Peters can compare plans and make an informed enrollment choice during the appointment.
- ANSWER c. Since Mr. Peters requested a description of the Part D plan, his agent must inform Mr.
Peters that he can only sign up for the MA-PD plan and cannot receive a brochure or any other
information about the Part D plan now because he did not agree in advance to discuss that plan
- ANSWER d. Since Mr. Peters requested a description of the Part D plan, his agent must discuss both the
Part D and the MA-PD plans and return after at least 48 hours to complete the Part D plan enrollment
form with Mr. Peters.
Question9 - ANSWER
Marks: 1 - ANSWER
, Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums with an
automatic monthly withdrawal from his savings account until it is exhausted, and then have his
premiums withheld from his Social Security check. What should you tell him? - ANSWER
Choose one answer. - ANSWER
- ANSWER c. The letter is to inform her that her Medigap plan's coverage has been determined by the
Federal government to be inadequate and the plan must therefore discontinue offering such coverage.
Ms. Eisenberg will have to select a different Medigap plan if she wants drug coverage.
- ANSWER d. The letter is to inform her that Medicare Part D prescription drug coverage is available, but
there is no need for her to change her drug coverage since it is just as good as Part D. She may keep her
current coverage through the Medigap plan.
Question11 - ANSWER
Marks: 1 - ANSWER
Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans.
Richard has several clients who have recently come to him for help who are in their initial coverage
election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will
soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob
had health coverage through Spartan but dropped the coverage when he retired early to travel overseas.
Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next
month, has coverage through Athena Health plan - a company Richard also represents. Who qualifies for
the opt-in simplified enrollment mechanism? - ANSWER
Choose one answer. - ANSWER
- ANSWER a. Alice because she will not have a break between her non-Medicare and Medicare coverage
through Spartan Health Plan.
- ANSWER b. Alice and Charlotte because each of them currently have health coverage and is in their
initial coverage election period (ICEP).
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