A client wants to give you an enrollment application on October 1 prior to the beginning of the Annual Election Period because he is leaving on vacation for two weeks and does not want to forget about turning it in. What should you tell him? - Answer You must tell him you are not permitted to take ...
AHIP EXAM
A client wants to give you an enrollment application on October 1 prior to the beginning
of the Annual Election Period because he is leaving on vacation for two weeks and does
not want to forget about turning it in. What should you tell him? - Answer You must tell
him you are not permitted to take the form. If he sends the form directly to the plan, the
plan will process the enrollment on the day the Annual Election Period begins.
A Medicare beneficiary has walked into your office and requested that you sit down with
her and discuss her options under the Medicare Advantage program. Before engaging
in such a discussion, what should you do? - Answer c. You must have her sign a scope
of appointment form, indicating which products she wishes to discuss. You may then
proceed with the discussion.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
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? - Answer a. Authorization may be obtained by
directing a beneficiary to a website to provide consent as long as the website includes a
mechanism for an electronic signature that is valid under applicable law.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a website marketing the MA plans with which it has contracts. Agent
Armstrong follows up with individuals who request more information about ABC MA
plans via the website and tries to persuade them to enroll in ABC plans. What statement
best describes the marketing and compliance rules that apply to Agent Armstrong? -
Answer d. Agent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets ABC MA plans are located.
Agent 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? - Answer d. Yes. When an
event has been advertised as "educational," discussing plan-specific premiums is
impermissible.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement
(Medigap) plan which he has had for several years. However, the plan does not provide
drug benefits. How would you advise Agent John Miller to proceed? - Answer d. Tell
prospect Jerry Smith that he should consider adding a standalone Part D prescription
drug coverage policy to his present coverage.
,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 discovers that the plan does 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? - Answer a.
Agent Lopez's entire compensation must be recouped because Ralph disenrolled within
3 months of enrollment.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks
you for advice as to whether this is possible. What should you tell her? - Answer c.
Marketing representatives may initiate electronic contact through e-mail but an opt-out
process must be provided.
All plans must cover at least the standard Part D coverage or its actuarial equivalent.
Which of the following statements best describes some of the costs a beneficiary would
incur for prescription drugs under the standard coverage? - Answer c. Standard Part D
coverage would require payment of an annual deductible, and once past the
catastrophic coverage threshold, the beneficiary pays whichever is greater of either the
co-pays for generic and brand name drugs or coinsurance of 5%.
Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap)
plan. Anita's older neighbor Mel has told her about the Medigap Part F plan in which he
is enrolled. It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Anita comes to you for advice. What should you tell her? -
Answer a. You are sorry to disappoint Anita but a Medigap Part F plan is no longer
available to those who turn age 65 after January 1,2020. Anita might instead consider
other Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him
at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him? - Answer a. C-SNP
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How
much may Dr. Brennan charge? - Answer b. Dr. Brennan can charge Mary Rogers no
more than the cost sharing specified in the PFFS plan's terms and condition of payment
which may include balance billing up to 15%of the Medicare rate.
During a sales presentation, your client asks you whether the Medicare agency
recommends that she sign up for your plan or stay in Original Medicare. What should
you tell her? - Answer d. Tell her that the Medicare agency does not endorse or
recommend any plan.
, If Mr. Johannsen gains the Part D low-income subsidy, how does that affect his ability to
enroll or disenroll in a Part D plan? - Answer He Qualifies for a Special Enrollment
Period and can enroll in or dis-enroll from a Part D plan and the subsidy will apply to the
plan he chooses.
If Mr. Johnson gains the Part D low-income subsidy, how does that affect his ability to
enroll or disenroll in a Part D plan? - Answer He Qualifies for a Special Enrollment
Period and can enroll in or dis-enroll from a Part D plan and the subsidy will apply to the
plan he chooses.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
employer-sponsored healthcare coverage. Juan is a naturalized citizen and has
contributed to the Medicare system for over 20 years. Juan asks you if he will be
entitled to Medicare and if he enrolls how that will impact his employer-sponsored
healthcare coverage. How would you respond? - Answer d. Juan is likely to be eligible
for Medicare once he turns age 65 and if he enrolls Medicare would become the primary
payor of his healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under its employer-sponsored group health
plan.
Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her? -
Answer b. You should tell Madeline that she will be able to enroll in Medicare Part A
without paying monthly premiums due to her husband's long work record and
participation in the Medicare system. You should also tell Madeline that she will pay
Part B premiums at more than the standard lowest rate but less than the highest rate
due her substantial income.
Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren.
As a result, Mary has been admitted to a rehabilitation hospital where she is expected to
reside for several months. The rehabilitation hospital is located outside the geographic
area served by her current Medicare Advantage (MA) plan. What options are available
to Mary regarding her health plan coverage? - Answer c. Mary may make an unlimited
number of MA enrollment requests and may disenroll from her current MA plan.
Mary Samuels recently suffered a stroke while visiting her daughter and grandchildren.
As a result, Mary has been admitted to a rehabilitation hospital where she is expected to
reside for several months. The rehabilitation hospital is located outside the geographic
area served by her current Medicare Advantage (MA) plan. What options are available
to Mary regarding her health plan coverage? - Answer Mary may make an unlimited
number of MA enrollment requests and may disenroll from her current MA plan.
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