AHIP Final Exam | Questions and
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Latest 2024/2025
Roberta is a retiree who has just learned that she has purchased a
Medicare Advantage (MA) plan from an unlicensed individual
representing BestCare Health Plan. What are Roberta's options, if any? -
Correct Answer - Roberta may request to change plans upon receiving
notification of the agent's unlicensed status
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?
- Correct Answer - 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
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?
,- Correct Answer - CMS requires plan sponsors to create and complete
a corrective action plan and may terminate a sponsor's contract
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?
- Correct Answer - I, II, and IV only Correct
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:
- Correct Answer - Betty and Denise, but not Alice (the employee) or Carl
or Edward (to whom exceptions apply). Correct
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. How will Agent Chan
be compensated under CMS rules?
- Correct Answer - 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
,Mrs. Walters is entitled to Part A and has medical coverage without drug
coverage through an employer retiree plan. She is not enrolled in Part B.
Since the employer plan does not cover prescription drugs, she wants to
enroll in a Medicare prescription drug plan. Will she be able to?
- Correct Answer - Yes. Mrs. Walters must be entitled to Part A or
enrolled in Part B to be eligible for coverage under the Medicare
prescription drug program
Mr. Sanchez is entitled to Part A, but has not enrolled in Part B because
he has coverage through an employer plan. If he wants to enroll in a
Medicare Advantage plan, what will he have to do?
- Correct Answer - He will have to enroll in Part B.
Mr. Kelly wants to know whether he is eligible to sign up for a Private
fee-for-service (PFFS) plan. What questions would you need to ask to
determine his eligibility?
- Correct Answer - You would need to ask Mr. Kelly if he is enrolled in
Part A and Part B and if he lives in the PFFS plan's service area
Mr. Gonzalez is entitled to Part A, but has not yet enrolled in Part B. If he
wants to enroll in a Private Fee-for-Service (PFFS) plan, what will he
have to do?
- Correct Answer - He will have to enroll in Part B prior to enrolling in the
PFFS plan.
, Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does
not include drug coverage and also enroll in a stand-alone Medicare
prescription drug plan. Under what circumstances can she do this?
- Correct Answer - If the Medicare Advantage plan is a Private Fee-for-
Service (PFFS) plan that does not offer drug coverage or a Medical
Savings Account, Mrs. Berkowitz can do this
Mrs. Roberts has Original Medicare and would like to enroll in a Private
Fee-for-Service (PFFS) plan. All types of PFFS plans are available in her
area. Which options could Mrs. Roberts consider before selecting a
PFFS plan?
- Correct Answer - A Medicare Advantage Prescription Drug (MA-PD)
PFFS plan that combines medical benefits and Part D prescription drug
coverage, a PFFS plan offering only medical benefits, or a PFFS plan in
combination with a stand-alone prescription drug plan
Mr. and Mrs. Nunez attended one of your sales presentations. They've
asked you to come to their home to clear up a few questions. During the
presentation, Mrs. Nunez feels tired and tells you that her husband can
finish things up. She goes to bed. At the end of your discussion, Mr.
Nunez says that he wants to enroll both himself and his wife. What
should you do?
- Correct Answer - As long as she is able to do so, only Mrs. Nunez can
sign her enrollment form. Mrs. Nunez will have to wake up to sign her
form or do so at another time
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